Anatomy
Imaginary line between IVC and gallbladder?
Cantile's line
*Separates R and L lobes of the liver
Risk of Gallbladder Cancer in patients with porcelain gallbladder?
0-5%
Most common cause of benign biliary stricture
Hx of Cholecystectomy
During Intraoperative hepatic US : lower frequency is used to view...?
Deeper structures
Primary sclerosing cholangitis is associated with what other disorder?
Ulcerative Colitis
Most posterior structure in portal triad ?
Portal vein
Stage and Management of Gallbladder Cancer involving the Lamina propria
T1a
Cholecystectomy
Most common type of choledochal cyst?
*Describe it
Type 1
Fusiform dilation of the extra-hepatic biliary system
Future liver remnant needed for for hepatic resection in patients with no existing liver disease
20%
MELD score components
INR
Bilirubin
Creatinine
Sodium
Replaced right hepatic artery most commonly is a branch off this structure?
*Bonus points to name origin of replaced left hepatic artery
SMA!
L gastric artery
T1b
cholecystectomy + limited hepatic resection (4b/5) + portal LDN
Management of an asymptomatic gallbladder polyp measuring 7 mm
Serial Ultrasound Imaging
What is the size cut off for a segmental duct that can be ligated if injured
< 3mm
> 4mm : consider re-implantation.
Management of :
Biliary Intraepithelial Neoplasia Grade 1
- Pre-malignant lesion for cholangiocarcinoma
- Incidentally present on 1% of cholecystectomies
- Does not require additional resection with no clinical implications if found
Right and left lobes of the liver are divided by what structure
Middle hepatic vein
Most common presentation of recurrent gallbladder cancer?
Carcinomatosis
Gallbladder Polyp - Indications for surgery (3).
1. Symptomatic (associated with stones)
2. > 10mm
3. PSC patients
Segments resected in a Left Lateral Segmentectomy
2,3
What is the difference between pneumobilia and portal venous gas
Pneumobilia: centrally distributed air within the biliary tree (seen in ERCP / choledochal fistula)
Portal venous gas: peripherally distributed air within 2 cm of the liver margin (concerning for ischemia)
What is Mirrizi Syndrome
a rare gallstone disease complication where an impacted gallstone in the cystic duct or gallbladder compresses the common hepatic duct, causing obstructive jaundice, fever, and right upper quadrant abdominal pain
Name the Bismuth -Corlette classification for peri-hilar cholangiocarcinoma (1-4)
Type 1 : involve common hepatic duct
Type 2 : are at hepatic bifurcation
Type 3 : involve the secondary hepatic ducts on one side
3a ; involve confluence and extend to proximal right hepatic duct
3b ; involve confluence and extend to proximal left hepatic duct
type 4 : involve secondary hepatic ducts on both sides (ie extend to the bifurcation of both the right and left hepatic ducts)
What is the name for intra duodenal dilation of the common bile duct ?
Choledochocele
Describe a Strasberg Class D injury to the biliary tree- and management
Lateral injury of the biliary system without loss of continuity + leakage: most commonly a lateral injury to the common hepatic duct
- ERCP w/ sphincterotomy and biliary stent
Describe a TIPS procedure
hepatic vein cannulated and stent placed connecting hepatic vein to portal vein bypassing the liver