Q3 What is not true regarding the role of (IOC) Intra Operative Cholangiography in Bile duct injury
a) IOC should be done in all cases of cholecystectomy as it prevents inadvertent injury
b) Cholangiography only serves to limit the extent of injury
c) It allows for immediate recognition of injury and repair
Q4. Most Accurate and clinically useful Measurement of Portal vein pressure is
a) Hepatic venous pressure gradient (HVPG)
b) Direct measurement of portal pressure
c) Splenic pulp pressure
d) Wedged hepatic vein pressure
Q5. False statement regarding endoscopic management of varices
a) All patients with cirrhosis should undergo screening endoscopy.
b) If no varices are found endocscopy should be done every 2-3 years
c) Endoscopy screening may be more cost effective than endoscopic screening
Answers
1. b
According to Strasberg's classification of biliary injuries, Type B injury is the one in which there is no bile leak. It is a occulson of Right sectoral duct.
For Bismuth classification of bile duct injuries see here
2) a
ERCP is not the initial investigation if there is a suspicion of complete ductal occlusion. This is because ERCP would not demonstrate the proximal extent of injury.In these cases PTC (Percutaneous Transhepatic Chonalgiography) would be more useful.
3. a
Routine intraoperative cholangiography does not decrease the rate of injuries associated with Lap Cholecystectomy. Cholangiography is clearly not preventive if the injury occurs after a normal study or if the study serves only to identify an injury that already has been inflicted
4) a
The HVPG has been used to assess portal hypertension since its first description in 195. It is the difference between the wedged hepatic vein pressure and free hepatic vein pressure. Wedged hepatic vein pressure- requires passage of a catheter into the hepatic vein under radiologic guidance until the catheter can be passed no further, that is, until the catheter has been “wedged” in the hepatic vein. It measures the sinusoidal pressure.
The most important thing to note is that HVPG is 0 in cases of extrahepatic (presinusoidal) portal hypertension.
5)c
The current consensus is that all patients with cirrhosis of the liver should be screened for esophageal varices by endoscopy. In patients in whom no varices are detected on initial endoscopy, endoscopy to look for varices should be repeated in 2 to 3 years. If small varices are detected on the initial endoscopy, endoscopy should be repeated in 1 to 2 years.
