Notes in 07 Hepatobiliary Interventions

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Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe {{c1::corkscrew appearance::sign}} is the classic finding angiographically of {{c2::liver cir…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn the cirrhotic liver, a mass that is {{c1::hyper}}vascular may represent {{c2::hepatocellular c…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Parenchymal liver Bx::intervention}} can evaluate the degree of {{c2::hepatic fibrosis}} to…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsUS guided liver biopsy is undertaken in the most {{c1::peripheral}} area, to avoid collateral dam…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Percutaneous transhhepatic cholangiography (PTC)::intervention}} is percutaneous contrast i…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe most common indications for PTC are relief of {{c1::biliary obstruction}} and providing bilia…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsPrior to PTC and Cholecystostomy, {{c1::gram (-) antibiotic prophylaxis}} is administered to miti…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn PTC, the right biliary tree is accessed via a {{c1::right midaxillary line two-puncture}} appr…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn PTC, the left biliary tree is accessed via a {{c1::left subxiphoid}} approach
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn PTC, {{c1::metallic::material}} stents are used in patients with strictures and a {{c2::&…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn PTC, {{c1::plastic::material}} stents for biliary strictures allow regular exchange and a…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsInstead of a stent to treat a biliary stricture, an internal/external biliary {{c1::drain::interv…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsComplications of PTC include:{{c1::hemorrhage}}{{c2::bile}} leak{{c3::hemobilia}} (from an arteri…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsPTC access in this picture is obtained via the {{c1::right mid axillary line approach}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsMost common cause of bile duct injury → {{c1::Iatrogenic (lap choly)}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Sclerosing cholangitis}} is a chronic inflammatory and fibrosing process that causes multif…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsSclerosing cholangitis may present clinically with {{c1::abdominal pain}}, {{c2::malaise}}, and {…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe treatment for sclerosing cholangitis is {{c1::liver transplant}}, however {{c2::PTC}} can pro…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c2::Unilateral}} biliary obstruction is commonly due to {{c1::primary bile duct malignancy::pat…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c2::Hilar}} biliary obstruction is most commonly due to {{c1::hilar cholangiocarcinoma (klatski…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsCase: Malignant biliary obstructionYellow arrow: bilateral {{c1::dilatation}} of hepati…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsCase: RUQ painYellow arrows, CT: Diffuse wall {{c1::thickening}} of the gallbladderTop right, HID…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsAcute calculous or acalculous cholecystitis in poor surgical candidates should be treated with {{…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::calculous}} cholecystitis, cholecystotomy is a temporary measure for treatment prior to …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::acalculous}} cholecystitis, cholecystotomy may be a curative treatment without cholecyst…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsWhen accessing the gallbladder percutaneously, the two approaches are {{c1::transhepatic}} (more …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn the {{c1::transhepatic}} approach to the gallbladder, an US guided needle is inserted int…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn the {{c1::transperitoneal}} approach to the gallbladder, a needle is inserted directly into th…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Transhepatic}} percutaneous gallbladder approach has a {{c2::increased}} liver laceration r…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Transperitoneal}} percutaneous gallbladder approach has a {{c2::decreased}} liver laceratio…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe cholecystostomy drain tube stays in situ until the patient has clinically {{c1::improved}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe cholecystostomy drain tube stays in situ until the repeat cholangiogram shows patency of the …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe cholecystostomy drain tube stays in situ for {{c1::six}} weeks, until a {{c2::fibrous tract}}…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Direct}} measurement of the portal vein is impractical and invasive, because it traverses t…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Indirect}} portal vein measurement is measured by an {{c2::IJV}} catheter, which determines…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsPortosystemic gradient may be estimated using the {{c1::corrected sinusoidal}} gradient, which re…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsPortal hypertension is defined as portosystemic gradient >{{c1::5}} mmHg
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::esophageal}} varices, blood is shunted from the {{c2::coronary (left gastric)}} vein to …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::gastric fundal}} varices, blood is shunted from the {{c2::splenic}} vein to the {{c2::az…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::splenorenal}} shunt, blood is shunted from the {{c2::splenic or short gastric}} vein to …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::mesenteric}} varices, blood is shunted from the {{c2::SMV/IMV}} vein to the {{c2::iliac}…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::caput medusa}} varices, blood is shunted from the {{c2::umbilical vein}} vein to the {{c…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn {{c1::hemorrhoidal}} varices, the blood is shunted from the {{c2::IMV}} vein to the {{c2::infe…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Transjugular intrahepatic portosystemic shunt (TIPS)}} creates a direct path between the {{…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe purpose of TIPS is to lower {{c1::portal}} pressures.
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe most frequent indications for TIPS are refractory {{c1::variceal hemorrhage}} and refrac…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsEvaluation of liver dysfunction is done pre-procedure with either:{{c1::MELD/Model for End Stage …
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Right heart failure::cardiac pathology}} is a contraindication to TIPS procedure due to the…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Severe active hepatic failure}} is a contraindication to TIPS procedure because it shunts b…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Hepatic encephalopathy}} is a contraindication to TIPS procedure because it increases serum…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBefore TIPS, patency of the {{c1::portal}} vein should be evaluated with {{c2::cross-sectional}} …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn TIPS, a covered stent is used to connect the {{c1::right hepatic}} vein to the {{c1::right por…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn TIPS, after right hepatic vein cannulation, wedged balloon {{c1::CO2 occulsion venography}} is…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn TIPS, CO2 is the preferred contrast agent because it is {{c1::less::more/less}} viscous than i…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn TIPS, after a tract between the portal and hepatic circulation is established, the tract is {{…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn TIPS, the target reduction in portosystemic gradient is to <{{c1::12}} mm Hg.
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsPost-TIPS procedure, patency of the established tract/shunt is assessed by {{c1::doppler ultrasou…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c1::1}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c1::2}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c1::3}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c1::5}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c1::6}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBallon-occluded retrograde transvenous obliteration (BRTO) can be used to manage {{c1::gastric va…
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::BRTO}} involves {{c2::sclerosing}} agent injection into a varix via {{c3::gastrorenal}} or …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO causes major gastrorenal shunt obstruction, which {{c1::increases}} portal venous pressure
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn management of refractory gastric variceal hemorrhage, BRTO has {{c1::comparable}} efficacy to …
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO step 1: Establish percutaneous access to the {{c1::femoral}} vein (most common) or {{c1…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO step 2: After access is obtained, the gastrorenal shunt is {{c1::catheterized}} via the {{c2…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO step 3: After catheterization, the gastrorenal shunt is {{c1::balloon occluded}} and the rel…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO step 4: {{c1::Sclerosant (sclerosing agent)}} is injected upstream to the varices, and the o…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO complications include:{{c1::ascites}} {{c2::spontaneous bacterial peritonitis}}{{c3::po…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsTIPS step {{c3::4}}:
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsLess common indications for PTC include percutaneous treatment of {{c1::biliary calculi}} and adj…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsMost contraindications for Percutaneous transhepatic cholangiography are {{c1::relative::relative…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsWhat is the treatment for Bile duct injury?{{c1::biliary diversion to drainage bag}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsSclerosing cholangitis occurs more commonly in {{c1::men::men/women}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsSclerosing cholangitis is associated with {{c1::IBD (ulcerative colitis)::autoimmune disease}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsSclerosing cholangitis leads to biliary {{c1::cirrhosis}} and increases the risk of {{c2::cholang…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsSclerosing cholangitis on cholangiogram shows multifocal {{c1::biliary strictures}} of intra- and…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe DDx of multifocal biliary strictures includes ChAMPS:{{c1::Chronic bacterial cholangitis}}{{c…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn unilateral biliary obstruction, does the contralateral biliary system often need intervention?…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsHilar obstruction (Klatskin tumor) most often requires {{c1::two::#}} biliary drain(s)
Published	05/01/2023	Interventional Radiology: Hepatobiliary Interventions{{c1::Transperitoneal}} cholecystostomy has a higher risk of {{c2::incomplete}} tract formation a…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsCorrected sinusoidal gradient = {{c1::[wedged hepatic vein pressure] - [free hepatic vein pressur…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsThe {{c1::right}} hepatic vein has relatively constant anatomy and tends to be {{c2::larger::larg…
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsFirst-line treatment for gastric variceal hemorrhage in the US and Europe → {{c1::TIPS}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsCan BRTO be used in patients without spontaneous gastrorenal or gastrocaval shunt?{{c1::No}}
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO can {{c1::worsen::improve/worsen}} ascites and esophageal varices
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsBRTO can {{c1::lower::raise/lower}} risk of liver failure and hepatic encephalopathy
Published	05/01/2023	Interventional Radiology: Hepatobiliary InterventionsIn contrast to TIPS, BRTO is associated with {{c1::lower::raise/lower}} rebleeding rate, hepatic …
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