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Chapter 15. Hepatobiliary

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

A. 5-cm FNH

B. 3-cm hepatic adenoma

C. 4-cm hydatid cyst

D. 6-cm hepatic hemangioma

E. 2-cm hepatic hamartoma

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

Which of the following is true regarding hemobilia?

A. Cholelithiasis is the most important cause of hemobilia.

B. Hepatoblastoma is the most commonly associated tumor.

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

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

E. Angioembolization is initial definitive treatment of choice.

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.

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

A. Transduodenal cyst excision

B. Excision with primary choledochorraphy

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

D. Liver transplantation

E. Observation

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.

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

A. Right hepatectomy

B. Percutaneous drainage

C. Marsupialization

D. Albendazole

E. Metronidazole

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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