liver and billiary tract

Question 1

In Asymptomatic cholelithiasis, cholecystectomy is considered if?

Answer 1

choledochal cysts, Caroli’s disease,
porcelain or calcifed gallbladder),
sickle cell disease,
paediatric patient, bariatric surgery
immunosuppression

Question 2

DIAGNOSIS AND MNGT?

<6 hrs- Steady, severe dull pain in the epigatrium or RUQ
Occurs at night or fatty meals

Answer 2

Biliary colic
Elective cholecystectomy – laparoscopic standard of care

Question 3

DIAGNOSIS?

Severe constant pain >6hr
Fever - <38.5
Murphys sign
Boas sign- right subscapular pain

Answer 3

Acute Cholecystitis

Question 4

Acute cholecystitis
investigation with negative stone in UTZ

Answer 4

Hida scan

Question 5

Acute cholecystitis
management if with positive CBD stone in UTZ

Answer 5

ERCP prior to surgery if CBD stones are present on US

Question 6

Acute cholecystitis
most common complication

Answer 6

• gangrenous gallbladder (20%) most common complication

Question 7

Diagnosis?
Acute cholecystitis with extra-luminal compression of CBD/CHD due to large stone in cystic duct

Answer 7

Mirrizi Syndrome

Question 8

Diagnosis?
patient on TPN with abdominal pain, elevated WBC

Answer 8

acalculous cholecystitis

can also be seen in ICU admission (most common),
DM, immunosuppression, trauma patient, TPN, and sepsis

Question 9

Acalculous cholecystitis UTZ finding

Answer 9

sludge in gallbladder

Question 10

Acalculous cholecystitis management for stable and unstable patients?

Answer 10

• NPO, IV fuids, and pain management
• IV broad-spectrum antibiotics, cholecystectomy
• if patient unstable → percutaneous cholecystostomy

Question 11

diagnosis?
biliary colic
* tenderness in RUQ or epigastrium
* acholic stool, dark urine, and fuctuating jaundice

Answer 11

Choledocholithiasis

Question 12

Diagnostic of choice Choledocholithiasis

Answer 12

MRCP (90% sensitive) - non-invasive diagnostic test of choice

Question 13

Charcots Triad?

Answer 13

fever, RUQ pain, jaundice

Question 14

Reynolds Pentad?

Answer 14

fever, RUQ pain, jaundice, shock, altered mental status

Question 15

Cholangitis Surgical Management

Answer 15

ERCP + sphincterotomy

Question 16

Cholangitis surgical managment if without ERCP

Answer 16

PTC with catheter drainage

Question 17

Cholangitis surgical management if ERCP and PTC failed?

Answer 17

Open or laparoscopic CBD exploration with T tube placement

Question 18

Most common benign hepatic lesion

Answer 18

congenital cyst

Question 19

Hepatic cyst with malignant transformation

Answer 19

Billary cystadenoma

Question 20

Hepatic cyst associated with renal disease, cerebral aneurysm

Answer 20

polycystic liver disease

Question 21

Most common solid benign mass of the liver

Answer 21

hemangioma

Question 22

benign lesion of the liver seen in OCP use, pregnancy

Answer 22

adenoma (with malignant transformation)