SU28.10-12 | Hepatobiliary and Splenic Surgery — Glossary

The American Association for the Surgery of Trauma grading system for organ injury; for the spleen, grades I (minor) to V (shattered/hilar).

Inflammation and infection of the gallbladder due to sustained cystic-duct obstruction, characterised by RUQ pain, fever and a positive Murphy's sign.

An anthelminthic drug used to treat hydatid disease, given before and after PAIR or surgery.

A serum tumour marker that is often raised in hepatocellular carcinoma; a normal level does not exclude the tumour.

Liver abscess caused by Entamoeba histolytica, classically single, in the right lobe, with sterile reddish-brown 'anchovy-sauce' pus; treated medically with metronidazole.

The opening of the common bile duct and pancreatic duct into the duodenum, guarded by the sphincter of Oddi.

The characteristic reddish-brown, sterile, liquefied necrotic material aspirated from an amoebic liver abscess.

Infection of obstructed bile in the biliary tree, classically presenting with Charcot's triad and requiring urgent biliary drainage.

Severe, self-limiting right upper quadrant or epigastric pain from transient gallstone obstruction of the gallbladder neck or cystic duct, without fever or jaundice.

The cystohepatic triangle bounded by the cystic duct, common hepatic duct and liver edge, containing the cystic artery — the key dissection landmark in cholecystectomy.

Fever (with rigors), right upper quadrant pain and jaundice — the classic presentation of ascending cholangitis.

Presence of gallstones in the common bile duct, causing obstructive jaundice and predisposing to cholangitis and pancreatitis.

Gallstones formed from cholesterol-supersaturated bile, classically in the '5 F's' patient (Fat, Female, Forty, Fertile, Family history).

Active extravasation of contrast on CT indicating ongoing arterial bleeding or a pseudoaneurysm, directing angioembolisation.

The division of the liver into eight functionally independent segments, each with its own portal pedicle and hepatic venous drainage, used to plan liver resection.

A palpable, non-tender gallbladder with jaundice is unlikely to be due to stones and should raise suspicion of malignant distal bile-duct obstruction.

The surgical step of clearly identifying the cystic duct and cystic artery as the only two structures entering the gallbladder before clipping, to prevent bile-duct injury.

Smaller cysts forming within a hydatid cyst, containing infective scolices; a characteristic imaging feature.

Splenic haemorrhage occurring hours to days after the initial trauma, sometimes after an initially reassuring assessment.

The liver's inflow from both the portal vein (about three-quarters) and the hepatic artery (about one-quarter).

The dog tapeworm whose larval stage causes hydatid cysts; humans are accidental intermediate hosts.

Bacteria with a polysaccharide capsule — Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis — cleared by the spleen and responsible for OPSI.

The protozoan parasite that causes intestinal amoebiasis and amoebic liver abscess, reaching the liver via the portal vein.

Endoscopic retrograde cholangiopancreatography; a mainly therapeutic procedure to clear bile-duct stones by sphincterotomy and extraction, carrying a risk of pancreatitis.

Focused Assessment with Sonography for Trauma; a rapid bedside ultrasound to detect free intraperitoneal fluid (blood).

A benign hyperplastic liver lesion with a central scar, usually asymptomatic and managed conservatively.

Malignant tumour of the gallbladder, associated with chronic gallstone irritation and porcelain gallbladder, often presenting late.

Solid concretions formed in the gallbladder from bile constituents; classified as cholesterol, pigment (black/brown) or mixed.

The commonest benign liver tumour, a vascular malformation usually found incidentally and managed by observation.

A benign liver tumour associated with oral contraceptive use, carrying a risk of bleeding and malignant change, often resected.

The commonest primary malignant tumour of the liver, arising on a background of cirrhosis, hepatitis B or C, and often associated with a raised alpha-fetoprotein.

Infection by the larval stage of the tapeworm Echinococcus granulosus, forming a slowly enlarging cyst, most commonly in the liver.

Pain referred to the left shoulder tip caused by blood under the left diaphragm irritating the phrenic nerve; a clue to splenic injury.

Minimally invasive surgical removal of the gallbladder, the gold-standard treatment for symptomatic gallstone disease.

The fibrous remnant of the umbilical vein, lying in the free edge of the falciform ligament.

A localised collection of pus within the liver, most often amoebic or pyogenic in origin.

A card or bracelet identifying a patient as asplenic so that fever or infection is treated as an emergency.

Magnetic resonance cholangiopancreatography; the non-invasive imaging of choice to demonstrate the biliary and pancreatic ducts and confirm CBD stones.

Arrest of inspiration on deep palpation of the right upper quadrant, indicating acute cholecystitis.

Treatment of a haemodynamically stable solid-organ injury by monitoring and supportive care rather than immediate surgery.

Treatment of a haemodynamically stable solid-organ injury by monitoring and supportive care rather than immediate surgery.

Post-hepatic jaundice from blocked bile flow, with raised conjugated bilirubin, ALP and GGT, dark urine and pale stools.

A fulminant, often fatal sepsis occurring in asplenic patients, caused chiefly by encapsulated bacteria.

Puncture, Aspiration, Injection of a scolicidal agent, and Re-aspiration — a percutaneous treatment for selected hydatid cysts, performed under albendazole cover.

A damage-control surgical manoeuvre packing gauze around the liver to control bleeding in an unstable trauma patient.

Gallstones of calcium bilirubinate; black pigment stones occur with haemolysis/cirrhosis, brown pigment stones with biliary infection and stasis.

Long-term oral antibiotic given to asplenic patients to prevent infection by encapsulated organisms.

Bacterial (often polymicrobial) liver abscess arising from biliary disease, portal pyaemia or haematogenous spread; treated with antibiotics, drainage and source control.

The body's network of phagocytic cells, of which the spleen is the largest organ, responsible for filtering blood and clearing opsonised bacteria.

Charcot's triad plus hypotension (shock) and altered mental status, indicating severe (suppurative) cholangitis.

A substance (e.g. hypertonic saline) instilled to kill the scolices of a hydatid cyst and prevent recurrence during PAIR or surgery.

Surgical removal of the spleen, indicated for shattered (grade V) or hilar injury or persistent haemodynamic instability.

Catheter-based occlusion of a bleeding splenic artery branch to control active haemorrhage and aid splenic salvage.

Traumatic damage to the spleen, the commonest organ injured in blunt abdominal trauma, ranging from minor laceration to complete shattering.

Surgical repair of the spleen to preserve splenic tissue and function rather than removing the organ.

The commonest and most dangerous cause of OPSI; the principal target of pneumococcal vaccination in asplenic patients.