Gall bladder.3. Calcular obstructive jaundice

Question 1

STONES IN THE BILE DUCTS

Answer 1

1. Alternative name
2. ORIGIN
3. SEQUELAE

Question 2

Alternative name for STONES IN THE BILE DUCTS

Answer 2

Choledocholithiasis

Question 3

ORIGIN of STONES IN THE BILE DUCTS

Answer 3

(1) Gall bladder: (Commonest)

2) Primary duct stones: (Not common

Question 4

Gall bladder in ORIGIN of STONES IN THE BILE DUCTS

Answer 4

1. Incidence

2. Pathogenesis

Question 5

Incidence of Gall bladder in ORIGIN of STONES IN THE BILE DUCTS

Answer 5

Commonest

Question 6

Pathogenesis of Gall bladder in ORIGIN of STONES IN THE BILE DUCTS

Answer 6

CBD stones are migrating from G.B.

Question 7

Primary duct stones in ORIGIN of STONES IN THE BILE DUCTS

Answer 7

1. Incidence

2. Pathogenesis

Question 8

Incidence of Primary duct stones in ORIGIN of STONES IN THE BILE DUCTS

Answer 8

Not common

Question 9

Pathogenesis of Primary duct stones in ORIGIN of STONES IN THE BILE DUCTS

Answer 9

2ry to infestation of the biliary tree by Ascaris & Clonorchis sinensis.

Question 10

SEQUELAE of STONES IN THE BILE DUCTS

Answer 10

1. No effect : A small stone in the CBD without obstruction.
2. Passed stone.
3. Calcular obstructive jaundice.

Question 11

Pathogenesis of Passed stone in SEQUELAE of STONES IN THE BILE DUCTS

Answer 11

Passed to the duodenum

Question 12

Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 12

1. CLINICAL PICTURE
2. SEQUELAE & COMPLICATIONS
3. DIFFERENTIAL DIAGNOSIS
4. INVESTIGATIONS
5. TREATMENT

Question 13

CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 13

1. Symptoms

2. Examination

Question 14

Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 14

1. The patient gives history of CCC with pain & fatty dyspepsia.
2. Jaundice
3. Charcot’s triad
4. Reynold’s pentad

Question 15

Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 15

1. Course
2. Degree
3. Associations
4. Note on the relation between size of stone and jaundice

Question 16

Course of Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 16

1. usually Painful
2. Slowly progressive
3. Fluctuating

Question 17

Degree of Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 17

usually does not reach a severe degree

Question 18

Associations of Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 18

Associated with dark frothy urine & pale stools

Question 19

The reason why urine is dark in Associations of Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 19

due to presence of direct bilirubin in urine

Question 20

The reason why urine is frothy in Associations of Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 20

due to presence of bile salts in urine

Question 21

Note on the relation between size of stone and jaundice in Jaundice in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 21

1. There is no relation between the size of the stone and the development of jaundice
2. A tiny stone impacted in the ampulla may cause jaundice, while large stone in a dilated CBD may not cause obstruction

Question 22

Charcot’s triad in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 22

1. List of symptoms

2. Pathogenesis

Question 23

List of symptoms of Charcot’s triad in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 23

Recurrent attacks of :

• Pain.
• Jaundice.
• Fever and rigors.

Question 24

Pathogenesis of pain in List of symptoms of Charcot’s triad in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 24

Right answer: As the patient already having CCC or due to cholangitis

Wrong answer (department) due to biliary colic

Question 25

Pathogenesis of Charcot's triad in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 25

Due to superadded cholangitis

Question 26

Reynold's pentad in Symptoms in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 26

1. Charcot's triad 2. Septic shock. 3. Altered mental status.

Question 27

Examination in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 27

1. Jaundice in not severe. 2. +ve Murphy's sign. 3. The gallbladder is not palpable

Question 28

The reason why the gallbladder is not palpable in Examination in CLINICAL PICTURE of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 28

1. Since it is fibrosed & shrunken | 2. Due to long standing CCC "Courvoisier's Law".

Question 29

SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 29

A. Effects on the liver B. Effects on the coagulation factors C. Hepato-renal failure

Question 30

Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 30

1. Hydro-hepatosis 2. Ascending cholangitis 3. White bile 4. 2ry biliary cirrhosis in long standing cases.

Question 31

Definition of Hydro-hepatosis in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 31

Dilatation of intrahepatic biliary radicles

Question 32

Ascending cholangitis in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 32

1. Alternative name | 2. Pathogenesis

Question 33

Alternative name for Ascending cholangitis in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 33

Cholangio-hepatitis

Question 34

Pathogenesis of Ascending cholangitis in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 34

due to 2ry infection.

Question 35

White bile in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 35

1. Pathogenesis | 2. Significance

Question 36

Pathogenesis of White bile in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 36

In severe cases liver cells stop to secrete bile while bile ducts will continue to secrete pale yellow mucous (white bile).

Question 37

Significance of White bile in Effects on the liver in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 37

indicates severe liver damage.

Question 38

Effects on the coagulation factors in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 38

Bile salts fail to reach the intestine )> failure of absorption of fat soluble vitamins especially Vit K )> Hypoprothrombinemia

Question 39

Hepato-renal failure in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 39

1. Alternative name | 2. Pathogenesis

Question 40

Alternative name for Hepato-renal failure in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 40

Renal shut down

Question 41

Pathogenesis of Hepato-renal failure in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 41

1. Absence of bile salts in the intestine leads to bacterial overgrowth )> bacterial transclocation which may fail to be filtered by hepatic "Kupffer cells". 2. This gram -ve endotoxemia causes renal cortical necrosis & acute renal failure.

Question 42

Pathogenesis of renal cortical necrosis & acute renal failure in Pathogenesis of Hepato-renal failure in SEQUELAE & COMPLICATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 42

Shift of blood from cortex to medulla

Question 43

DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 43

Malignant obstructive jaundice

Question 44

Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 44

1. Age and gender 2. Pain 3. Course of jaundice 4. Degree of jaundice 5. Palpation of gall bladder 6. Murphy's sign

Question 45

Age and gender of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 45

Middle age females

Question 46

Age and gender of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 46

Old age males

Question 47

Pain of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 47

Painful

Question 48

Pain of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 48

Usually painless

Question 49

Course of jaundice of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 49

Intermittent

Question 50

Course of jaundice of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 50

Progressive except in periampullary carcinoma

Question 51

Degree of jaundice of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 51

Light Yellow

Question 52

Degree of jaundice of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 52

Deep yellow

Question 53

Palpation of gall bladder of Calcular obstructive in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTSjaundice

Answer 53

Gallbladder not palpable

Question 54

Palpation of gall bladder of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 54

Palpable gallbladder

Question 55

Murphy's sign of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 55

+ve Murphy's sign

Question 56

Murphy's sign of Malignant obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 56

-ve Murphy's sign

Question 57

The reason why jaundice is intermittent in Course of jaundice of Calcular obstructive jaundice in Difference between Calcular obstructive jaundice and Malignant obstructive jaundice in DIFFERENTIAL DIAGNOSIS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 57

Due to remission and exacerbation of attacks of inflammation around the stone obstructing the CBD )> fluctuation of dilatation and constriction of the passage )> fluctuation of serum total bilirubin and bile salts )> intermittent jaundice

Question 58

INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 58

A. Laboratory B. Radiological

Question 59

Laboratory investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 59

1) Liver function tests 2) Kidney function tests: * Serum creatinine, BUN & K 3) CBC : 4) Prothrombin time.

Question 60

Liver function tests in Laboratory investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 60

1. Elevated total, direct bilirubin, ALP & Gamma GT. | 2. ALT & AST are high only if there is cholangitis.

Question 61

Finidings of CBC in Laboratory investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 61

1. Normal TLC | 2. Leucocytosis

Question 62

Significance of Leucocytosis in Finidings of CBC in Laboratory investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 62

Leucocytosis means cholangitis.

Question 63

Cholangitis is diagnosed by

Answer 63

LFT: show high ALT & AST CBC: show Ieucocytosis

Question 64

Radiological investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 64

1) Abdominal U.S : the most appropriate investigation | 2) ERCP : Diagnostic & therapeutic.

Question 65

Abdominal U.S in Radiological investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 65

1. Significance | 2. Advantages

Question 66

Significance of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 66

The most appropriate investigation of Calcular obstructive jaundice

Question 67

Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 67

1. It reveals dilated CBD & dilated IHBR 2. It reveals gall stones. 3. Differentiate between obstructive and cholestatic jaundice (swollen hepatocytes)

Question 68

TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 68

A. Initial management B. Definitive management

Question 69

Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 69

1. Hospitalization. 2. Liver support 3. Vit K administration 4. Antibiotics 5. Prevention of renal failure

Question 70

Liver support in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 70

high glucose intake in the form of Glucose 10% I.V

Question 71

Vit K administration in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 71

1. Route | 2. Benefits

Question 72

Route of Vit K administration in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 72

Via drip

Question 73

Benefits of Vit K administration in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 73

To correct the coagulation abnormalities

Question 74

Antibiotics in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 74

1. List | 2. Benefits

Question 75

List of Antibiotics in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 75

3rd generation cephalosporins

Question 76

Benefits of Antibiotics in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 76

To prevent cholangitis.

Question 77

Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 77

A. General measures B. Specific measures

Question 78

General measures in Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 78

a. Mannitol I.V (osmotic diuretic). | b. Adequate hydration by I.V. fluids.

Question 79

Specific measures in Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 79

1. List | 2. Benefits

Question 80

List of Specific measures in Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 80

Oral bile salts

Question 81

Oral bile salts in List of Specific measures in Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 81

Ursofalk 200mg | ursodeoxycholic acid

Question 82

Benefits of Specific measures in Prevention of renal failure in Initial management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 82

To diminish liability of endotoxaemia.

Question 83

Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 83

a) ERCP b) Open cholecystectomy c) Missed CBD stones

Question 84

ERCP in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 84

1. Success rate | 2. Principle

Question 85

Success rate of ERCP in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 85

90%

Question 86

Principle of ERCP in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 86

1. Sphincterotomy 2. Stone extraction by dormia basket or balloon catheter 3. Followed by laparoscopic cholecystectomy 3 months later

Question 87

The reason why laparoscopic cholecystectomy is done 3 months later in Principle of ERCP in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 87

So that all lab investigations become normal

Question 88

Oral question : Can we do laparoscopic cholecystectomy now instead of the wait for 3 months ?

Answer 88

Yes in cases of normal or mild elevation of lab investigations

Question 89

Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 89

1. Indication | 2. Principle

Question 90

Indication of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 90

when ERCP fails to remove the stone.

Question 91

Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 91

1. CBD exploration and Choledocholithotomy | 2. Ways of closure of the CBD after choledocholithotomy

Question 92

Principle of CBD exploration and Choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 92

1. The supradudenal part of CBD is exposed, opened between 2 stay suture 2. Calculi are extracted by stone forceps 3. Confirming absence of stenosis or missed stones

Question 93

Confirming absence of stenosis or missed stones in Principle of CBD exploration and Choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 93

1. Bake's dilator is passed in the CBD to the ampulla 2. Flushing the duct with saline 3. Intra-operative cholangiography 4. Choledocoscope

Question 94

Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 94

a. Choledocho-duodenostomy b. Closure of the CBD over a T-tube c. Trans-dudenal sphincteroplasty

Question 95

Indications of Choledocho-duodenostomy in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 95

1. CBD diameter > 1.5 cm. 2. Presence of intrahepatic stones. 3. Impacted stone in lower end CBD.

Question 96

Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 96

1. Indication | 2. Post operative Care of T-tube

Question 97

Indication of Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 97

CBD diameter

Question 98

Post operative Care of T-tube in Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 98

1. The T-tube is connected to a receptacle (urinary bag). 2. It is left in place for 10-14 days & before its removal 3. Confirming absence of missed stones before removal 4. The small opening in the CBD after removal of T - tube closes spontaneously within a week provided there is no distal obstruction.

Question 99

The reason why it is left in place for 10-14 days & before its removal in Post operative Care of T-tube in Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 99

To allow Formation of fibrous tissue around the tube )> fibrous track

Question 100

Confirming absence of missed stones before removal in Post operative Care of T-tube in Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 100

1. Clamping of The T-tube as a test for 48 hours | 2. T-tube cholangiography

Question 101

Clamping of The T-tube as a test for 48 hours in Confirming absence of missed stones before removal in Post operative Care of T-tube in Closure of the CBD over a T-tube in Ways of closure of the CBD after choledocholithotomy in Principle of Open cholecystectomy in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 101

There must be a. No abdominal pain. b. No fever. c. No jaundice. d. No escape of bile around the tube. e. Normal faecal coloration means that bile is reaching the gut.

Question 102

Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 102

1. Incidence | 2. Management

Question 103

Incidence of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 103

2%

Question 104

Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 104

A. Patient with T - tube B. Patient without T - tube

Question 105

Management of Patient with T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 105

one of the Followings 1. Flushing with saline. 2. Dissolution of stones 3. Percutaneous extraction 4. ERCP, sphincterotomy & stone extraction (Best).

Question 106

Dissolution of stones in Management of Patient with T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 106

1. Chenodeoxycholic acid. 2. Heparin. 3. MTBE.

Question 107

Percutaneous extraction in Management of Patient with T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 107

1. The T-tube is removed 4-6 weeks after surgery instead of 10-14 days 2. The stone is removed using dormia basket through its fibrous track

Question 108

The reason why The T-tube is removed 4-6 weeks after surgery instead of 10-14 days in Percutaneous extraction in Management of Patient with T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 108

To form more fibrous tissue )> strong fibrous track

Question 109

Best management in Management of Patient with T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 109

ERCP, sphincterotomy & stone extraction

Question 110

Management of Patient without T - tube in Management of Missed CBD stones in Definitive management in TREATMENT of Calcular obstructive jaundice in SEQUELAE of STONES IN THE BILE DUCTS

Answer 110

ERCP & sphincterotomy