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Flashcards in Gall Bladder Deck (174)
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1
Q

CHARCOT’s Triad
INTERMITTENT FJP

A

Seen in ACUTE CHOLANGITIS
INTERMITTENT
PAIN
JAUNDICE
FEVER

2
Q

REYNOLDS TRIAD

🧠⚡CASH⚡

A

Seen in Acute Suppurative CHOLANGITIS
✨ CHARCOT’s triad
✨ Altered Mental Status
✨ SHock

3
Q

Choledocholithiasis

A

Stones in the CBD
90% from Gall bladder
10% originate in CBD

4
Q

IOC FOR CHOLEDOCHOLITHIASIS

A

MRCP

5
Q

IOC FOR CBD MICROLITHS

A

Endoscopic Ultrasound

6
Q

🧑🏻‍⚕️ Clinical Features for Choledocholithiasis

A

✨ Asymptomatic
✨ Acute CHOLANGITIS- CHARCOT’s triad and Reynolds Triad
✨ Obstructive Jaundice

7
Q

MANAGEMENT: CBD AND GALL STONE DETECTED BEFORE SURGERY

A

ERCP+ Sphincterotomy
F/b after few days
Laparoscopic Cholecystectomy

8
Q

Indicators of CBD Stone in presence of GB stone:

A

ALP ⬆️⬆️
H/o Jaundice
USG: CBD >10mm diameter

9
Q

Management: CBD Stone+GB Stone detected during surgery

A

Laparoscopic Cholecystectomy + Laproscopic Exploration of CBD
If ❌⬇️
Open exploration of CBD
{Exploration=make Cut in the CBD LONGITUDINAL ➡️ REMOVE THE STONES}
⬇️
Insert T-TUBE in CBD (to decompress the bile duct)
⬇️
Insert dye after 7-10days
⬇️
No residual stones➡️ Remove T tube

10
Q

ERCP
Has EEExtra benefits

A

Both Diagnostic and Therapeutic

MRCP- only diagnostic

11
Q

Bismuth Classification used for:

A

Bile Duct Injury

12
Q

Bile Duct Injury classifications:

A

Bismuth Classification
Strasberg classification

13
Q

Bismuth Corlette classification used for

🧠⚡BC ⚡

A

Biliary Strictures
Cholangiocarcinoma

14
Q

Strasberg A and B

A
15
Q

Strasberg C,D,E
STRASBERG E= BISMUTH CLASSIFICATION

A

Strasberg E: CBD involvement

16
Q

How ERCP is DONE?
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATICOGRAPHY

A

Side Viewing Duodenoscope is used
Dye is injected that delinates the anatomy of the biliary tree

17
Q

MC COMPLICATION OF ERCP
2ND MC COMPLICATION

A

ERCP induced Pancreatitis MC
Duodenal Perforation

18
Q

Sphincterotomy with ERCP DONE @ which position

A

11o’clock position incision➡️remove the CBD stones
NEVER DONE AT 3O’clock and 9O’clock

19
Q

BURHENNE METHOD

A

To remove stones present in CBD via T-Tube
Inject Dye after 7-10 days➡️T-Tube Cholangiogram➡️Stone present➡️Retain T tube for (3-4weeks)➡️Tract is formed⬇️
Remove the stone 🪨 through the tract

20
Q

Maximum size of stone that can be removed by ERCP

A

1.5cm

21
Q

CBD STONES AFTER CHOLECYSTECTOMY: TYPES

A

RESIDUAL STONE 🪨: IF PRESENTS WITHIN<2YRS
RECURRENT STONE 🪨: IF PRESENTS after>2yrs

22
Q

Causes of Recurrent CBD stones
ACC

A

Ascariasis
Clonorchis infection
primary CBD stone
Cholangitis

23
Q

MANAGEMENT OF POST CHOLECYSTECTOMY CBD STONES

A

ERCP+SPHINCTEROTOMY
⬇️IF FAILS
TRANSDUODENAL SPHINCTEROTOMY
⬇️IF FAILS
SUPRADUODENAL CHOLEDOCHOTOMY
(Longitudinal incision in CBD and remove stones)

24
Q

SUTURING ADVICE FOR CBD INCISION

A

Absorbable sutures only (Vicryl/PDS)
Knots outside the lumen

25
Q

Why Transverse Incision not given to CBD?

A

TRANSVERSE cuts heals to form STRICTURES

26
Q

MIRRIZI SYNDROME
MIRRI=MARRY=Adhered=BANDH jana

A

GB becomes adherent to CBD dt inflammation. GB Stone 🪨 presses against CBD

27
Q

CSENDES CLASSIFICATION USED FOR
CSENDes= Send= NUDES=WIFE=MARRY

A

MIRRIZI SYNDROME

28
Q

C/F of MIRRIZI SYNDROME

A

Obstructive Jaundice
Acute Cholecystitis- Charcots Triad and Reynolds triad

29
Q

MANAGEMENT OF MIRRIZI SYNDROME

A

Laproscopic Cholecystectomy
Partial Cholecystectomy: in pts whose GB IS DENSELY ADHERENT to CBD

30
Q

Complication/Presentation of GALL STONES x12
🧠⚡ A⁴C²E–M²G²⚡

A
  1. Asymptomatic/ Incidental detection
  2. Acute Cholecystitis
  3. Acute Cholangitis
  4. Acute Pancreatitis
  5. Chronic Cholecystitis
  6. Choledocholithiasis
  7. Emphysematous Cholecystitis
  8. Mucocele nd EMPYMA
  9. MIRRIZI syndrome
  10. Gallstone ileus
  11. GB Cancer
31
Q

MurPhy’s Sign
Abrupt CEASE of Breathing d/t Pain

A

Seen in Acute Cholecystitis
PT winces in pain when pressed in the Rt Hypochondrium

32
Q

Boa’s Sign
riB

A

Hyperesthesia in region of 12th RIB

33
Q

Sonogrophic MurPhy’s sign

A

Seen in ACUTE CHOLECYSTITIS
Focal tenderness when compressed by Sonographic probe

34
Q

IOC FOR GB STONES / ACUTE CHOLECYSTITIS/ CHRONIC CHOLECYSTITIS

A

USG

35
Q

IOC FOR
STAGING GB CANCER
STAGING LIVER CANCER
STAGING BILE DUCT CA
STAGING PANCREAS CA

A

CT SCAN

36
Q

MERCEDES BENZ SIGN

A

Xray finding in RADIO-OPAQUE GB STONES
TRIRADIATE STONES
CENTER OF GALL STONE CONTAINS RADIOLUCENT GAS

37
Q

SEAGULL SIGN

A

Xray finding in RADIO-OPAQUE GB STONE
BIRADIATE GALL STONES

38
Q

TOKYO CONSENSUS GUIDELINES FOR

A

ACUTE CHOLECYSTITIS

39
Q

TOKYO 🗼 Consensus Guidelines
Grade 2 DANGEr ⚡

A

Duration of symptoms>72 hrs
Abscess(pericholecystic/hepatic)
Neutrophils and WBC>18000/MM3
Gangrenous Cholecystitis
Emphysematous Cholecystitis

40
Q

MANAGEMENT OF ACUTE CHOLECYSTITIS

A
41
Q

Rokitansky Aschoff Sinuses seen in HPE of

A

✨ Chronic Cholecystitis
✨ Adenomyomatosis- benign condition with hypertrophy of mucosal epithelium

42
Q

Chronic Cholecystitis
⭐ USG
⭐ MANAGEMENT

A

⭐ USG- WALL ECHO SHADOW (WES) SIGN

⭐ Management- Laproscopic Cholecystectomy

43
Q

Emphysematous
➡️ Cholecystitis C=C
➡️ PyElonephritis
..CDE..

A

C=clostridium
E=E coli

EC seen in D(Diabetes and immunosuppression)

44
Q

Emphysematous Cholecystitis Clinical Features

A

Pain Fever Sepsis CREPITUS
GAS IN GALL BLADDER

45
Q

Pneumobilia

🧠⚡SUPER GAS⚡

A

Air in the biliary tree
✨ SUrgery (Biliary/Enteric)
✨ Pancreatitis chronic
✨ Emphysematous Cholecystitis
✨ R-CP- ERCP
✨ GAllstone ileus
✨ Sphincterotomy/incompetent sphincter

46
Q

HeMOBilia
SandBlOOM Syndrome

A

Melena
Obstructive Jaundice
Biliary Colic

47
Q

Obstructed GB

A

⭐ MUCUS Accumalates➡️MUCOcele➡️ infection➡️Empyma

⭐ TRANSUDATE Accumalates ➡️ HYDROPS

48
Q

DIFFERENCE BETWEEN
CHOLELITHIASIS
CHOLEDOCHOLITHIASIS
ACUTE CHOLECYSTITIS
ACUTE CHOLANGITIS

A

CHOLELITHIASIS- PAIN ✔️
CHOLEDOCHOLITHIASIS- PAIN ✔️ Jaundice ✔️
ACUTE CHOLECYSTITIS- PAIN✔️PYREXIA✔️
ACUTE CHOLANGITIS- PAIN ✔️ PYREXIA ✔️ Jaundice ✔️

49
Q

IOC: Gall Stone Ileus

🧠⚡CEIl ⚡

A

CECT

50
Q

IOC FOR MIRRIZI SYNDROME

A

MRCP(Magnetic Resonance CHOLANGIOPANCREATICOGRAPHY)

51
Q

BOUVERET SYNDROME

A

Seen in Gall stone Ileus
Stone leads to Gastric Outlet obstruction
C/F: Distension
Obstipation
Pain 😢
Nausea and Vomiting 🤮

52
Q

RIGLERS TRIAD SEEN IN
POS

A

XRAY ABDOMEN IN GALLSTONE ILEUS
✨ Pneumobilia
✨ Obstructive gall stone in RT ILIAC FOSSA
✨ Small Intestinal Obstruction features- dilated bowel loops & Air-fluid levels

53
Q

Management of Gall Stone Ileus
MEC-RA

A
54
Q

SAINTS TRIAD
1st and Last Letter: SD²

A

Stones(gall stones)
Diverticulosis of Colon
Diaphragmatic Hiatal Hernia

55
Q

Limitation of USG in Biliary Tract Pathology

A

Difficulties in identifying DISTAL CBD STONES
⬇️
DISTAL PART OF CBD IS COVERED BY DUODENUM, BOWEL GAS HINDERS ITS visualization

56
Q

Use of PTC in Hepatobiliary pathology

A

Used when Endoscopic or Surgical procedures are 🚫 CONTRAINDICATION
⬇️
Both Diagnostic amd Therapeutic

57
Q

ERCP is good for detection of CBD Stones, but NOT USED?

A

Highly Invasive
⬇️
Used only for Therapeutic interventions

58
Q

Which investigation are best for detection of CBD Stones?

A

MRCP
MRI

59
Q

Absolute 🚫 CONTRAINDICATION of LAPAROSCOPIC CHOLECYSTECTOMY

A
  1. Unable to Tolerate General Anaesthesia
  2. Refractory Coagulopathy
  3. Gall Bladder Carcinoma
60
Q

Relative 🚫 CONTRAINDICATION of LAPAROSCOPIC CHOLECYSTECTOMY

A
  1. Diffuse Peritonitis
  2. Previous upper abdominal surgery with EXTENSIVE ADHESIONS
  3. Severe Cardiopulmonary Disease
  4. Morbid Obesity
  5. Pregnancy
  6. Cholangitis
  7. Cirrhosis & (OR) Portal HTN
  8. Cholecystenteric Fistula
61
Q

Prerequisites for MEDICAL therapy in CHOLELITHIASIS

A
  1. Functional GALL BLADDER
  2. Radiolucent stones
  3. Stones < 10 mm
  4. Cholesterol stones
62
Q

Which Gall stones are RESPONSIVE to MEDICAL THERAPY?

A

Cholesterol stones

⭐ Pigment stones are NOT RESPONSIVE

63
Q

Which patients can be given MEDICAL THERAPY for CHOLELITHIASIS

A
  1. Symptomatic patients without COMPLICATIONS
  2. NORMAL Gall Bladder Function ➕ Patent cystic duct
64
Q

💊💉 MANAGEMENT RECURRENT CHOLEDOCHOLITHIASIS after CHOLECYSTECTOMY

A

Long term UDCA

65
Q

Position of PATIENT in LAPAROSCOPIC CHOLECYSTECTOMY

A

Reverse TRENDELENBURG Position

Head end UP, Foot end DOWN

66
Q

Traditional LAPROSCOPIC CHOLECYSTECTOMY

A
  1. Infraumbilical Port: Camera
  2. Epigastric Port: Maryland Dissector
  3. Right HYPOCHONDRIAL: Blunt Grasper
  4. Lumber Port: Toothed Grasper
67
Q

SILS
Meaning

A

Single Incision LAPROSCOPIC Surgery
LAPROSCOPIC CHOLECYSTECTOMY via SINGLE INFRAUMBILICAL PORT

68
Q

Position of SURGEON & ASSISTANT in LAPAROSCOPIC CHOLECYSTECTOMY

A

Left Side

69
Q

⚡⚡ MOST COMMON COMPLICATION of SILS

A

Umbilical Hernia risk ⬆️

70
Q

Surgery to Perform if it is DIFFICULT to DISSECT the CALOT’S TRIANGLE

A

🎯 FUNDUS FIRST CHOLECYSTECTOMY
🎯 RETROGRADE CHOLECYSTECTOMY

71
Q

⚡⚡ MOST COMMON COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

A

Right SHOULDER TIP PAIN
(because of retained CO2)

Others:
1. Hemorrhage
2. Injury to Bile Ducts
3. Conversion to Open Surgery
4. Residual CBD Stones
5. Strictures in CBD or BILIARY TREE
6. Residual CBD Stones
7. Post CHOLECYSTECTOMY syndrome

72
Q

Frozen CALOT

A
73
Q

MOYNIHAN’S hump
(OR)
CATERPILLER Hump

A

RIGHT HEPATIC ARTERY can have a TORTUOUS COURSE & can LIE in HEPATOCYSTIC TRIANGLE
⬇️
Hemorrage Occurs During CHOLECYSTECTOMY

74
Q

Causes of Post CHOLECYSTECTOMY syndrome

A

Cholecystitis like features, even after CHOLECYSTECTOMY

⭐ Retained CBD stones
⭐ Biliary Dyskinesia
⭐ Sphincter of ODDI Dysfunction

75
Q

INCISION in OPEN CHOLECYSTECTOMY

A

Kocher INCISION
Right SUBCOSTAL Incision

76
Q

💊💉 MANAGEMENT of BILIARY INJURY identified during SURGERY

A
  1. Partial INJURY in BILE DUCT: Repair Injury using NON-ABSORBABLE SUTURES (OR) T-tube
  2. Complete TRANSECTION but NO LOSS of Segment: ANASTAMOSE over T-tube
  3. Complete TRANSECTION with LOSS of Segment: Roux en Y Hepatico-duodenostomy/Jejunostomy
77
Q

🧑🏻‍⚕️ Clinical Features: Bile leak after CHOLECYSTECTOMY

A
  1. Abdominal pain
  2. Fever
  3. ⬆️ Leucocytes
  4. Jaundice
  5. Features of Sepsis
78
Q

🩺 IOC for BILE LEAK

A

MRCP > ERCP

QBANK: ERCP is BEST in POST-CHOLECYSTECTOMY BILE LEAKS
⬇️
BECAUSE BOTH DIAGNOSTIC & THERAPEUTIC

79
Q

💊💉 MANAGEMENT BILE LEAK patient PRESENTS within 2 DAYS of CHOLECYSTECTOMY

A

Re-Explore & REPAIR

80
Q

💊💉 MANAGEMENT BILE LEAK patient PRESENTS after 2 DAYS of CHOLECYSTECTOMY

A

USG guided PIGTAIL CATHETER to Drain Collection (BILIOMA)
⬇️
ERCP ➕ STENT Placement

81
Q

⚡⚡ MOST COMMON BILE DUCT INJURY

A

Type A STRASBERG
⬇️
Cystic Duct Leaks from SMALL DUCTS in Liver Bed

82
Q

Type C STRASBERG

A

Leak from an ABBERENT RIGHT HEPATIC DUCT

83
Q

Risk Factors for GALL BLADDER Cancer

🧠⚡S²P²AM ⚡

A
  1. Stones (GB Stones)
  2. Salmonella typhi carriers
  3. Porcelain Gall Bladder
  4. Polyps GB
  5. APBDJ (Abnormal pancreatico-biliary duct junction)
  6. Metal Contamination
  7. Choledochal cyst
  8. Cholecysto-enteric fistula (Gall Stone ileus)
  9. Estrogen
  10. Ulcerative colitis
84
Q

APBDJ ⬆️ ⬆️ the RISK of

A
  1. Gall Bladder Cancer
  2. Cholangiocarcinoma
85
Q

APBDJ ⬆️ ⬆️ the RISK of

A
  1. Gall Bladder Cancer
  2. Cholangiocarcinoma
86
Q

Why GANGETIC BED is ENDEMIC for GB Cancer?

A

Heavy Metal Contamination of Water

87
Q

Types of GB Polyps

A
  1. Cholesterol Polyps
  2. Adenomatous Polyps
88
Q

Identify

A

CHOLESTROL POLYPS of GALL BLADDER
-Small
-Multiple
-Pedunculated

89
Q
A

CHOLESTROL POLYPS of GALL BLADDER

90
Q

Identify

A

ADENOMATOUS POLYPS of GALL BLADDER
✨ Single
✨ Large
✨ Sessile
✨ Risk of GB CANCER

91
Q

Which GB POLYP ⬆️ Risk of GB CANCER?

A

Adenomatous POLYPS of GALL BLADDER

92
Q

🌸 TYPES of GB CANCER

A

Adenocarcinoma

✨ INFILTRATING
✨ NODULAR
✨ PAPILLARY

93
Q

🎯 WORST PROGNOSIS GB CANCER

🎯 BEST PROGNOSIS GB CANCER

A

🎯 WORST PROGNOSIS GB CANCER
✨ INFILTRATING

🎯 BEST PROGNOSIS GB CANCER
✨ PAPILLARY

94
Q

🧑🏻‍⚕️ Clinical Features of GB CANCER

A
  1. Abdominal Lump
  2. JAUNDICE : VERY LATE
  3. Pain
  4. Anorexia & Weight Loss

⭐ PYRIFORM SHAPE OF GB is NOT RETAINED

95
Q

⭐ JAUNDICE is VERY LATE FEATURE IN

⭐ JAUNDICE is EARLY FEATURE IN

A

⭐ JAUNDICE is VERY LATE FEATURE IN
🎯 GB CANCER

⭐ JAUNDICE is EARLY FEATURE IN
🎯 PERIAMPULLARY CANCER

96
Q

1st LYMPH NODE to be affected in GB CANCER

A

Lymph Node of LUND

97
Q

⚡⚡ MOST COMMON SITE OF DISTANT METASTASIS in GB CANCER

A

LIVER

98
Q

🩺 IOC for DIAGNOSIS AND STAGING OF GB CANCER

A

CECT

99
Q

T-STAGING: GB CANCER

🧠⚡T2 is MUSCULARIS PROPRIA in MOST GIT Cancer, except GB Cancer ⚡
🧠⚡Submucosa is ABSENT in GB ⚡

A
100
Q

N-staging: GB Cancer
🧠⚡Smallest Organ in abdomen: Only 2 subdivisions ⚡

A
101
Q

M staging of GB CANCER

A

M0
M1

102
Q

💊💉 MANAGEMENT of GB CANCER

A
103
Q

💊💉 MANAGEMENT GB Cancer T3 without NODAL or Peritoneal involvement

A
  1. Extended Right Hepatectomy
  2. Caudate Lobectomy
  3. Lymphadenectomy
104
Q

💊💉 MANAGEMENT of T4 GB Cancer

A

Palliative Management

  1. Jaundice ➡️ Endoscopic Biliary Stenting
  2. Pain ➡️
    a. Analgesics
    b. Percutaneous Necrolysis of celiac ganglion
  3. Intestinal Obstruction
    ✨ Endoscopic Duodenal Wall Stent
105
Q

Strawberry Gall Bladder

A

Cholestrolosis

106
Q

ASSOCIATIONS of EHBA

A
  1. Situs inversus
  2. Preduodenal Portal Vein
  3. Cardiac defects
  4. Polysplenia
  5. Absent IVC
107
Q

🩺 IOC for EHBA

A

HIDA Scan

108
Q

GOLD STANDARD INVESTIGATION FOR EHBA

A

Intraoperative Cholangiogram

109
Q

🧑🏻‍⚕️ Clinical Features of EHBA

A

Inflammatory Fibrosis of Biliary tree
⬇️
Atresia
⬇️
Cirrhosis

  1. Jaundice at BIRTH
  2. PRURITIS
  3. PALE STOOLS
  4. LIVER FAILURE FEATURES
110
Q

TRIAGULAR CORD SIGN seen in

A

USG of INTRAHEPATIC BILE ATRESIA

111
Q

Types of EHBA

A
112
Q

💊💉 MANAGEMENT of TYPE I EHBA

A

Roux en Y Hepaticojejunostomy

113
Q

Identify the Procedure

A

Roux en Y Hepaticojejunostomy

114
Q

💊💉 MANAGEMENT of TYPE 2 and 3 EHBA

A

Kasai’s procedure

Intestine is connected DIRECTLY to the LIVER

115
Q

Identify

A

KASAI’s procedure
PORTO-ENTEROSTOMY

116
Q

⚡⚡ MOST COMMON CAUSE of LIVER TRANSPLANT in CHILDREN

A

EHBA

117
Q

⭐ TODANI CLASSIFICATION used for

⭐ MODIFIED ALONSO-LEJ CLASSIFICATION used for

A

CHOLEDOCHAL CYST

118
Q

⭐ TODANI CLASSIFICATION

🧠⚡ 123 EDC ⚡
🧠⚡A for “And or Additional”andB for “Bunch” ⚡

A

Type I:Entire CBD dilated

Type II:Diverticulum

Type III:Choledochocele (Intraduodenal portion of CBD)

Type IV: Extrahepatic + Intrahepatic

Type IVa: Both intrahepatic AND extrahepatic cysts

Type IVb: Multiple extrahepatic cysts only

Type V: Intrahepatic cysts only (Caroli’s disease)

Type VI: Dilatation of CYSTIC DUCT

119
Q

Choledochocele

A

Dilatation of INTRADUODENAL Part of CBD

120
Q

CAROLI’S disease

A

Intrahepatic cysts only

121
Q

🩺 IOC of CHOLEDOCHAL CYST

A

MRCP

122
Q

🧑🏻‍⚕️ Clinical Features of CHOLEDOCHAL CYST

A
  1. Lump
  2. Jaundice
  3. Pain
123
Q

CHOLEDOCHAL CYST ⬆️ ⬆️ the RISK of

A

✨ CHOLANGIOCARCINOMA
✨ JAUNDICE (Ineffective drainage of Bile)

124
Q

💊💉 MANAGEMENT of CHOLEDOCHAL CYST
🧠⚡Liver Transplant if INTRAHEPATIC Dilatation⚡

A

Type 1: Roux-en-Y Hepaticojejunostomy
Type2: Roux-en-Y Hepaticojejunostomy
(OR) Cut DIVERTICULUM ➕ Repair CBD
Type 3: ERCP ➕ Sphincterotomy
Type 4a: LIVER TRANSPLANT
Type 4b: KASAI Procedure
Type 5: LIVER TRANSPLANT

125
Q

CHOLANGIOCARCINOMA: ASSOCIATIONS
🧠⚡ 8Cs⚡

A

C-Caroli’s disease
C-Choledochal cyst
C-Colitis (ulcerative colitis)
C-Cholangitis (sclerosing)
C-Clonorchis sinensis
C-Congenital Hepatic Fibrosis
C-C/c typhoid carrier state
C-Carcinogens like rubber,automotive factories

126
Q

⚒️ RISK FACTOR for CHOLANGIOCARCINOMA

A
  1. Obesity
  2. DM
  3. HBV & HCV
  4. CHOLEDOCHAL CYST
  5. APBDJ
  6. THOROTRAST
  7. 1° SCLEROZING CHOLANGITIS
127
Q

Autoimmune condition MORE COMMON in MEN

A

1° SCLEROZING CHOLANGITIS

128
Q

Antibodies in 1° SCLEROZING CHOLANGITIS

A
  1. Anti-Smooth Muscle
  2. Anti-Nuclear ANTIBODY
129
Q

ASSOCIATION of 1° SCLEROZING CHOLANGITIS

A
  1. IBD
  2. HLA B8 & DR3
  3. Riedel’s thyroiditis
  4. Retroperitoneal Fibrosis
130
Q

MRCP Appearance of 1° SCLEROZING CHOLANGITIS

A

Beaded Appearance

131
Q

Extra-INTESTINAL Manifestations of IBD that DO NOT RESOLVE AFTER COLECTOMY

A
  1. 1° SCLEROZING CHOLANGITIS
  2. Ankylosing Spondylitis
132
Q

COURVOISIER’S LAW

A
133
Q

🩺 IOC of 1° SCLEROZING CHOLANGITIS

A

MRCP

134
Q

⭐ BISMUTH-CORLETTE CLASSIFICATION used for

⭐ BISMUTH CLASSIFICATION used for

A

⭐ BISMUTH-CORLETTE CLASSIFICATION used for
🎯 Perihilar Tumour (CHOLANGIOCARCINOMA)

⭐ BISMUTH CLASSIFICATION used for
🎯 BILE DUCT INJURY

135
Q

⭐ BISMUTH-CORLETTE CLASSIFICATION

A
136
Q

💊💉 MANAGEMENT of RESECTABLE CHOLANGIOCARCINOMA

A

✨ Tumour @ DISTAL CBD: Whipple’s procedure

✨ Tumour @ SUPRADUODENAL CBD: Hepatico-jejunostomy

✨ Tumour @ HIGH-UP CBD: KASAI’S Procedure

⬇️
⬇️
CHEMOTHERAPY
GEMCITABINE-Based

137
Q

💊💉 MANAGEMENT of UNRESECTABLE CHOLANGIOCARCINOMA

A

Palliative MANAGEMENT
-Manage Jaundice
✨ ERCP & STENTING
✨ PTBD

-CHEMO
Gemcitabine

138
Q

Marker used for PROGRESSION of CHOLANGIOCARCINOMA

A

Serum CA 19-9

139
Q

⚡⚡ MOST COMMON SITE OF DISTANT METASTASIS IN CHOLANGIOCARCINOMA

A

Liver

140
Q

Cause of HEMOBILIA

A

Arterial Bleeding

✨ Trauma
✨ Iatrogenic
🎯 Post ERCP
🎯 Post PTBD
✨ Bloom Syndrome

141
Q

Quincke’s TRIAD seen in
🧠⚡JUP Quickly!! ⚡

A
  1. Jaundice
  2. Upper GI hemorrhage MELENA
  3. Pain
142
Q

🩺 IOC of HEMOBILIA

A

CT Angiography

143
Q

💊💉 MANAGEMENT of HEMOBILIA

A

Self Resolving
⬇️
⬇️
Trans-Arterial Embolization

144
Q

BILHEMIA

A

Fistula BETWEEN Vein & Biliary Tree
⬇️
Bile leaking into Blood Stream

145
Q

🩺 IOC for BILHEMIA

A

CT Angiography

146
Q

💊💉 MANAGEMENT of BILHEMIA

A

ERCP & Stent the FISTULA or EMBOLIZATION

147
Q

ABERNETHY MALFORMATIONS

A

Congenital Portosystemic shunts

148
Q

🩺 IOC of ABERNETHY MALFORMATIONS

A

CT ANGIOGRAPHY

149
Q

💊💉 MANAGEMENT of TYPE 1 ABERNETHY MALFORMATIONS

💊💉 MANAGEMENT of TYPE 2 ABERNETHY MALFORMATIONS

A

💊💉 MANAGEMENT of TYPE 1 ABERNETHY MALFORMATIONS
🎯 TRANSPLANT

💊💉 MANAGEMENT of TYPE 2 ABERNETHY MALFORMATIONS
🎯 EMBOLIZATION

150
Q

⚡⚡ MOST COMMON SITE OF STRICTURE FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

⚡⚡ MOST COMMON SITE OF STRICTURE FOLLOWING OPEN CHOLECYSTECTOMY

A

⚡⚡ MOST COMMON SITE OF STRICTURE FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
🎯 COMMON HEPATIC DUCT

⚡⚡ MOST COMMON SITE OF STRICTURE FOLLOWING OPEN CHOLECYSTECTOMY
🎯 COMMON BILE DUCT (CBD)

151
Q

💊💉 MANAGEMENT of BILHEMIA

A

ERCP & STENT the FISTULA (OR) EMBOLIZATION

152
Q

⚡⚡ MOST COMMON BILE LEAK AFTER CHOLECYSTECTOMY IS FROM

A

Cystic Duct
💊💉 MANAGEMENT
Biliary Ensoprosthesis (STENT)

153
Q

Types of Gall Stones

A

✨ Pigment
🎯 Brown
🎯 Black

✨ Cholesterol
✨ Mixed

154
Q

⚡⚡ MOST COMMON Gall Stone Overall

⚡⚡ MOST COMMON Gall Stone in ASIA

A

⚡⚡ MOST COMMON Gall Stone Overall
🎯 Mixed

⚡⚡ MOST COMMON Gall Stone in ASIA
🎯 Pigment stones

155
Q

⚒️ RISK FACTOR for GALL STONE FORMATION

A
  1. Lithogenic Bile
  2. Stasis
  3. Nucleation
156
Q

Lithogenic Bile
⬆️ Cholesterol & ⬇️ Bile acids & ⬇️ Lecithin
🧠⚡OCC, ⬇️ Bile Acids: BOCE ⚡

A

⬆️ Cholesterol
🎯 Obesity
🎯 Cholesterol Rich Diet
🎯 Clofibrate therapy

⬇️ Bile acids
🎯 1° Biliary Cirrhosis
🎯 OCPs
🎯 CYP7A1 gene mutation
🎯 Enterohepatic circulation impaired
✨ Ileal disease
✨ Ileal resection
✨ Cholestyramine
✨ Colestipol

⬇️ Lecithin
🎯 MDR3 gene mutation

157
Q

✨ Normal Bile Acids to Cholesterol ratio in Bile

✨ Ratio below which Gall Stones are precipitated

A

✨ Normal Bile Acids to Cholesterol ratio in Bile
🎯 25:1

✨ Ratio below which Gall Stones are precipitated
🎯 13:1

158
Q

Nucleation Factors for GALL STONEA

A
  1. Mucin
  2. Non Mucin Glycoprotein
  3. Infection
    ✨ Clonorchis
    ✨ Cholangitis
    ✨ Ascariasis
159
Q

Anti-nucleation Factors for Gall Stones

A

Apolipoprotein A1
Apolipoprotein A2

160
Q

Causes of GALL BLADDER HYPOMOTILITY

A
  1. TPN (prolonged)
  2. Octreotide
  3. OCPs
  4. Pregnancy
  5. Post Vagotomy
  6. Fasting (prolonged)
  7. Burns (massive)
161
Q

Why USG is 🩺 IOC for GB STONE

A
  1. Superficial location of Gall Bladder
  2. Absence of overlying Bowel Gas
162
Q

USG for GB Stones is NOT USEFUL in

A
  1. Excess Body Fat
  2. Intraluminal Bowel Gas
  3. Operator dependent
163
Q

Post Acoustic Shadow is seen with which Stones

A

GB Stone
Kidney Stone

164
Q

USG Findings of GB STONE

A
  1. Post Acoustic Shadow
  2. GB wall thickening
  3. Pericholecystic Fluid ➕
165
Q

Surgical Intervention in ASYMPTOMATIC GB STONE is done in
🧠⚡S²P²M: BED C²⚡

A
  1. Salmonella carrier
  2. Stone ≥ 3cm
  3. Porcelain GB with stone (Calcification of wall of Gall Bladder)
  4. Polyp with stone
  5. Multiple small stone
  6. Bariatric Surgery
  7. Endemic zone of GB cancer
  8. DM
  9. Choledochal cyst
  10. Choledocholithiasis
  11. Transplant or Immunosuppression therapy
166
Q

Abdominal X-Ray is useful in which biliary pathologies

A
  1. Calcified Gall Stones
  2. Emphysematous Cholecystitis
  3. Porcelein GB
  4. Limey Bile
  5. Gall Stone ileus
167
Q

Use of HIDA / DIDA / DISDA

A

✨ Confirmation of Suspected Acute Cholecystitis

✨ Acalculous Cholecystopathy

168
Q

HIDA scan

A

Hepatobiliary Imino Diacetic Acid Scan

169
Q

DIDA / DISDA Scan

A

Di-isopropyl Imino Diacetic Acid Scan
Dynamic Tc99m DIDA Cholescintigraphy

170
Q

LIMEY Gall Bladder

A

Opacified GALL BLADDER

✨ Toothpaste lile substance is filled within the gall bladder containing Calcium Phosphate & Calcium Carbonate

171
Q

Congenital Anomalies of the Gall Bladder

A
  1. Absence of Gall Bladder
  2. Phrygian Cap
  3. Double (OR) Triple Gall Bladder
  4. Mobile (OR) Floating (OR) Mesenteric Gall Bladder
  5. Long Cystic Duct with Low Insertion of Cystic Duct into CBD
  6. Absent CYSTIC DUCT
  7. Accessory Cholecystohepatic duct (Duct of Luschka)
  8. Cystic artery originates from Hepatic artery
  9. Tortuous Right Hepatic Duct ➡️ Moynihan’s HUMP
  10. Double CYSTIC Duct
172
Q

Causes of OBSTRUCTIVE JAUNDICE (OR) Surgical JAUNDICE

A
  1. Congenital
    ✨ EHBA
    ✨ CHOLEDOCHAL Cyst
  2. Inflammatory
    ✨ Ascending Cholangitis
    ✨ Sclerosing Cholangitis
  3. Infective
    ✨ Ascariasis
    ✨ Clonorchis
  4. Obstructive
    ✨ CBD STONE
    ✨ Structures in CBD
  5. NEOPLASTIC
    ✨ Periampullary cancer
    ✨ Ca Head of Pancreas
    ✨ Cholangiocarcinoma
    ✨ Klatskin tumour
  6. Extrinsic compression by Lymph nodes
173
Q

Causes of Cholangitis

A
  1. Choledocholithiasis
  2. Biliary stricture
  3. Neoplasm
  4. Post ERCP
  5. Others
    ✨ Pseudocyst of pancreas
    ✨ chronic Pancreatitis
    ✨ Biliary Parasitic Infection
174
Q

Uses of ERCP

A
  1. Gold standard for CBD Stone Removal
  2. Stenting for inoperable Tumours
  3. ENDOSCOPIC basketting & stone retrieval
  4. Biopsy
  5. Preoperative Bile Drainage
  6. Sphincter of Oddi Dysfunction