EHPVO with Portal Hypertension

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Q) An young male with cholangitis, EHPVO + Portal Biliopathy was drained with a plastic biliary stent next step?

a) Repeat biliary Stenting every 3 months then followed up

b) Replace plastic to bare metal stent

c) Prepare for Lineorenal shunt surgery

d) Do MRCP and proceed accordingly


Points  about Portal Biliopathy

Portal biliopathy (PB) is a clinical condition defined as the presence of abnormalities in the biliary tree (including biliary tree and gallbladder) in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma.

The spectrum of biliary abnormalities include both  intra- and extra-hepatic biliary stenosis (single or multiple)

With or without consensual above dilation

Bile duct wall irregularity or thickening

Bile duct angulation

Varicose veins located at the ductular walls and gallbladder

 

Bile duct blood supppy

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Q) Blood supply of  Supra duodenal bile duct, what is false? ( CBD Questions) ( AIIMS 2020) 

a) 2% Non Axial 
b) Downward 38% from RHA
c) Gb venous drainage directly to PV
d) Main artery supply to retro pancreatic CBD is retroduodenal artery

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