Q) A 38 year lady undergoes USG abdomen for vague pain abdomen. ON USG she has a large 12 cm lesion in the right lobe of liver, which on CT turns out to be hemangioma. True about management of hemangioma liver
a) All hemangioma more than 10 cm should be resected
b) OCPs and pregnancy should be avoided in young females as there is risk of rupture
c) Arterial embolization should be routinely done in large hemangiomas
d) If surgery is decided hemangioma located at the periphery should be enucleated
Ans) d
Whatever the size there is no role of resection for asymptomatic hemangioma. Risk of rupture is very small and therefore there is no rationale for stopping OCPS, pregnancy or physical activities.
Arterial embolization, which may be considered for temporary control of hemorrhage has limited success and is occasionally associated with morbidity
In symptomatic hemangioma liver resection is the treatment of choice, in peripheral tumors enucleation and in centrally placed tumors, formal resection should be done
Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)
a) Alpha feto protein should be done 6 monthly
b) Ultrasound abdomen should be done 6 monthly
c) Candidates for liver transplant should be screened every 3 months
d) Nodules more than 2 cm should be followed up more regularly
Answer b
Cirrhosis is prone for development of HCC. Screening has to be stringent. Earlier ultrasound of liver and alpha feto protein were both used for screening
In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.
The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.
Q) Which statement is not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
Answer c
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.
RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes.
Cause for recurrent pyogenic cholangitis
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
Stones and strictures
Clinical Presentation of Recurrent pyogenic Cholangitis
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
Radiology for Recurrent Pyogenic Cholangitis
MRCP can be diagnostic and is preferred because of its non invasive nature.
Surgical treatment
Goal is to clear the biliary tree and to bypass or resect the strictures
Beger Procedure in Chronic Pancreatitis | Surgery MCQ
Q: True about Beger procedure for chronic pancreatitis
# Theme NEET SS Pancreas MCQ
a) Posterior branch of gastro duodenal artery is preserved.
b) Beger procedure is a pancreatic head mass resection that can be done for small pancreatic tumors.
c) Intra pancreatic, choledochal and ampullary structures are removed.
d) Neck of the pancreas is not transected
🆓 This is a free MCQ — click below to view the answer.
✅ Correct Answer: a) Posterior branch of GDA is preserved
Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.
The difference from similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted whereas in Frey, neck of the pancreas is not cut.
This procedure is not recommended if there is suspicion of carcinoma head of pancreas and Whipple is the procedure for that. For small tumors it can be used.
Posterior branch of GDA is preserved in Beger Procedure.
Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.
