HPB tips for intern

[Grazia Lamberti]

Hey all, newbie GS intern starting on HPB service, which I don't know much about. Any tips on bread and butter topics/recommended reading would be great.


Sent from my iPhone using SDN mobile

---

Members don't see this ad.

 

[dr zaius]

Read about Whipple's, CBD explorations, distal pancs, and their indications/contraindications (and all the other common HPB operations that I'm forgetting at the moment).

Review liver imaging techniques (liver MRI, eovist, tagged red cell scans, etc)

Familiarize yourself with when a patient needs a transplant/when to initiate transplant eval.

Learn quick what drain output looks like when there's a bile or pancreatic leak (this will be something to pick up once you start working).

Go to your senior sooner rather than later.

Review TPN and tube feeds.

All I can think of at the moment.

 

[Trauma Surgeon]

Read about Whipple's, CBD explorations, distal pancs, and their indications/contraindications (and all the other common HPB operations that I'm forgetting at the moment).

Review liver imaging techniques (liver MRI, eovist, tagged red cell scans, etc)

Familiarize yourself with when a patient needs a transplant/when to initiate transplant eval.

Learn quick what drain output looks like when there's a bile or pancreatic leak (this will be something to pick up once you start working).

Go to your senior sooner rather than later.

Review TPN and tube feeds.

All I can think of at the moment.

Dude! Is that all you expect from your interns, specially their first week? We expect them to do the Whipple, at least as assisting surgeon

For OP, managing the patients pre- and post op with right pain medication, TPN, knowing what tube does what and when to remove them and so on is essential IMO. Also, if something does not "feel right" it isn't in these patient population! Better to think that tachycardia is due to rebleeding and hemorrhage than simple pain, and call your senior…

If you want to be a star (or see your self as HBP surgeon in the future) you can learn what images should be ordered or when to initiate transplant eval. But, that is too much to ask for from an intern...

 

[Grazia Lamberti]

Thanks!! I'm extremely frustrated at the moment because I've been trying to study Whipples, but so much of it is "just words," and very difficult to visualize even with an anatomy atlas+ Sabiston. I'm petrified of getting pimped and chewed out on my first day, as inevitable as both may be...

Thanks for reminding me that it's okay for interns not to know things. Now if only I could convince myself of that....


Sent from my iPhone using SDN mobile

 

[vhawk]

No one is gonna expect the intern to know how to do a whipple, if you can define it thats great. As far as knowledge base goes, its your first month so honestly dont worry about it that much, but knowing that there are "eight" liver segments, knowing the blood supply to the panc and why we have to do whipples, and knowing some basics about pancreatic cancer will more than suffice.

I agree with the above that its actually more important to know how to manage HPB patients, which means become familiar with what a PBD/PTC tube is, what a G tube is, what a GJ or a J tube is, what a Dobhoff tube is, how to manage TPN.

 

[TypeADissection]

I'm gonna echo what's been said above. No one is expecting you to know how to do these complex procedures. Half of the battle will be learning the vocabulary. Write down all the abbreviations you hear, look them up (indications, limitations, etc.), ask lots of questions, always have ins and outs and don't be afraid to ask the nurses if they haven't tallied them yet because you'll most likely be pre-rounding before they do it, and have fun. HPB is a great service. Lots of complex pathology, lots of cool cases, and also many sobering reminders that clipping the common duct during a "routine" cholecystectomy is a lot more common than not.

 

[dr zaius]

I'm gonna echo what's been said above. No one is expecting you to know how to do these complex procedures. Half of the battle will be learning the vocabulary. Write down all the abbreviations you hear, look them up (indications, limitations, etc.), ask lots of questions, always have ins and outs and don't be afraid to ask the nurses if they haven't tallied them yet because you'll most likely be pre-rounding before they do it, and have fun. HPB is a great service. Lots of complex pathology, lots of cool cases, and also many sobering reminders that clipping the common duct during a "routine" cholecystectomy is a lot more common than not.

Yea, I agree. No one will expect you to know how to do a Whipple. The point I was trying to (poorly) make was reading about them to understand the anatomy, which helps to manage the patient post op.

Totally agree about the CBD. "It's just a simple lap chole" can turn into "Oh ****" really, really quick.