ABSITE UPDATED ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
●● What separates the right and left lobes of the liver?
Answer: Cantlie's line
- line between the gallbladder fossa and IVC
●● Lobe I of the liver corresponds to which anatomic segment?
Answer: Caudate lobe
●● Lobes II-III of the liver corresponds to which anatomic segment?
Answer: Left lateral segments
●● Lobe IV of the liver corresponds to which anatomic segment?
Answer: Left inferior anteromedial
●● Lobe V of the liver corresponds to which anatomic segment?
Answer: Right inferior anteromedial
●● Lobes VI-VII of the liver corresponds to which anatomic segment?
Answer: Right Posterolateral
,●● Lobe VIII of the liver corresponds to which anatomic segment?
Answer: Right superior anteromedial
●● Describe the venous drainage of the liver
Answer: 3 hepatic veins (right, middle and left) drain into IVC
Medial and left hepatic vein usually merge before draining into IVC
●● What is the most common abberant hepatic vascular anatomy?
Answer: - Replaced right hepatic: branches off SMA, traveling behind
pancreas and CBD
- Replaced left hepatic: branches off left gastric, traveling in
gastrohepatic ligament
●● What is the management of asymptomatic gallstones?
Answer: Observation
●● What is the management of uncomplicated symptomatic
cholelithiasis?
Answer: Elective cholecystectomy
●● How is symptomatic cholelithiasis managed in pregnancy?
,Answer: - Higher rates of spontaneous abortion with non-operative
management
- Laparoscopic cholecystectomy during the second trimester
- Place ports via open Hassan technique
- Keep pneumoperitoneum as low as possible
- Place bump under right side to offload vena cava
●● What is the management of acute cholecystitis?
Answer: Early cholecystectomy if surgically fit
Cholecystostomy tube if unable to tolerate surgery
●● Cholecystostomy tubes for acute chole patients
Answer: - If recovered from critical illness: interval chole
- Recurrent Sxs are common after chole tube removal
- If no improvement in symptoms after placement of PCT: OR for
cholecystectomy
- Cholecystostomy tubes do not provide benefit for gangrenous
gallbladder or perforation
, ●● Which guidelines are used for acute cholecystitis?
Answer: Tokyo guidelines
●● Grade I Cholecystitis
Answer: Mild Cute Cholecystitis
- no organ dysfunction
- limited disease in the gallbladder
●● Grade II Cholecystitis
Answer: Moderate Acute Cholecystitis
- No organ dysfunction
- Extensive disease in the gallbladder
- Elevated WBC, Murphy's +, duration > 72 hrs
- Significant inflammation on imaging
●● Grade III Acute Cholecystitis
Answer: Severe Acute Cholecystitis
- Acute cholecystitis with organ dysfunction
- meaning: pressor requirement, neurologic dysfunction, Cr > 2, INR >
1.5, platelets < 100,000
●● Which patients may benefit from a prophylactic cholecystectomy?
QUESTIONS AND CORRECT ANSWERS
●● What separates the right and left lobes of the liver?
Answer: Cantlie's line
- line between the gallbladder fossa and IVC
●● Lobe I of the liver corresponds to which anatomic segment?
Answer: Caudate lobe
●● Lobes II-III of the liver corresponds to which anatomic segment?
Answer: Left lateral segments
●● Lobe IV of the liver corresponds to which anatomic segment?
Answer: Left inferior anteromedial
●● Lobe V of the liver corresponds to which anatomic segment?
Answer: Right inferior anteromedial
●● Lobes VI-VII of the liver corresponds to which anatomic segment?
Answer: Right Posterolateral
,●● Lobe VIII of the liver corresponds to which anatomic segment?
Answer: Right superior anteromedial
●● Describe the venous drainage of the liver
Answer: 3 hepatic veins (right, middle and left) drain into IVC
Medial and left hepatic vein usually merge before draining into IVC
●● What is the most common abberant hepatic vascular anatomy?
Answer: - Replaced right hepatic: branches off SMA, traveling behind
pancreas and CBD
- Replaced left hepatic: branches off left gastric, traveling in
gastrohepatic ligament
●● What is the management of asymptomatic gallstones?
Answer: Observation
●● What is the management of uncomplicated symptomatic
cholelithiasis?
Answer: Elective cholecystectomy
●● How is symptomatic cholelithiasis managed in pregnancy?
,Answer: - Higher rates of spontaneous abortion with non-operative
management
- Laparoscopic cholecystectomy during the second trimester
- Place ports via open Hassan technique
- Keep pneumoperitoneum as low as possible
- Place bump under right side to offload vena cava
●● What is the management of acute cholecystitis?
Answer: Early cholecystectomy if surgically fit
Cholecystostomy tube if unable to tolerate surgery
●● Cholecystostomy tubes for acute chole patients
Answer: - If recovered from critical illness: interval chole
- Recurrent Sxs are common after chole tube removal
- If no improvement in symptoms after placement of PCT: OR for
cholecystectomy
- Cholecystostomy tubes do not provide benefit for gangrenous
gallbladder or perforation
, ●● Which guidelines are used for acute cholecystitis?
Answer: Tokyo guidelines
●● Grade I Cholecystitis
Answer: Mild Cute Cholecystitis
- no organ dysfunction
- limited disease in the gallbladder
●● Grade II Cholecystitis
Answer: Moderate Acute Cholecystitis
- No organ dysfunction
- Extensive disease in the gallbladder
- Elevated WBC, Murphy's +, duration > 72 hrs
- Significant inflammation on imaging
●● Grade III Acute Cholecystitis
Answer: Severe Acute Cholecystitis
- Acute cholecystitis with organ dysfunction
- meaning: pressor requirement, neurologic dysfunction, Cr > 2, INR >
1.5, platelets < 100,000
●● Which patients may benefit from a prophylactic cholecystectomy?
