Hepatobiliary Surgery — Flashcards

Flashcard 51: What is the treatment of bilhemia?_____

Answer: stent placement or sphincterotomy

Flashcard 52: What is the next step in the management of a post-operative bile leak (CBD/common hepatic duct injury) if the leak persists 1-2 days after USG-guided drainage?

Answer: ERCP (Endoscopic Retrograde Cholangiopancreatography)

Extra: Standard management of post-cholecystectomy bile leaks: 1. **Percutaneous drainage** of collections (USG/CT guided). 2. If the leak persists, **ERCP** is the next step to define the anatomy and provide internal drainage (via stenting or sphincterotomy). 3. Major ductal injuries (e.g., Strasberg E) may ultimately require **Roux-en-Y Hepaticojejunostomy**, which is usually delayed by 6-12 weeks to allow inflammation to subside. *Note: Primary repair over a T-tube is typically an intra-operative management strategy for small lateral injuries, not the standard next step for a persistent post-operative leak.*

Flashcard 53: Classification of Choledochal Cysts:Saccular diverticulum off the common bile duct is classified as _____ choledochal cyst

Answer: Type II

Flashcard 54: Classification of Choledochal Cysts:The most common choledochal cyst type is _____

Answer: Type I

Flashcard 55: _____ is used after CBD exploration (post choledochotomy) to allow bile to drain while the sphincter of Oddi is in spasm postoperatively

Answer: Kehr s T tube

Flashcard 56: Classification of Choledochal Cysts:Cysts involving the intrahepatic and extrahepatic biliary tree are classified as _____

Answer: Type IVa

Flashcard 57: According to Strasberg classification of bile duct injury, Bile leak from the cystic duct or from minor hepatic ducts is classified as Type _____

Answer: A

Flashcard 58: Most common benign liver tumor to rupture spontaneously causing hemoperitoneum: _____

Answer: Hepatic adenoma

Flashcard 59: Which instrument is specifically used for stone retrieval from the common bile duct during choledocholithotomy?

Answer: Desjardin's Choledocholithotomy forceps

Flashcard 60: _____ forceps are used to hold the fundus and Hartmann pouch of gall bladder during cholecystectomy

Answer: Sponge holding