Q11)All are true for CBD exploration except
a)Transcystic exploration is suited for 6-8 mm stones only
b) It is possible only when cystic duct is parallel to the CBD
c) Cystic duct needs to be diltaed to 10 mm
d) Clearance is possible in 95-98% cases
Q12) Regarding MRCP what is not true?
a) Hepatic vein has bright signal
b) Stones appear as enhanced signals
c) Bile duct appears as enhanced signal
d) Portal vein appears as void signal
Q13) Not true about the association of Primary Sclerosing Cholangitis (PSC) and Ulcerative Colitis (UC)
a) Ulcerative Colitis appears 8-10 years earlier than PSC
b) Association is present in 70%
c) Symptoms of PSC improve after Total proctocolectomy
d) Patients with UC and PSC have increased risk of colonic dysplasia
Q14) Most common cause of Budd Chiari syndrome in India is
a) Membranous IVC obstruction
b) Polycythemia
c) Myeloproliferative disorders
Q15)What is not required for formation of cholesterol gallstones
a) Supersaturation of bile
b) Nucleation
c)Gall bladder stasis
d)Infection
Answers
11)b
All are true except b
Cystic duct needs to be at an angle to the CBD and not parallel to it for instrument insertion and manipulations.
Clearance of all common bile duct stones is achieved in 75% to 95% of patients with laparoscopic common bile duct exploration.
12)b
Stones in MRCP appear as a VOID SIGNAL
MRCP showing a void signal (stone) in the gall bladder and also in Common hepatic duct
13 c
Treatment of UC has no effect on the course and Prognosis of Ulcerative colitis
14) a
In India and asia it is membranous obstruction of the IVC and in the west myeloproliferative disorders
15) d
The pathogenesis of cholesterol gallstones involves three stages:
(1) cholesterol supersaturation
(2) crystal nucleation
(3) stone growth.
The key to maintaining cholesterol in solution is the formation of both micelles, a bile salt-phospholipid-cholesterol complex, and cholesterol-phospholipid vesicles. Present theory suggests that in states of excess cholesterol production, these large vesicles may also exceed their capability to transport cholesterol, and crystal precipitation may occur. Cholesterol solubility depends on the relative concentration of cholesterol, bile salts, and phospholipid.
cholesterol supersaturation results in a metastable state in which cholesterol precipitation may or may not take place and additional factors in bile must be present, therefore, to either enhance or inhibit the nucleation of cholesterol leading to the next stage in gallstone formation
Nucleation refers to the process in which solid cholesterol monohydrate crystals form and conglomerate. Several pronucleating factors including mucin glycoproteins, immunoglobulins, and transferrin accelerate the precipitation of cholesterol in bile.
Infection leads to formation of brown pigment calculi
