Gallbladder pancreas

Question 1

Nerve supply of gallbladder

Answer 1

T8 and T9 (epigastric)

Vagus and sympa

Question 2

How much bile formed per day

Answer 2

500-1000 ml

Question 3

CCK action to gallbladder and sphincter of oddi?

Answer 3

GB Contraction

Sphincter of Oddi relaxation

Question 4

Diagnostic studies for proximal and distal biliary ducts respectively:

Answer 4

Proximal bile duct: PTC (percutaneous transhepatic cholangiography)

Distal bile duct: ERCP

Question 5

Sonographic signs of acute cholecystitis:

Answer 5

Gallbladder thickening
Pericholecystic fluid
Sonographic murphy’s

Question 6

Most common type of gallstone

Answer 6

Cholesterol type

Question 7

Gallstone type: SINGLE, large smooth

Answer 7

Pure cholesterol

Question 8

Gallstone type: MULTIPLE, multifaceted “mulberry shaped”

Answer 8

Mixed type (>70% cholesterol)

Question 9

Gallstone type: small brittle spiculated, calcium bilirubinate, carbonate and phosphate
Due to HEMOLYSIS and CIRRHOSIS

Answer 9

Black pigment stones

Question 10

Gallstone type: soft and mushy, only stone that can arise from the bile ducts
Due to BACTERIAL INFXN or BILE STASIS

Answer 10

Brown pigment stones

Question 11

Characterized by recurrent biliary colic and due to partial obstruction of the cystic duct

Answer 11

Chronic cholecystitis

Question 12

Initiating event of acute checystitis

Answer 12

Obstruction of cystic duct

Question 13

Cystic artery is a branch of

Answer 13

Right hepatic artery

Question 14

Most specific test for gallstone

Answer 14

HIDA scan

Question 15

Gold standard diagnostic test for chiledocholithiasis

Answer 15

ERCP

Question 16

Two combination for cholangitis to occur

Answer 16

Bacterial contamination (gram negative aerobes)
Obstruction

Question 17

What is charcot’s triad?

Answer 17

Fever
Pain
Jaundice

Question 18

Reynold’s pentad

Answer 18

Fever
Pain
Jaundice
Disorientation
Septoc shock

Question 19

Most common form of choledochal cyst

Answer 19

Fusiform

Question 20

Triad of choledochal cyst

Answer 20

Abdominal pain
Jaundice
Mass

Question 21

Choledochal cyst in intrahepatic ducts

Answer 21

CAROLI’s disease

Tx: liver transplant

Question 22

May develop to form cholangiocarcinoma

Most common in men

Answer 22

Primary Sclerosing Cholangitis

Question 23

2 liver disease that requires liver transplantation

Answer 23

Primary sclerosing cholangitis

CAROLI’s disease

Question 24

Treatment of gallbladder CA with extension to perimuscular connective tissue (T2)

Answer 24

Extended cholecystectomy
Liver resection (4a and 5)

Question 25

Treatment of gallbladder CA with extension beyond serosa

Answer 25

``` Extended right hepatectomy Liver resection (4 to 8) ```

Question 26

Most common presentation of bile duct carcinoma

Answer 26

Painless jaudice

Question 27

Tumor marker for bile duct carcinoma

Answer 27

CA 19-9 CA 125 CEA

Question 28

Most common congenital anomaly | Functional obstruction of duct of santorini

Answer 28

Pancreas Divisum

Question 29

2nd part if duodenum surrounded by a rim of pancreatic tissue May cause proximal small intestinal obstruction

Answer 29

Annular pancreas

Question 30

Flank ecchymosis

Answer 30

Grey turner's sign

Question 31

Periumbilical ecchymosis

Answer 31

Cullen's sign

Question 32

Ranson's prognostic signs | At admission

Answer 32

``` Age >55 years old Wbc count FBS LDH SGOT ```

Question 33

Ranson's prognostic signs | Initial 48 hours

Answer 33

``` Hct Elevated BUN serum Ca PO2 Base deficit Fluid deficit ```