Hepatobiliary

Question 1

Acute cholecystitis needs what

Answer 1

Acute cholecystectomy
Within 72hrs, if delayed then after giving antibiotics

Question 2

Normal bile duct calibre

Answer 2

4cm

Question 3

Bile draining post cholesystectomy

Answer 3

Do ERCP and stenting or sphincterotomy if needed

Question 4

What to do if bile duct got injured

Answer 4

Reconstruction by hepatobiliary surgeon

Question 5

Pancreatic cancer with liver metastasis

Answer 5

Palliative chemo

Question 6

Post ERCP still jaundice and new generalized abdominal pain

Answer 6

Do CT
To exclude ampulla trauma
Duodenal perforation
Pancreatitis

Question 7

Why ERCP is technically challenging

Answer 7

Side view endoscope

Question 8

Confirm pancreatic necrosis

Answer 8

FNAC for culture but it has risk of seeding infection so careful
Do before necrosectomy

Question 9

Diagnostic and planning work up for gall stone

Answer 9

USG
Diameter of CBD
Liver function test

Question 10

Difficult to dissect Calot’s triangle due to dense adhesion for exceeding timeline of 72hrs period of acute cholecystitis

Answer 10

Do operative cholecystoSTOMY
and leave it until situation settles
Then definitive surgery

Question 11

When to do pancreatic necrosectomy

Answer 11

Infected necrosis on FNAC
AND hemodynamically unstable

Question 12

Unable to cannulate ampulla for jaundice from carcinoma of pancreatic head

Answer 12

Percutaneous transhepatic cholangiogram and drain under USG

BUT before that undertake staging of the disease whether it is resectable or not cause PTC drain has high risk of dislodging

Question 13

What is called when gall stone becomes impacted in Hartmann’s pouch

Answer 13

Mirizzi syndrome
Which makes Calot’s triangle difficult to delineate

Question 14

Importance of mirizzi syndrome

Answer 14

High risk of CBD injury

Question 15

Site of bile salts absorbtion

Answer 15

Ileum

Question 16

Complication of mirizzi syndrome

Answer 16

Empyema

Question 17

How to manage intra operative finding of mirizzi syndrome with empyema

Answer 17

Operative cholecystoSTOMY

Question 18

Septic shock with RUQ tenderness without gall stone, without jaundice and normal calibre bile duct

Answer 18

Acute acalculous cholecystitis

Question 19

Which disease is mostly associated with acalculous cholecystitis

Answer 19

Type 2 DM

Question 20

How to scan liver lesion of HCC prior to excision

Answer 20

MRI

Question 21

Time to appear pseudocyst after acute pancreatitis

Answer 21

After 4 weeks

Question 22

Elevated marker of pancreatic pseudocyst

Answer 22

Amylase

Question 23

Glasgow criteria mnemonic for both alcohol and stone related pancreatitis

Answer 23

PANCREAS [severe if 3 or more present]
PaO2<8kPa
Age>55yrs
Neutrophilia WCC>15k
Calcium<2mmol/L
Renal function urea>16mmol/L
Enzymes LDH>600iU/L:AST>200iU/L
Albumin<3.2g/L
Sugar>10mmol/L

Question 24

Definitive Treatment of gall stone pancreatitis

Answer 24

Cholecystectomy once acute attack has settled

Question 25

How to prevent infection in pancreatic necrosis

Answer 25

Imipenem

Question 26

USG feature of hemangioma

Answer 26

Hyperechoic

Question 27

Treatment of bile leak from CBD after lapcol

Answer 27

ERCP sphincteroTOMY and CBD stenting This is called cystic stump leak

Question 28

Which blood function do we need before ERCP

Answer 28

Coagulation profile

Question 29

Investigation to exclude both pancreatitis and perforated viscus

Answer 29

Contrast CT of abdomen and pelvis

Question 30

Percentage of CBD stone presenting with gall stone

Answer 30

10%

Question 31

How to prepare coagulation profile before pancreatic cancer surgery

Answer 31

Vit K LMWH Relieve biliary obstruction with plastic stenting (metallic ones may become embedded)

Question 32

How to reduce endotoxemia before pancreatic cancer surgery

Answer 32

Lactulose IV mannitol Bile salt substitution

Question 33

What is endotoxemia

Answer 33

https://images.app.goo.gl/k8xaTqnTvtHD37Sf6 Endotoxemia is defined as the elevation of plasma levels of lipopolysaccharides (LPS) that may be due to increased gut permeability, high levels of intestinal LPS-containing bacteria, or both. https://images.app.goo.gl/4dYMCoXma2o1ifKH9

Question 34

Treatment of hepatocellular adenoma

Answer 34

Resection In males it has high risk of malignant transformation

Question 35

What to do if CBD stone can't be removed even after ERCP

Answer 35

Choledocho duodeno stomy

Question 36

Risk of Choledocho duodeno stomy

Answer 36

Long term risk of ascending cholangitis but are of less concern in older patients

Question 37

Relation of liver function test with cholecystectomy

Answer 37

We can proceed with surgery if liver function is normal

Question 38

Triad of cholangitis

Answer 38

Charcot's triad Pain (RUQ) Fever (usually with rigors) Jaundice Rigor: a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating, especially at the onset or height of a fever.

Question 39

Treatment of cholangitis with CBD <4cm

Answer 39

ERCP & stenting