Hepatobiliary and Pancreatic Surgery
Core concepts
Understand biliary anatomy including the confluence of the hepatic ducts, the cystic duct, and the ampulla. Know the presentation and management of gallstone disease, choledocholithiasis, cholangitis, and pancreatitis. Master the differences between acute and chronic pancreatitis, and the indications for ERCP versus surgery. Understand liver anatomy by Couinaud segments, the significance of the portal triad, and the principles of hepatic resection, including future liver remnant. Know pancreatic cancer presentation, the role of CA 19-9, and the Whipple procedure. Understand the pathophysiology of jaundice and its preoperative implications.
Traps in questions
Questions often test the timing of cholecystectomy in gallstone pancreatitis and the role of MRCP versus ERCP. Distinguish cholangitis (fever, jaundice, right upper quadrant pain, septic physiology) from cholecystitis. Another trap is assuming all pancreatic masses are resectable; vascular involvement matters. Be careful with liver function tests in obstructive versus hepatocellular jaundice. Watch for questions about post-ERCP pancreatitis risk.
Worked rule of thumb
For a patient with gallstone pancreatitis and no cholangitis, perform cholecystectomy during the same admission after resolution; if cholangitis or persistent obstruction is present, ERCP first. For jaundice with dilated ducts, image before intervening.
Exam strategy
Link each presentation to the obstructed level. Extrahepatic obstruction raises direct bilirubin and alkaline phosphatase; hepatocellular injury raises transaminases.