Category: Bile Ducts

Questions in Biliary System

Physiology of biliary obstruction

Physiology of biliary obstruction

Q) Infection in obstructive jaundice all are true except

a) There is loosening of hepatic tight junctions and cholangiovenous reflux

b) IgM production from liver cells decreased

c) Reduced bacteriostatic & bactericidal action due to decreased bile salts in bowel

Answer 

In  patients  with  long-standing  obstruction,  intrahepatic bile ductule  proliferation occurs with an increase in the length and tortuosity of the canaliculi. The  biliary  system  normally  has  a  low  pressure  (5  to  10  cm H2O);  however,  in  the  setting  of  complete  or  partial  biliary obstruction,  biliary  pressure  can  approach  30  cm  H2O. 

Read on........

Cholangiocarcinoma

Cholangiocarcinoma

Q) Cholangiocarcinoma type IIIB bismuth Corlette bilirubin 10, left portal vein and hepatic artery
involved. Best approach is
A. Preoperative left biliary drainage followed by resection
B. Preoperative right biliary drainage followed by resection
C. Left portal vein embolisation followed by resection
D. Palliative drainage

Answer 

Pediatric liver transplant

Pediatric liver transplant

Q  ) Most common indication for Pediatric liver transplant (DNB SS) 
A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
D. HCV

Free answer 

Biliay atresia

MOst common cause or liver transplant in children. Presents as persistent jaundice after birth. Etiology is not clear

Findings include absent extrahepatic ducts and gallbladder. Biopsy is diagnostic

Choledochal cyst

Choledochal cyst

Q) False about choledochal cyst is 

a) Type IV is also known as Caroli's disease

b) Type I choledochal cyst is the most common type

c) Type III is also called as choledochocele

d) Type II choledochal cyst is diverticular disease

Answer is for premium members

This question was asked in NEET this year and a similar question on choledochal cyst is already on the website for some time.

http://www.mcqsurgery.com/2017/06/09/choledochal-cyst/

Recurrent Pyogenic Cholangitis

Recurrent Pyogenic Cholangitis

Q) Not true about  recurrent pyogenic cholangitis :

a) Mostly there are intrahepatic strictures with involvement of the left side duct

b) It can present as choledochoduodenal fistula

c) In it there is complete biliary obstruction which  leads to marked jaundice and pruritis

d) MRCP and other other cholangiography can be diagnostic

Answer c

In recurrent pyogenic cholangitis (RPC)  complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.

Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.

It can present as choledocholithiasis  with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.

MRCP can be diagnostic and is preferred because of its non invasive nature.

 

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