General Surgery Board Review Gastrointestinal Surgery Flashcards

What is the most common complication of acute necrotizing pancreatitis that requires surgical or radiologic intervention?

Answer: Infected pancreatic necrosis

Infected pancreatic necrosis, confirmed by CT-guided FNA or clinical deterioration, is the most dangerous and commonly interventionally-managed complication of severe necrotizing pancreatitis.

Charcot's triad of fever, jaundice, and right upper quadrant pain is pathognomonic for which condition?

Answer: Ascending cholangitis

Charcot's triad indicates ascending cholangitis caused by biliary obstruction with bacterial infection; Reynolds' pentad adds hypotension and altered mental status indicating suppurative cholangitis.

Which scoring system most commonly assesses severity of acute pancreatitis within the first 48 hours of admission?

Answer: Ranson's criteria

Ranson's criteria use 11 parameters (5 on admission, 6 at 48 hours) to predict severity and mortality in acute pancreatitis; APACHE II is also widely used for dynamic reassessment.

Surgical resection of a hilar cholangiocarcinoma (Klatskin tumor) typically requires which operative approach?

Answer: Major hepatectomy with extrahepatic bile duct excision and biliary reconstruction

Resection of Klatskin tumors requires major hepatectomy (usually right or left with caudate lobe) combined with extrahepatic bile duct excision and hepaticojejunostomy for curative intent.

On CT scan, which finding in a pancreatic head mass most reliably indicates unresectability in pancreatic ductal adenocarcinoma?

Answer: Superior mesenteric vein or portal vein encasement greater than 180 degrees

Encasement >180 degrees of the superior mesenteric artery, celiac axis, or SMV/portal vein that cannot be reconstructed indicates locally advanced, borderline, or unresectable disease per NCCN criteria.

The Child-Pugh score for estimating hepatic reserve in liver disease includes which five parameters?

Answer: Total bilirubin, serum albumin, INR, degree of encephalopathy, and severity of ascites

The Child-Pugh score uses five parameters: total bilirubin, serum albumin, INR (or prothrombin time), degree of hepatic encephalopathy, and severity of ascites, each scored 1–3.