Blood supply of bile duct

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Q)Blood supply of biliary tract? Which is false

a) 2% blood supply is  nonaxial
b) Downward 38% from RHA
c) GB venous drainage directly to Portal vein
d) Main artery supply to retro pancreatic CBD is retroduodenal artery

Subvesical duct

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Q) . False about  subvesical duct
a) Embedded in cystic plate
b) Communicate with CHD
c) Communicate  with  GB
d) Does not drain any specific segment of liver 

GB polyp

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Q)  Not an indication of cholecystectomy in gall bladder polyp?

a) Size more than 1 cm

b) Associated gall stones

c) Age more than 50 years

d) More than 3 in number

Ans d) No relation with number

The only polypoid lesions that have malignant potential and are associated with a significant rate of harboring
malignancy are adenomatous polyps

The most consistent predictors are single polyps, size greater than 1 cm, and age older than 50

BG 796

Management of Cholangiocarcinoma

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Q) False about management of cholangiocarcinoma?

a) Resection can be done in  absence of histological diagnosis
b) External  radiotherapy better than brachytherapy
c) Lobar hepatectomy can be done

d) None



Type III Choledochal cyst

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Q) Choledochal cyst III, treatment (MCH GI 2019) 

A) Partial hepatic resection
B) Choledochojejunostomy

C) Transduodenal excision
D) Endoscopic drainage


Biliary Atresia

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Q1) Most common  congenital anomaly associated with biliary atresia?

a) Polysplenia
b) Teratology of falot
c) Malrotation

d) preduodenal portal vein

Timing of cholecystectomy in biliary pancreatitis

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Q) What is true regarding timing of cholecystectomy in biliary pancreatitis

a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks

b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded

c) Early cholecystectomy has been shown to have more complications than interval choelcystectomy

d) Early cholecystectomy increases technical complications

 Ans b

"Poncho trial " answers this question

Early  cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces

  1. The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
  2. low added risk of complications.

Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks

SKF page 1079

Management of biliary strictures

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Q) Which of the following is false about management of benign biliary stricture?

a) After HJ,success rate of 80-90% for benign biliary stricture is achieved

b) Recurrent stricture in 5 years is 30%

c) MOst important factor for recurrent stricture is the initial level of injury

d) Liver failure after stricture repair is around 20%