Q6. Most common site for cholangiocarcinoma is
a) Intrahepatic
b) Hepatic duct bifurcation
c) Lower End of CBD (Common Bile Duct)
d) Lower 1/3rd of CBD
Q7. Which is the least common in anatomic variations of extrahepatic biliary system?
a) Trifurcation of Right anterior, right posterior and left hepatic ducts.
b) Right anterior duct joining the common hepatic duct
c) Right Posterior joining the common hepatic duct
d) Anomalies of the gall bladder
Q8. Which of the following is not true for Acalculus cholecystitis?
a) It accounts for 5-10% cases of Acute Cholecystitis.
b) This entity has a more fulminant course of disease progression
c) More commonly seen after burns trauma or major cardiac surgeries.
d) Cholescintigraphy is the investigation of choice for detecting Acute Acalculus Cholecystitis.
Q9. How much bileis produced by liver /day?
a) 100-300 ml
b) 300-500 ml
c) 500-1000ml
d) 500-1200 ml
Q 5. Which of the following is not a criteria for diagnosing Sphincter of Oddi Dysfunction
a) CBD diameter more than 12 mm on USG
b) Decrease in CBD pressure after infusion of Cholecystokinin
c) Ampullary pressure more than 40 mm Hg
d) Delayed emptying of contrast from CBD after ERCP
Answers
6.b
60-80% of tumors are located at the Hepatic Duct bifurcation.( Sabiston 18th edition page 1584) In earlier reviews (Maingot' 10th edition page 1841) , the most common site mentioned is Common bile Duct (33-40%) followed by Common Hepatic duct (30-32%) and Hepatic duct bifurcation (20%).
From other reviews 55% are in the upper 1/3rd, 15% in the middle 1/3rd and 20% in the lower 1/3rd 10 % are diifuse.
Sabiston 18 th page 1584.
7. d
Variations are very common in the anatomy of extraheaptic system.
The typical anatomy of the left hepatic duct formation by the ducts draining segments II, III, and IV of the liver and right hepatic formation by the right posterior (segments VI and VII) and right anterior (segments V and VIII) hepatic ducts is seen in 55-60% cases.
Trifurcation of Left hepatic, right posterior and right anterior is seen in 12%
Right anterior joins CHD distal to the junction of RP and LHDin 16%
Right posterior joins CHD distal to the junction of RA and LHD in 4%
Gall bladder anomalies are the least common.
8. d
1-2% of all patients undergoing cholecystectomy have a diagnosis of Acute acalculus cholecystitis. IN 5-10 % cases of acute cholecystitis no gall stones are found.
Most frequently Acalculus cholecystitis occur in the elderly patients in ICU setting eg after major trauma, burns, Long term parenteral nutrition or after major Vascular or cardiac surgery.
Main Pathophysiology is gall bladder stasis, gall bladder ischemia and visceral ischemia so the gall bladder is more prone for gangrene and perforation.
Ultrasound is the investigation of choice and not Cholescintigraphy because with the latter false positive rate maybe as high as 40%
9. c
Bile flow is approximately 500ml to 1000 ml in most patients. It is dependent on neurogenic, chemical and humoral system.
Increase in bile secretion Decrease in bile secretion
Vagal stimulation Splanchnic nerve secretion
Secretin
Cholecystokinin
10. b
In sphincter of Oddi Dysfunction, after CCK infusion, the pressure in the CBD increases and not decrease.
All other choices are true
