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Chapter 15. Hepatobiliary

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Which of the following lesions should be resected in the asymptomatic patient?

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A. 5-cm FNH

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B. 3-cm hepatic adenoma

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C. 4-cm hydatid cyst

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D. 6-cm hepatic hemangioma

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E. 2-cm hepatic hamartoma

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Although regression of hepatic adenomas has been reported after discontinuation of oral contraceptives, the potential for bleeding and malignant transformation favors routine resection.

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Which of the following is true regarding hemobilia?

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A. Cholelithiasis is the most important cause of hemobilia.

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B. Hepatoblastoma is the most commonly associated tumor.

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C. It always presents with acute upper or lower gastrointestinal bleeding.

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D. A tagged RBC scan is the diagnostic modality of choice.

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E. Angioembolization is initial definitive treatment of choice.

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Hemobilia is bleeding within the biliary tract. Causes include trauma, surgery, malignancy, and infections. Angiography is the most accurate and helpful diagnostic and therapeutic modality.

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A 2-year-old boy is found to have fusiform dilation of the extrahepatic biliary duct. What is the best treatment option?

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A. Transduodenal cyst excision

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B. Excision with primary choledochorraphy

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C. Complete cyst excision with Roux-en-Y reconstruction

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D. Liver transplantation

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E. Observation

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Fusiform extrahepatic dilation is a type I choledochal cyst. Surgical resection is necessary to avoid recurrent episodes of infection from stasis of the bile within the cyst cavity as well as the risk of developing a cholangiocarcinoma. Type 3 cysts rarely progress to malignancy and usually do not require resection. However, types 1 and 2 do have a cancer risk. Therefore, the extrahepatic bile duct is resected and a Roux-en-Y choleenterostomy is performed.

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Regarding a 6-cm encapsulated cyst of the right lobe of the liver in a febrile patient, what is the best treatment?

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A. Right hepatectomy

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B. Percutaneous drainage

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C. Marsupialization

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D. Albendazole

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E. Metronidazole

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Pyogenic liver abscesses are best treated with initial drainage and broad-spectrum antibiotics. Albendazole is reserved for hydatid/echinoccal cysts, while metronidazole is used for amebic cyts. Resection and marsupialization are not first-line treatments of benign liver cysts.

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