Q True about Bile duct injuries in cholecystectomy
a) Only 15% are recognized at the time of surgery
b)Routine Operative cholangiography definitely reduces the incidence of bile duct injury
c) In incomplete obstruction of bile duct, jaundice occurs early
d) Surgical outcome depends on timing of surgery
Answer for premium members
After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams
Q) Not an indication of cholecystectomy in gall bladder adenoma?
a) Size more than 1 cm
b) Associated gall stones
c) Age more than 60 years
d) More than 3 in number
Q) Infection in obstructive jaundice all are true except
a) There is loosening of hepatic tight junctions and cholangiovenous reflux
b) IgM production from liver cells decreased
c) Reduced bacteriostatic & bactericidal action due to decreased bile salts in bowel
In patients with long-standing obstruction, intrahepatic bile ductule proliferation occurs with an increase in the length and tortuosity of the canaliculi. The biliary system normally has a low pressure (5 to 10 cm H2O); however, in the setting of complete or partial biliary obstruction, biliary pressure can approach 30 cm H2O.
Q) Cholangiocarcinoma type IIIB bismuth Corlette bilirubin 10, left portal vein and hepatic artery
involved. Best approach is
A. Preoperative left biliary drainage followed by resection
B. Preoperative right biliary drainage followed by resection
C. Left portal vein embolisation followed by resection
D. Palliative drainage
Q ) Most common indication for Pediatric liver transplant (DNB SS)
A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
MOst common cause or liver transplant in children. Presents as persistent jaundice after birth. Etiology is not clear
Findings include absent extrahepatic ducts and gallbladder. Biopsy is diagnostic
Q) False about choledochal cyst is
a) Type IV is also known as Caroli's disease
b) Type I choledochal cyst is the most common type
c) Type III is also called as choledochocele
d) Type II choledochal cyst is diverticular disease
Answer is for premium members
This question was asked in NEET this year and a similar question on choledochal cyst is already on the website for some time.
Q What is the management of choledochal cyst (bile duct cyst) adherent to portal vein?
a) Excision and Roux en y hepaticojejunostomy
b) Internal drainage into roux en y jejunal limb
c) Hepatic lobectomy
d) The internal lining of the cyst can be excised, leaving the external portion of the cyst wall intact.
Q) Not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledochoduodenal fistula
c) In it there is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
MRCP can be diagnostic and is preferred because of its non invasive nature.