Assessment of patient nutritional status and functional reserve allows surgeons to identify malnourishment and potential recovery before major abdominal surgery. Evolving nutritional and fluid management strategies, along with improving anesthesia, pain management, and hemodynamic monitoring, seek to minimize homeostatic alterations.…
Overview Improvements in patient selection criteria, advances in hepatopancreatobiliary (HPB) surgical techniques, and perioperative care have enabled increasing numbers of older and previously deemed inoperable patients to undergo HPB surgery. Despite this increase in comorbidities, recent studies have documented the…
Overview The management of hepatobiliary and pancreatic disease has evolved greatly since the 1990s. Today’s operative surgeon has several valuable adjuncts to aid in accurate preoperative evaluation and planning for benign and malignant disease. Advances in contrast-enhanced computed tomography (CT),…
Introduction Percutaneous image-guided needle biopsy (PNB) is the cornerstone for diagnosis and treatment of many diseases involving the liver. Minimally invasive, PNB is an effective outpatient procedure with a low complication rate. The success of PNB requires proper patient selection,…
Imaging and diagnosis The diagnosis of benign and malignant diseases of the pancreas and biliary tree historically have relied on a detailed history and complete physical examination, with correlation of the results of clinical chemistries. Imaging of the hepatic and…
Overview Once a mainstay of diagnosis in hepatobiliary and pancreatic diseases, indications for catheter angiography have changed significantly in the past three decades. This is mainly because of the widespread adoption of noninvasive imaging modalities such as multidetector computed tomography…
Direct cholangiography overview Direct cholangiography, the introduction of contrast medium into the biliary system, can be performed under fluoroscopic guidance percutaneously, endoscopically, or intraoperatively via surgically placed catheters. The nonoperative techniques are percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography…
The field of radiology has undergone tremendous growth over recent decades, with continuous advances in diagnostic imaging that include innovations in medical devices, such as the creation of dual energy–source multidetector computed tomography (CT); innovations in imaging agents, such as…
Nuclear medicine uses radioactive pharmaceuticals, or radiopharmaceuticals , for diagnostic imaging and internal radiotherapy of a variety of diseases. This chapter discusses clinical applications of diagnostic nuclear medicine imaging for the care of patients with hepatic, pancreatic, and biliary (hepatopancreatobiliary…
Introduction to pancreatic imaging Transabdominal ultrasound (US) is a noninvasive, inexpensive, and rapid method of evaluating morphologic changes in the pancreas and may be used as an initial investigation in the setting of abdominal pain or suspected obstructive jaundice. However,…