GI Surgery & Hepatobiliary

Topics in this chapter

• Biliary Obstruction and Cholangitis
• Liver Tumors and Hepatobiliary Surgery
• Pancreatic Disease and Operations
• GI Bleeding and Portal Hypertension
• Colorectal and Ischemic Abdominal Disease
• Pediatric and Neonatal GI Surgery
• Abdominal Trauma and Vascular Complications

Practice questions

1. Question 1Q-A47C8D

   A 45-year-old male presents with recurrent episodes of massive upper gastrointestinal bleeding. He has a history of chronic alcohol abuse and cirrhosis with portal hypertension. Upper endoscopy shows large esophageal varices. Emergency sclerotherapy is performed, but bleeding recurs within 2 hours. Which of the following is the most appropriate next step in management?

   1. A.Repeat endoscopic band ligation
   2. B.Transjugular intrahepatic portosystemic shunt (TIPS)
   3. C.Emergency mesocaval shunt
   4. D.Orthotopic liver transplantation
   See the answer and solution
2. Question 2Q-9E0FEA

   A 55-year-old female presents with right upper quadrant pain, jaundice, and intermittent fevers (Charcot's triad) of 3 days duration. Ultrasound shows a dilated common bile duct with multiple stones. She is admitted and started on intravenous antibiotics, but her condition deteriorates within 12 hours with the development of altered mental status and hypotension (Reynolds' pentad). What is the most urgent definitive management required?

   1. A.Open common bile duct exploration and T-tube insertion
   2. B.Urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage
   3. C.Elective laparoscopic cholecystectomy after 6 weeks
   4. D.Percutaneous transhepatic cholangiography (PTC) after 48 hours
   See the answer and solution
3. Question 3Q-304451

   A 60-year-old male undergoes a Whipple procedure (pancreatoduodenectomy) for periampullary carcinoma. On postoperative day 5, the drain output increases to 150 mL/day of clear, yellowish fluid with an amylase level greater than 3 times the serum amylase value. The patient is afebrile and hemodynamically stable. What is the most appropriate initial management?

   1. A.Immediate exploratory laparotomy and takedown of the pancreaticojejunostomy
   2. B.Conservative management with somatostatin analogues, maintenance of drain in situ, and nutritional support
   3. C.Re-operation for completion pancreatectomy
   4. D.Broad-spectrum antibiotics and emergency CT-guided percutaneous drain placement
   See the answer and solution
4. Question 4Q-30930D

   A 35-year-old female presents with a 6-month history of dull right upper quadrant discomfort. She takes oral contraceptives. Contrast-enhanced CT scan of the abdomen shows a well-circumscribed, 6 cm hypodense mass in segment IV of the liver with a central scar that enhances on delayed phases. What is the most likely diagnosis?

   1. A.Hepatic adenoma
   2. B.Focal nodular hyperplasia
   3. C.Cholangiocarcinoma
   4. D.Hepatic hemangioma
   See the answer and solution
5. Question 5Q-5CC978

   During an emergency exploratory laparotomy for a penetrating stab wound to the right upper quadrant, a surgeon encounters a large, expanding, uncontained hematoma in zone II of the retroperitoneum. What is the standard management for this hematoma?

   1. A.Immediately open the retroperitoneum and identify the bleeding vessel
   2. B.Leave an expanding zone II retroperitoneal hematoma untouched unless it ruptures
   3. C.Pack the abdomen, perform temporary closure, and transfer for angioembolization
   4. D.Perform a diagnostic peritoneal lavage
   See the answer and solution