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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

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.

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 the initial definitive treatment of choice.

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.

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 choledochorrhaphy

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

D. Liver transplantation

E. Observation

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.

What is the best treatment for a 6-cm encapsulated cyst of the right lobe of the liver in a febrile patient?

A. Right hepatectomy

B. Percutaneous drainage

C. Marsupialization

D. Albendazole

E. Metronidazole

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 ...

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