Hepato-biliary

A 46-year-old with right upper quadrant pain, fever, and positive Murphy sign has leukocytosis and gallstones on ultrasound. Best initial management?

A 63-year-old with jaundice and RUQ pain has bilirubin 5.6 mg/dL, ALP 480 IU/L, and dilated CBD on ultrasound. Next best test/step?

A septic patient with Charcot triad and hypotension has ascending cholangitis. Priority intervention?

A postoperative patient develops fever and bilious drain output after laparoscopic cholecystectomy. Most likely source?

Best initial management for a suspected cystic duct stump leak after cholecystectomy?

A 72-year-old critically ill ventilated patient develops RUQ pain, fever, and gallbladder wall thickening without stones. Best management?

A 58-year-old has pneumobilia, small bowel obstruction, and an ectopic gallstone on CT. Diagnosis?

Preferred initial operation for gallstone ileus with obstructed ileum in an elderly frail patient?

A 54-year-old with chronic cystic duct stone compressing the common hepatic duct has obstructive jaundice. Diagnosis?

Preoperative strategy to minimize bile duct injury in difficult cholecystectomy (severe inflammation)?

A 67-year-old with obstructive jaundice and pruritus has a hilar mass consistent with perihilar cholangiocarcinoma. Initial workup priority?

Which patients with perihilar cholangiocarcinoma should undergo preoperative biliary drainage?

A cirrhotic (Child-Pugh A, no portal hypertension) has a solitary 3-cm HCC in segment VI. Best curative option?

Transplant criteria most widely used for HCC selection?

A patient with bilobar colorectal liver metastases (CRLM) responds to chemotherapy; FLR after proposed resection would be 18% in a normal liver. Next step?

Oncologic principle for resection of CRLM?

A 49-year-old with obstructive jaundice has CA 19-9 of 600 U/mL and a pancreatic head mass excluded. MRCP shows distal CBD stricture with mass at the distal bile duct. Likely diagnosis?

After laparoscopic cholecystectomy, patient has persistent jaundice and pruritus; MRCP shows a short mid-CBD stricture months later. Best definitive management?

A 40-year-old with symptomatic gallstones asks about nonoperative management. Best counseling?

Indication for cholecystectomy for gallbladder polyp?

A porcelain gallbladder is found incidentally in a 56-year-old asymptomatic, fit patient. Best approach?

Incidental T1a gallbladder carcinoma (invades lamina propria only) after simple cholecystectomy. Next step?

Incidental T1b gallbladder cancer (invades muscularis). Recommended oncologic completion?

A 70-year-old with PSC develops new dominant extrahepatic biliary stricture and weight loss. Concern?

Best imaging to screen/surveil HCC in cirrhosis?

On CT, a 4-cm arterial enhancing lesion with venous/delayed washout in a cirrhotic liver suggests:

Hemangioma features on imaging?

A 34-year-old woman has a 6-cm hepatic adenoma on OCPs. First-line management?

Focal nodular hyperplasia (FNH) hallmark on imaging?

A 27-year-old woman in late pregnancy presents with RUQ pain and hypotension; imaging shows intraperitoneal bleeding from a liver mass. Most likely diagnosis?

A hemodynamically stable patient with grade IV blunt liver injury on CT (contained laceration). Best management?

Hemodynamically unstable patient with suspected major liver injury after trauma. First OR maneuver?

A 49-year-old with symptomatic biliary dyskinesia has normal ultrasound and HIDA ejection fraction of 12% reproducing pain. Next step?

A 69-year-old with obstructive jaundice and pruritus has a resectable distal cholangiocarcinoma. Best operation?

Following major hepatectomy, a key predictor of postoperative liver failure is:

In suspected choledocholithiasis with intermediate probability (mild LFT rise, nondilated CBD), best next step?

A patient with emphysematous cholecystitis (air in GB wall) presents toxic. Management?

After difficult subtotal fenestrating cholecystectomy, patient develops persistent bile leak from GB fossa drain. Best step?

A 55-year-old with recurrent pyogenic cholangitis and intrahepatic pigment stones localized to left lobe. Definitive management?

Which laboratory/imaging pattern supports primary sclerosing cholangitis (PSC)?

A 71-year-old with cirrhosis and portal hypertension presents with new ascites and fever. Paracentesis PMN 480/mm³. Best treatment?

A 58-year-old with biliary pancreatitis improves clinically. When should cholecystectomy be performed in mild disease?

In predicted severe biliary pancreatitis with persistent cholestasis/ascending cholangitis, the next step is:

During laparoscopic cholecystectomy, severe inflammation obscures Calot’s triangle. Safe bailout?

Which classification system is commonly used for post-cholecystectomy bile duct injuries?

Optimal timing for definitive reconstruction of a complete CBD transection recognized late?

A 36-year-old woman has pruritus, cholestatic labs, and positive antimitochondrial antibodies. Diagnosis and first-line therapy?

A 29-year-old man with ulcerative colitis has cholestatic labs; MRCP shows intra/extrahepatic beading. Most important long-term cancer screening?

Which patients with HCC are candidates for curative ablation (RFA/MWA) as first-line?

The hallmark imaging pattern diagnostic of HCC in cirrhotics is:

First-line systemic therapy for unresectable advanced HCC in many current guidelines?

A 45-year-old woman on OCPs has a 7-cm hepatic adenoma that persists after stopping estrogen. Best management?

Typical imaging and treatment for hydatid (Echinococcus) hepatic cyst?

Amebic liver abscess management in a stable patient?

Pyogenic liver abscess standard care?

A 62-year-old with hemobilia (RUQ pain, GI bleed, jaundice) after liver biopsy. Best diagnostic/therapeutic step?

Budd–Chiari syndrome (hepatic vein thrombosis) initial management?

A 60-year-old with gallbladder polyps 8 mm and PSC. Best plan?

Choledochal cyst type I (Todani) in a 22-year-old. Preferred treatment?

Choledochal cyst type III (choledochocele) preferred therapy?

For perihilar cholangiocarcinoma, which surgical principle is correct?

Preoperative portal vein embolization (PVE) is indicated when: