1. If someone comes in with acute cholecystitis, don't operate on them immediately-- IVF, watch them; percutaneous cholecystostomy if a fluid collection collects and you need to drain. Go through liver to have something between the gallbladder and abdomen wall so you dont leak bile into your peritoneal cavity.
2. Distal pancreatectomy-- options for spleen management:
-Take spleen and pancreas together. Will need pneumovax/meningococcal every 5 years, annual flu shot.
-Take pancreas tail, take splenic aa/vv, leave spleen supplied by short gastrics: if the tumor is integrated with splenic aa/vv, it's hard to save those vessels. to save the short gastrics though you have to be very careful of cutting on the greater curve of the stomach or manipulating that area (i.e. flipping up the spleen), since if you damage those vessels the spleen wont have any blood supply. There is a low chance of splenic infarction, esp in the inferior part of the spleen. If it goes necrotic, they will have bad LUQ pain and you will have to go back in 8-10 days out from surgery.
-Take pancreas tail, leave splenic aa/vv. This is hard, technically, and adds ~1 hour; you have to dissect the pancreas off the splenic vessels. You may get unacceptable bleeding
3. If you're doing a re-anastomosis after a hartmann, if the anastamosis is <6 cm from the anal verge, you may have to do a diverting ileostomy to take pressure off the new anastamosis.
4. For DVT prophylaxis, some people like to do subQ heparin in the first 24 hours after surgery and lovenox after that-- lovenox can't be reversed, and in the first 24 hrs postop the risk of bleeding is higher. People without a CI (bleeding) should be anticoagulated while they're in the hospital. Some people may need prolonged DVT prophylaxis-- up to 28 days, notably people with cancer, with big incisions (big laparotomy), obese, history of DVT. Lovenox is renally cleared so is dose-adjusted to 30mg/day (rather than 40 mg/day) in people with GFR <30, although small studies have shown that it does not increase major bleeding events, though it may increase minor bleeding events. {Chest} Lovenox has been shown to be slightly more effective than heparin, although with proportionally increased bleeding risk. The main benefit is lovenox is once daily subQ injections, while heparin is usually administered as TID subQ injections. The main disadvantage of lovenox is that it's more $$$$, so if your patients can't afford it, they'll have to inject themselves TID.
5. Things to do to speed up recovery of bowel motility:
-exercise, mobility
-chewing gum stimulates bowel "Sham feedings and the action of chewing stimulate bowel motility by a cephalic-vagal mechanism and have been shown to increase levels of neural and humoral factors that subsequently increase function in several different segments of the gastrointestinal tract." - {JAMA surgery} From the same article, speculation on the origins/cause of postoperative ileus: "The etiology of postoperative ileus remains controversial. Bowel motility is suppressed postoperatively owing to sympathetic hyperactivity and increased concentrations of circulating catecholamines.6 Pacemaker dysfunction owing to bowel manipulation is another postulated mechanism of postoperative ileus.7 In addition, electrolyte abnormalities, peritoneal and/or retroperitoneal irritation, and narcotic analgesia effects may contribute to postoperative ileus.8 The focus of more recent studies has been on neural and humoral factors. Vasoactive intestinal peptide directly inhibits smooth muscle contraction in the intestine, and levels of it are increased after operation.9 In addition, pain increases the release of substance P, which is also known to inhibit bowel motility.10,11 Operations also inhibit the promotility hormones gastrin, neurotensin, and pancreatic polypeptide.8"
6. Pneumonia definitions: 
-community-acquired: clinical or radiographic findings within first 48 hours of admission.
-healthcare-associated: CAP patients with recent contact with healthcare system.
-hospital-acquired: findings 48-72 hours after admission.
-ventilator-acquired: 48-72 hours after getting ET tube.
{source}
7. Most common pathogens of pneumonia... 
-CAP: s.pneumo, h.flu, atypicals, viruses
-Hospital-acquired: s.pneumo, h.flu, atypicals, legionella, aspiration, viruses
-ICU: s.pneumo, staph aureus/MRSA, gram negatives, legionella, h.flu
8. Criteria to admit someone with CAP: CURB-65
-Confusion
-BUN>20
-Resp rate>30
-BP systolic <90, diastolic <60
-Age>65
If they have 0-1 criteria, they are low risk and should be treated as an outpatient, 2 criteria they should be admitted, 3+ criteria should go to ICU (esp if 4 or 5 criteria)
9. Treatment for CAP in 
-outpatient setting: z-pack, 500 mg qd for 3 days. or clarithro, 500mg BID for 5 days. Or doxy 100mg BID for 7-10 days.
-inpatient setting: respiratory quinolone (moxi/levo) or b-lactam (ceftri, ceftax, unasyn) PLUS macrolide, since macrolides have limited gram-neg coverage.
-ICU setting: b-lactam (see above) PLUS either azithro or a resp quinolone. If you're worried about pseudomonas, double cover with an anti-pseudomonal b-lactam (zosyn, cefepime, mero, imipenem) and an anti-pseudomonal quinolone (cipro-- make sure not resistant in your hospital). If you're worried about MRSA, add vanc or linezolid to your cocktail.
10. Surgical patients do not all need H2-blocker/PPI prophylaxis for stress ulcer/chemical aspiration. Risk factors for chemical aspiration: post-op ileus (esp not NPO), opiate narcotics that worsen ileus, plus sedation in the form of an anxiolytic or sleep aid = bad cocktail for chemical aspiration. Keep the head of the bed elevated 30-45 degrees. If someone doesn't have GERD/didn't come in on a PPI/H2 blocker, it's not necessarily good policy to reflexively put everyone on one. Changing the acidity of the stomach may encourage increased and/or worse type bacterial overgrowth; increasing likelihood of GI infections or lung infections from microaspiration.

1. A patient that comes in with tachycardia, hypotension, and diminished breath sounds in one lung has a tension pneumothorax until proven otherwise. Stick a needle in them (mid clavicular line, 2nd intercostal space) immediately, ask questions later; use a large-bore needle (14+, push until you hear a hiss). You do not need any other clinical signs (tracheal deviation, JVD, etc), you don't need confirmation via CXR. If you see tension pneumo on a CXR, you waited too long.
2. Places your patients can hide blood/hemorrhage:
-thighs
-pelvis
-abdomen
-chest
-the floor... check the floor.
3. When you do your FAST ultrasound to detect intra-abdominal bleeding, look in the following four places where blood tends to pool: {source}
-Rectovesical pouch/Pouch of douglas in the pelvis
-Hepatorenal recess (pouch of morison): look at pleural space, sub-diphragmatic space, morison's pouch, R paracolic gutter/inferior kidney pole
-Splenorenal recess: same 4 places as above; fluid in LUQ tends to accrue in subphrenic before splenorenal. additionally, fluid on LUQ is blocked from going down L paracolic gutter by the phrenicocolic ligament (sustenaculum lienis-- slings under and supports spleen) so it tends to move across the midline to the R
-Pericardial space to r/o tamponade. Don't panic if you see a small amount of fluid-- its only bad if its circumferential.
4. Things to remember about FAST exam: {source}
-While some people say you can detect as little as 100cc of fluid, you normally need around 500-600, so recheck if the first one was negative
-Fat can sometimes be mistaken for free abdominal fluid, as can fluid contained within GI lumen. Free abdominal fluid will tend to have "pointy" edges,.
5. ABCDEs again, because anyone can't get enough of this: 
-Airway. Assess by trying to speak to someone, attempting to rouse them with pain.  Check patency by figuring out if you can ventilate them-- can you bag-mask them? meaning when you mask, do their sats improve, can you hear breath sounds? Try to DL them, can you see anything?
-Breathing: are they breathing? Does their chest move, can you feel air moving out of their mouth, can you hear lung sounds?
-Circulation: what are their vital signs? Make sure to use big IVs above the diaphragm, because you don't want to worse any potential abdominal hemorrhage. Initial bolus 20-30 mL/kg or just give them 2L. You also want to continually assess perfusion-- pulses, mental status, urine output.
-Disability: check long bones for fractures, check mental status/GCS
-Environment: remove all clothing, check everywhere for injury.
6. If you think you put an air embolus in someone, have them lie trendelenburg so that the air bubble becomes stuck in their heart and doesn't go to their lungs.
7. If you take someone to the OR for abdominal hemorrhage, open them up with a big incision and see if there is blood there; attempt to suction; if you are unable to keep up, then proceed to pack the crap out of it, like this: put your hand on the liver, press down, and shove lots of sponges behind the liver (like 4, 5 entire packs), then put your hand on the spleen, shove a lot behind that, then put your hand on the bladder and pack around that, and then pull up the mesentery and pack behind that. Then proceed to remove the least blood-soaked laps first and find and stop the bleeding, proceeding to bloodier areas.
8. In trauma, blood may be a better primary resuscitation fluid than crystalloids, avoiding dilutional coagulopathy; and it may be best to administer blood, ffp, and platelets in a 1:1:1 ratio. {review article}
9. If you go to the CT scan for someone who's been in a MVC with a star-sign (i.e. shattered windshield), do a non-contrast head CT first to r/o brain bleed, then do with-contrast chest abdomen pelvis to find an internal bleed.
10. LR may be a better resuscitation crystalloid than NS, possibly because of less acidosis and more coagulation-- i.e. less bleeding, as the calcium in LR soaks up the citrate chelator in pRBCs.

1. HIT can cause paradoxical arterial thrombi; antibody binding to platelets may activate them, and if platelets are fragmented, they are even more thrombogenic than whole platelets
2. DDx of acute-onset dyspnea:
-cardiac: failure to pump blood forward, leading to back-flow of fluid into the lungs. This failure can be due to arrhythmia, valve failure, ischemia, acute CHF decompensation, etc.
-pulmonary: failure to ventilate or perfuse. This can be due to alveolar collapse (atelectasis, pneumothorax), alveoli filling with non-oxygen (pneumonia/aspiration), upper respiratory tract obstruction (OSA, anaphylaxis, asthma, bronchitis, larygneal/tracheal edema, foreign body), failure to perfuse (PE, pulmonary HTN)
-blood: anemia, CO poisoning, metabolic acidosis
-brain: stroke
-psych: panic attack, hyperventilation
-neuromuscular: guillain-barre, myasthenia gravis, ALS, deconditioning
3. Dumping syndrome: hyperosmolar contents moving from stomach to small bowel. Often associated with gastric bypass, but can also be caused by things like pyloroplasty or antrectomy for medically refractory GERD. Leads to osmotic diarrhea, small bowel volume overloading (cramping, bloating, vomiting), and hypovolemia (weakness, dizziness). Can also lead to hypoglycemia, as the rapid-loading of small bowel with glucose triggers excessive insulin release.
-Early-onset: 15-30 mins after meals
-Late-onset: 1-3 hours after meals,
4. Both analogues of vasopressin and somatostatin both cause splanchnic vasoconstriction, but somatostatin analogues cause less coronary vasoconstriction.
5. For management of DVT or PE, put them on a heparin drip: 70-100 U/kg as a bolus, and then 15-25 u/kg as maintenance. Heparin is anti-coagulative and also anti-inflammatory, reduces pain associated with DVT. Check PTT 6 hours after you initiate treatment (should be 1.5-2x normal). Monitor PTT TID the next day, and then qd every day after that. Also follow platelets to monitor for development of HIT. Bridge to coumadin (4-5 day overlap). Anti-coagulate for 3-6 months. If DVTs continue to recur, they may need to be on lifelong a/c.
6. Fever and increased WBC after lap chole: either infection or anastomosis leak. Do a HIDA scan +/- ERCP to look for possible leak, CT if you suspect abscess. If there's an abscess, drain it. If there is a leak, put in a temporary stent to drain bile with ERCP. If they don't get better quickly, go back to the OR.
7. Biliary/Foregut cancers:
-5-year survival with pancreatic adenoCA, even with complete resection 10-15%, although some new data suggests survival may be up to 40% with early enough detection and no local spread. Median survival for those getting palliative care for unresectable tumors: 8 mos
-5-year survival for cholangioCA, 5-10%, <5% with spread. These tumors are often detected late and quickly invade local vascular structures and the liver because of their location.
8. Management of uncomplicated acute pancreatitis: NPO (TPN if you think their nutrition status requires), IV hydration, pain control, monitor electrolytes (esp Ca). Not everyone needs a CT. Perhaps do an u/s to rule out stones; if there are stones, do a lap chole when they are stable (follow amylase and lipase)
9. Ranson's prognostic signs: (developed originally for alcoholic pancreatitits)
At presentation
-Age>55
-WBC>16
-Glucose>200
-LDH>350
-AST>250
At 48 hours
-Hematocrit decrease >10%
-Fluid sequestration > 6 L
-BUN increase 5mg/dL
-Ca<8
-PaO2<60
-Base deficit>4
If someone meets 3 criteria, 28% mortality, 5-6 criteria mortality is 40%, 7-8 criteria, mortality is 100%
10. If someone comes in with acute-onset epigastric pain, elevated amylase/lipase, and signs of septic shock, think acute necrotizing pancreatitis, or bowel ischemia/perforation (PUD, volvulus, etc). With acute pancreatitis, there is a massive systemic inflammatory response that can cause significant third-spacing of fluids leading to distributed shock and poor perfusion of all organs, as well as ARDS that may be worsened with the large amount of fluids you're about to give. Treat with fluids, fluids, fluids; CT scan to make sure it's pancreatic pathology and not bowel or anything else, and to look for an abscess (drain it if you see one... try catheter first, but if its too loculated or complex you may need to go to the OR for drainage). IV antibiotics that have good coverage of gram negatives and anaerobes. ABG to determine adequacy of oxygenation (pO2) and ventilation (pCO2) if their breathing is starting to get compromised or their sats go down; you may need to intubate. If they get more septic-looking after a few days of care, suspect abscess, drain it. If they don't get better, suspect pancreatic pseudocyst; keep them NPO and give fluids and observe. Most psuedocysts will resolve on their own in 6 weeks; if not, then either drain percutaneously or surgically create a connection between pseudocyst and posterior stomach wall. You have to wait 7 weeks because it takes that long for the walls of psuedocyst to become amenable to suture.

1. PICC:
-Indication: med term infusing things (chemo, abx, TPN), or withdrawing things (HD, plasmapharesis)
-CI: coagulopathy, renal failure Cr>3 (need to save peripheral veins for dialysis access grafts/fistulas-- use IJ)
-Complications: infection, thrombus, hit an artery instead of vein and cause hematoma
2. Non-tunneled central lines: uldall, quinton-- temporary, used for urgent dialysis access. IJ/fem/subclavian, avoid subclavian to avoid central vein stenosis
3. Tunneled central lines: hickman, groshong, broviac- have cuff which stimulates tissue growth, keeps line in place. Good for putting things in long term: TPN, antibiotics. Not for dialysis
4. EVDs drain to gravity, set the cmH20 pressure by setting the height of the drain relative to the height of the patient. When placing the shunt, put it in Kocher's point: frontal horn, lateral ventricle
5. For internal shunts: VP shunt first line, VA or V-pleural if you can't get the VP (scarring/adhesions, infection).
6. Axillary lymph node dissection (ALND): 
-Benefits: full axilla dissection, staging, decrease local recurrence which eventually decreases mortality
-Cons: increased morbidity (lymphedema), postop complications (seroma, drain infections, cellulitis)
Sentinel node biopsy lower complications, same survival compared to ALND.
"Available evidence suggests that axillary node dissection is associated with more harm than benefit in women undergoing breast-conserving therapy who do not have palpable, suspicious lymph nodes, who have tumors 3.0 cm or smaller, and who have 3 or fewer positive nodes on sentinel node biopsy" {JAMA review}
7. Melena in an older man (>50) is colon cancer until proven otherwise, particularly with R colon/cecum if there is black, tarry stools. Workup: CBC, iron. Colonoscopy to find the lesion. CXR, LFTs, to rule out mets. CEA too.
8. Biomarkers:
-CEA to detect recurrent colon CA, 30% recurrent cancers are CEA neg-- usually poorly differentiated or if the primary was CEA-
-Octreotide is taken up by neuroendocrine tumors (i.e. carcinoid)
9. Radiation has no role in colon cancer. Chemo may be helpful in bad T2 colon cancers (signet ring, mucous making, +perforation, +venous invasion) and is helpful in T3 cancers. 5FU + leucovorin (not used as rescue as for methotrexate, but rather synergizes with 5FU because it inhibits thymidylate synthase)

1. Breast cancer stats
-1 in 8 women who live to 85 will get it
-3.4% lifetime risk of death
2. NSABP B04 trial: role of radical mastectomy. Among patients with clinically node negative (i.e. no palpable nodes, because this was done in an era before scans) there was no difference in survival between those who got radical mastectomy (breast, pec major, entire axillary contents) and those who got simple mastectomy +/- node radiation.
3. Clinically node-negative: 30% will still have cancer in their nodes; clinically node-positive (i.e. palpable nodes) 70% will have cancer in their nodes, since frequently caused by things like inflammation, particularly after a biopsy
4. What actually kills you in breast cancer is mets (brain, bone, adrenals, lung, liver), and so by the time most of these breast cancers were detected in the early days, it was already too late for surgical resection to make a difference thus it is thought why no survival difference between radical and simple mastectomy.
5. NSABP B06 trial: role of breast conservation. Compared modified radical mastectomy to lumpectomy and ALND +/- radiation. No difference in survival between breast-losing and breast-conserving therapy, but the addition of radiation significantly decreased likelihood of local recurrence-- which many decades later was shown to be associated with increased survival, but the effect was subtle, visible only in the long-term and with high-power: {Lancet}
6. Options for tissue diagnosis of breast cancer:
-FNA: tells you limited information, essentially cancer vs non-cancer. Good to r/o the possibility of cancer/reassure someone when they are young, healthy, and 99% likely to have a fibroadenoma but are anxious and want a biopsy
-Core needle: standard for diagnosis. Gives you enough tissue for histology, grading, receptors-- HER, ER, etc.
-Incisional: biopsy of skin-- i.e. peau d'orange for inflammatory breast cancer, or a weird looking nipple looking for pagets
-Excisional: rarely done, because we rarely go to OR without tissue diagnosis. Often because you went to the OR to excise what you thought was a benign mass (ductal papilloma) but later happened to find DCIS in the sample.
7. Options for breast cancer surgery: mastectomy (+/- immediate reconstruction) or lumpectomy; if you get lumpectomy, you HAVE to get radiation.
8. Absolute contraindications for breast-conserving surgery:
-Inability to get radiation-- i.e. previous chest/mantle radiation for hodgkin's
-Multi-centric diagnosis-- 2+ cancers in different quadrants.
-Diffuse malignancy with microcalcifications-- will make future tracking of progression difficult to impossible.
-Persistent positive margins after multiple (1-2x) reasonable attempts at surgical resection.
9. Relative contraindications for breast-conserving surgery: 
-Large tumor size relative to breast size
-Pregnancy, particularly in the 1st and 3rd trimester. Radiation is CI in pregnancy, chemo is not.
-Collagen vascular diseases? Increased risk of late-complications? Maybe, maybe not.
10. Things that are NOT contraindications to breast-conserving therapy:
-Lymph node +/-: the breast surgery is independent of the axillary surgery. You can still do ALND
-Location in breast
-Family history, genetic mutations
-Aggressiveness of cancer, risk of systemic relapse

1. CDH: pulmonary HTN from thickening of pulmonary vessels due to increased intrathoracic pressures; additionally, ipsi and contralateral lung hypoplasia from pressure on the mediastinum on the opposite side.
-Bochdalek: failure of pleuropericardial folds to fold. this occurs on L more than R, posterior more than anterior.
-Morgani: failure of septum transversum to form properly.
2. Treatment for CDH: Breathless intubation. Get the tube in before the baby even cries, because crying could lead to increased gas in the GI tract which will worsen the compression on the lungs. Do not try to bag, for the same reason. Put in an NG tube to decompress, go on ECMO if you need to.
3. If you seen any midline anomaly (like TEF), work up/examine for signs of VACTERL anomalies--
-vertebral (CXR, u/s to look at spine-- kids have windows between vertebrae so you can look with u/s)
-anorectal (exam)
-cardiac (echo)
-TEF (NG + xray)
-renal (check that they are making urine, renal u/s to look at upper GU, VCUG to look at lower GU)
-limb (exam).
4. Bilious vomiting requires an upper GI series STAT. This is a surgical emergency, because it indicates malro/volvulus until proven otherwise.
5. Omphalocele is associated with many other defects. There is a peritoneal covering over bowels, its usually midline, there are occasionally other organs that herniate, the defect is usually >4cm. Other defects tend to be above the omphalocele (cardiac, lung hypoplasia) or below (GU, kidneys). They are rarer than gastroischesis 1:5000. These cannot be pushed in like gastroischisis, you have to wait for skin to grow around it, and then push it in around a year of age, sometimes you can't.
6. Gastroischesis: R>L, <4cm, not associated with other defects, you push it in after they're born. Put the whole thing into a silo, slowly twist the top of the silo so it pushes the guts back in.
7. Metabolic defects assoc with pyloric stenosis: chronic vomiting, you get loss of K and H, so hypokalemia, metabolic alkalosis with paradoxical aciduria. You lose volume from vomiting, so you secrete aldo which increases resorption of Na, lose K and H. Treatment is with boluses of NS until they pee (which tells you the volume is adequate). Then you give maintenance D5 0.45NS +20mEq K @1.5x maintenance rate until the electrolyte abnormalities are corrected.
8. Malro: the cecum doesn't do its counter-clockwise rotation, and stays up by the duodenum. Additionally, the mesentery of the small bowel is tight and bunched up, making volvulus much more likely. Ladd's bands form between cecum and R abdominal wall, crushing the duodenum and causing bilious vomiting. Treat by cutting the ladd's bands, stuff the small bowel on the R side of the abdomen, the large bowel on the L side, remove appendix because if you don't, if they get appendicitis they will get LLQ pain and it will go undiagnosed. Diagnosis of malro: do an upper GI series, watch for the contrast to go into stomach and then make the C-curve to the R, down, left back across the midline indicating a continuous duodenum. If the dye fails to re-cross the midline, suspect malro.
9. Intussuception: ileo-ileo is common, happens frequently, nothing to worry about. Ileo-colic is the bad one.
10. Hydroceles usually go away by 1 year, no need to fix it surgically, unless it is a communicating hydrocele, or there is a hernia. Transillumination will not tell you the difference between a hydrocele and a hernia. The way to tell is that a hydrocele can only be palpated in the base of the scrotum near the testicle, while the hernia can be palpated up the spermatic cord. Inguinal hernias are at a higher risk for incarceration in kids vs adults, so you should repair them; preemies get hernias more than full term babies, so fix their hernias before they leave the hospital.

1. Borders of inguinal canal: 
-Superior: conjoint tendon (aponeuroses of internal oblique & transversus abdominis)
-Inferior: inguinal ligament
-Dorsal: tranversalis fascia
-Ventral: external oblique
2. Hasselbach's triangle: bordered by lateral rectus/semilunar line medially, inferior epigastric vv laterally, inguinal ligament inferiorly. Direct hernias occur into hasselbach's triangle, indirect hernias lateral to the epigastric vessels.
3. There is a space medial to the femoral vein, between the it and the lacunar ligament, at the most medial part of the space inferior to the inguinal ligament and superior to the ligament of cooper; this space is tight, and anything that gets stuck there is unlikely to be able to be manually reduced.
4. For hernia repairs, putting in a mesh has a lower recurrence rate (<1%) compared to Bassini repairs (sewing conjoint tendon to inguinal ligament)
5. Hernia tips:
-Hernias tend to occur on the R more than the L
-When you do abdominal surgery, make sure to repair the trnasversalis fascia well, because its the strength layer of the abdominal wall
6. Richter hernias-- the anterior/ventral wall of a segment of bowel is trapped -> venous edema -> necrosis. If you then reduce this hernia, it may perforate. If someone comes in with a relatively unimpressive looking hernia but with a lot of pain, after you reduce them, observe them for signs of rupture or peritonitis.
7. Spigelian hernias: at junction of arcuate and semilunar lines. The hernia only goes through the transversalis fascia, so it is unable to be appreciated on palpation, as it is still covered by the external and internal oblique muscles. Diagnose with CT, treat with laparoscopic repair.
8. Hepatic mass: before you biopsy, rule out hemangioma because they bleed a lot. Use radiolabeled RBCs, watch for filling from outside-in. Hepatic adenomas can also be bloody, and tend to respond to hormones-- i.e. OCPs or pregnancy. They are likely to rupture with pregnancy, so make sure to treat them before your patients get pregnant.
9. Hepatic cysts: simple hepatic cysts can be watched, complex cysts are suggestive of echinococcus; blood tests for echinococcus antigens to r/o. Drain carefully to prevent spillage of contents into the peritoneum, inject sclerosing agent (hypertonic saline).
10. Hepatic abscesses: Amebic abscesses can be treated with flagyl without drainage-- if you drain it, you might get a bacterial superinfection. Bacterial abscesses need to be drained, (if they are large and few) pts will usually have systemic signs of infection. IF there are many small abscesses, 4-6 weeks of IV abx. Bacterial abscesses can form from migration from GI tract into biliary system, or from bacteremia (from injection drug use or peritonitis working into the portal vein) seeding.