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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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D. 6-cm hepatic hemangioma
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E. 2-cm hepatic hamartoma
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Answer: B. 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 the initial definitive treatment of choice.
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Answer: E. 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 choledochorrhaphy
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C. Complete cyst excision with Roux-en-Y reconstruction
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Answer: C. 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 III cysts usually do not require resection. Types I and II do have a cancer risk. Therefore, the extrahepatic bile duct is resected and a Roux-en-Y choleenterostomy is performed.
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What is the best treatment for a 6-cm encapsulated cyst of the right lobe of the liver in a febrile patient?
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Answer: B. Pyogenic liver abscesses are best treated with initial drainage and broad-spectrum antibiotics. Albendazole is reserved for hydatid/echinococcal cysts, while metronidazole is ...