Hepatobiliary And Pancreatic Surgery (100q).1

Segments are subdivisions in both the French and American systems.

Segments are determined primarily by the hepatic venous drainage

The French anatomic system is more applicable than the American system to clinical hepatic resection

Segments are important to the understanding of the topographic anatomy of the liver

Antibiotics alone are adequate for the treatment of most cases.

All patients require open surgical drainage for optimal management

Optimal treatment involves treatment of not only the abscess but the underlying source as well.

Percutaneous drainage is more successful for multiple lesions than for solitary ones

Adenomas are true neoplasms with a predisposition for complications and should usually be resected

Focal nodular hyperplasia (FNH) is a neoplasm related to birth control pills (BCPs) and usually requires resection

Hemangiomas are the most common benign lesions of the liver that come to the surgeon's attention

Nodular regenerative hyperplasia does not usually accompany cirrhosis.

If resected, proximal lesions are usually curable

The more proximal the lesion, the more likely is resection to be curative.

Radiation clearly prolongs survival

Transplantation is usually successful if the lesion seems confined to the liver

None of the above is true.

Tumors are the most common cause.

The primary treatment of severe hemobilia is an operation.

Percutaneous cholangiographic hemobilia is usually minor

Ultrasonography usually reveals a specific diagnosis

Ligation of the right hepatic artery

Ligation of the left hepatic artery

Ligation of the hepatic artery distal to the gastroduodenal branch

Ligation of the hepatic artery proximal to the gastroduodenal artery

Metabolic acidosis.

Respiratory alkalosis.

Metabolic alkalosis

Respiratory acidosis.

Endoscopic sclerotherapy.

Distal splenorenal shunt

Esophagogastric devascularization (Sugiura procedure).

Side-to-side portacaval shunt

End-to-side portacaval shunt

Distal splenorenal shunt.

Conventional splenorenal shunt

Endoscopic sclerotherapy.

Side-to-side portacaval shunt

Left gastric (coronary) vein

Short gastric vein.

Splenic vein.

Left gastroepiploic vein.

Hypersplenism

Variceal hemorrhage.

Ascites

Encephalopathy

A 50-year-old cirrhotic man had an emergency portacaval shunt for bleeding varices and postoperatively had an ascites leak and mild superficial wound infection.

A 57-year-old woman with primary biliary cirrhosis (PBC) has difficult to control ascites and diuretic-induced encephalopathy

A 46-year-old resistant alcoholic has chronic ascites uncontrolled by diuretics combined with repeat paracentesis

A 34-year-old woman taking BCPs had rapid onset of ascites and is found to have hepatic vein thrombosis causing the Budd-Chiari syndrome

Choledochal cyst should be treated by Roux-en-Y cystojejunostomy

Sclerosing cholangitis is characterized by long, narrow strictures in the extrahepatic biliary duct system

Operative (needle) cholangiography is indicated in patients who at operation appear to have no gallbladder

The long cystic duct, which appears to be fused with the common duct and enters it distally, should be dissected free and ligated at its entrance into the common duct.

The presence of gallstones in a patient with intermittent episodes of right-side upper quadrant pain

The presence of gallstones in an asymptomatic patient

The presence of symptomatic gallstones in a patient with angina pectoris.

The presence of asymptomatic gallstones in a patient who has insulin-dependent diabetes.

Prevent cholangiovenous reflux by decompressing the duct system.

Remove the obstructing stone, if one is present

Alleviate jaundice and prevent permanent liver damage.

Prevent the development of gallstone pancreatitis

The condition is seen most frequently in women older than 70.

Concomitant with the bowel obstruction, air is seen in the biliary tree

The usual fistula underlying the problem is between the gallbladder and the ileum.

When possible, relief of small bowel obstruction should be accompanied by definitive repair of the fistula since there is a significant incidence of recurrence if the fistula is left in place.

Ultrasound studies may be of help in identifying a gallstone as the obstructing agent

Cholecystoenteric fistula.

A calcified gallbladder.

Adenoma of the gallbladder

Xanthogranulomatous cholecystitis

All of the above.

Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection

Radiation therapy.

Chemotherapy

Combined treatment involving surgical therapy, chemotherapy, and radiation.

None of the above

Intravenous fluid and electrolyte therapy.

Withholding of analgesics to allow serial abdominal examinations.

Subcutaneous octreotide therapy

Nasogastric decompression

Prophylactic antibiotics

Chronic pancreatitis is the inevitable result after repeated episodes of acute pancreatitis

Patients with chronic pancreatitis commonly present with jaundice, pruritus, and fever.

Mesenteric angiography is useful in the evaluation of many patients with chronic pancreatitis

Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis

For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate surgical option.

It is the fifth most common cause of cancer death in the U.S.

Most cases occur in the body and tail of the pancreas, making distal pancreatectomy the most commonly performed resectional therapy.

For cancers of the head of the pancreas resected by pancreaticoduodenectomy, prognosis appears to be independent of nodal status, margin status, or tumor diameter.

The most accurate screening test involves surveillance of stool for carbohydrate antigen (CA 19–9).

The most important diagnostic study for insulinoma is an oral glucose tolerance test.

It may be helpful to perform ERCP in an effort to localize the tumor

Most patients with insulinoma present with extensive disease, rendering them only rarely resectable or curable

An important component of the preoperative evaluation in patients with presumed insulinoma involves confirming elevated C-peptide or proinsulin levels and screening for anti-insulin antibodies.

The body and tail of the pancreas drain via an accessory ampulla distal to the ampulla of Vater. The uncinate process drains via the ampulla of Vatercorrectly describes pancreas divisum?

The entire pancreatic ductal system drains via the ampulla of Vater

The entire pancreatic ductal system drains via an accessory ampulla proximal to the ampulla of Vater

The body and tail of the pancreas are absent. The uncinate process drains via the ampulla of Vater

Gastric inhibitory peptide

Somatostatin

Pancreatic polypeptide

Secretin

Insulin, somatostatin, glucagon, secretin

Insulin, somatostatin, cholecystokinin, pancreatic polypeptide

Insulin, somatostatin, glucagon, pancreatic polypeptide

Insulin, secretin, glucagon, cholecystokinin