资料室Hepatobiliary and Pancreatic Surgery
General Objectives
1.Demonstrate knowledge of the anatomy, physiology, and pathophysiology of the
liver, biliary tract, and pancreas.
A. Medical Expert/Clinical Decision Maker
A.1 Knowledge: Basic Science and Anatomy
1.Demonstrate knowledge of the anatomy, physiology and pathophysiology of the liver,
biliary tract and pancreas.
Junior Level
Liver and Biliary Tract
1.Describe the anatomy of the liver, biliary system, and pancreas including commonly
found variations.
2.Describe the physiology and function of liver, biliary system, and pancreas to include:
a.Gluco metabolism
b.Protein synthesis
c.Coagulation
d.Drug metabolism
e.Reticuloendothelial system
f.Function of bile in fat metabolism
3.Explain the formation of bile, its composition, its function in digestion and its
metabolism.
4.Describe the pathophysiology of gallstone formation.
Pancreas
1.Describe the anatomy of the pancreas, including regional vascular anatomy.
2.Discuss the physiology of the pancreas, including endocrine and exocrine function
and hormonal regulation.
a.Endocrine
i.islet cells
1.Alpha (Glucagon)
2.Beta (Insulin)
3.Delta (Somatostatin)
4.Non-Beta (pancreatic polypeptide)
b.Exocrine-
i.acinar cells
1.Lipa
2.Amyla
c.Hormonal regulation
i.Secretin-bicarbonate cretion
ii.Cholecystokinin–enzyme cretion
A.2 Knowledge: General Clinical
1.Demonstrate the ability to manage dia and injury of the liver, biliary tract and
pancreas amenable including the role for surgical and nonsurgical interventions. Junior Level
Liver and Biliary Tract
1.Perform history and physical examination specifically focud on liver and biliary
system.
伤感2.Select and interpret appropriate laboratory and radiological evaluations in the work
up of the jaundiced patient
Pancreas
1.Perform history and physical examination focud on the pancreas.
2.Select and interpret appropriate laboratory and radiological examinations in
evaluation of pancreatic dia, including:
Senior Level
Liver and Biliary Tract
1.Perform detailed evaluation of patients with liver and biliary dia and plan
appropriate management and operative approach.
Pancreas
1.Perform detailed evaluation of patients with pancreatic dia and plan appropriate
medical or surgical management.
Chief Level
Liver and Biliary Tract
1.Coordinate overall care of patients with hepatobiliary dia including:
a.Initial evaluation
b.Appropriate diagnostic studies
c.Indicated consultations
军衔肩章Pancreas
1.Coordinate overall care of patients with complex pancreatic dia, including initial
evaluation, appropriate diagnostic studies, operative intervention and postop care A.3 Knowledge: Specific Clinical Problems
Junior Level
Liver and Biliary Tract
1.Outline the work-up and differential diagnosis of the jaundiced patient.
2.Discuss various types of liver cysts and the appropriate management of each.
3.Discuss the pathophysiology and treatment of the following:
a.Mass lesions of the liver (benign and malignant tumors of the liver, metastatic
秋的作文lesions to the liver)
b.Congenital anomalies of the liver, bile ducts, and Congenital
biliary atresia, choledochal cysts, caroli’s dia
c.Biliary lithiasis and its complications (gallstone ileus, gallstone pancreatitis)
d.Infections (pyogenic and amebic hepatic abscess)
e.Hepatitis, viral and non-viral
f.acalculous cholecystitis
g.Biliary motility problems
h.Acute and chronic pancreatitis and their complications
i.Pancreatic neoplasms
j.Sclerosing cholangitis
k.Primary biliary cirrhosis
l.Secondary biliary cirrhosis
m.Benign biliary strictures
Pancreas
1.Explain the pathophysiology of pancreatitis to include:
a.Common etiologies such as:
i.Gallstones
ii.Alcohol related
iii.Trauma
iv.Steroid-induced
v.Postoperative
vi.Post endoscopic retrograde cholangiopancreatography (ERCP)
vii.Idiopathic
b.Diagnosis, evaluation and medical management
c.Role of peritoneal lavage
2.Complications of pancreatitis, such as:
a.Adult respiratory distress syndrome
b.Hypovolemia
c.Pudocyst
d.Abscess
e.Infected pancreatic necrosis
3.Indications for operative management of pancreatitis
4.Management of gallstone pancreatitis with timing of surgery
5.Ranson’s criteria for asssing pancreatitis and its correlation with prognosis
6.Explain the pathophysiology of carcinoma of the pancreas to include:
a.Typical history and prentation
b.Diagnostic evaluation using:
i.Computed axial tomography
ii.Ultrasound
iii.ERCP
iv.Percutaneous transhepatic cholangiography (PTC)
v.Arteriography
vi.Laparoscopy/laparotomy
7.Indications for:
a.Operative versus nonoperative biliary drainage
b.Percutaneous versus endoscopic stenting
c.Rection
d.Concomitant gastrojejunostomy with operative biliary bypass
e.Discuss prentation, evaluation and management of pancreatic pudocysts
with attention to:
f.Complications of pudocysts (hemorrhage, infection, rupture)
g.Timing of drainage
h.Percutaneous versus surgical drainage
i.Indications for external versus internal drainage
j.Choice of internal drainage procedure
k.Explain the diagnosis and management of pancreatic ascites.
Senior Level
Liver and Biliary Tract
1.Pathophysiology and management of
2.Cirrhosis and portal hypertension including management alternatives for
细叶芒草complications
3.Various etiologies of cirrhosis (alcohol and hepatitis)
4.Differential diagnosis of portal hypertension (prehepatic, hepatic, posthepatic)
5.Medical management of ascites, encephalopathy and other complications of cirrhosis
6.Child’s classification of cirrhosis and its relationship to prognosis and surgical
mortality.
7.Perioperative management of the cirrhotic patient
8.Medical management of bleeding esophageal varices using Vasopressin, Sengstaken-
Blakemore tube, sclerotherapy and transjugular intrahepatic portosystemic shunts (TIPS)
9.Surgical management of bleeding esophageal varices to include:
a.Selection of operative candidates
b.Appropriate lection of procedures such as:
i.Selective and nonlective shunts
ii.Devascularization procedures
iii.Esophageal tranction
10.Surgical management of ascites with peritoneovenous shunts to include patient
lection and complications
11.Discuss Budd-Chiari Syndrome (pathophysiology and management)
12.Detailed Management of choledocholithiasis
13.alternatives to surgery in the management of gallstones, such as:
豪放派诗词
a.Oral dissolution with ursodeoxycolic acid
b.Extracorporeal shock wave lithotripsy
c.Endoscopic sphincterotomy
14.Asss management alternatives for common bile duct stones:
a.Open versus laparoscopic common bile duct exploration
b.ERCP
15.Indications and outcomes for liver Transplantation
16.Management strategies for chronic pancreatitis
Pancreas
1.Describe the etiology, pathophysiology and management of chronic pancreatitis to
include:
a.Indications for operative management
b.Selection of appropriate operative procedure such as:
i.Longitudinal pancreaticojejunostomy (Puestow-Gillesby Procedure)
ii.Caudal pancreaticojejunostomoy (Duval Procedure)
iii.Subtotal pancreatectomy
iv.Pancreatoduodenectomy
2.Role of celiac ganglion ablation (chemical splanchnicectomy) in pain control
3.Summarize the common qulae of chronic pancreatitis to include pain, fat
malabsorption and diabetes
4.Discuss diagnosis, evaluation and surgical management of cystic neoplasms of the黄玫瑰花
pancreas (mucinous and rous cystadenomas; cystadenocarcinoma).
5.Describe the diagnosis, evaluation and surgical management of the following islet cell
tumors of the pancreas:
奔向未来a.Gastrinoma (Zollinger-Ellison Syndrome)
b.Blucagonoma
c.Somatostatinoma
d.Insulinoma
e.VIPoma (Verner-Morrison Syndrome, WDHA Syndrome)
6.Describe the diagnosis and management of pancreas divisum.
