Biliary

Question 1

post prandial RUQ pain with no US evidence of stone or sludge. Dx biliary dyskinesia, what is the next step?

Answer 1

lap chole

Question 2

Patient presents w acute cholangitis s/p LTP. what is the most likley cause?

Answer 2

anastomotic biliary stricture

Question 3

24 M with PSC, which of the following is appropriate surveillance?

Answer 3

abdominal MRI/MRCP every 6 months

Question 4

post chole choledocholithiasis, what kind of stones? and what to do?

Answer 4

Primary of duct stones

(pigmented calcium bilirubina), tx with ERCP

Question 5

70 F with RUQ pain and US with gallstones. labs wnl.
Goes to OR and there are dense dhesions to the GB and numerous lesions on the surface of the right liver. How to proceed?

Answer 5

Lap Biopsy of liver lesions and frozen section (likely gb carcinoma with metastatic liver dz)

Question 6

Criteria for unresectable disease

Answer 6

1. liver mets
2. peritoneal mets
3. mal ascites
4. tumor involvement of paraaortic lymph nodes
5. encasement of major vessels

Question 7

55 F s/p cholecystectomy with sxs of biliary colic and normal US. what could it be?

Answer 7

sphincter of oddi manometry

Question 8

62 F obese, IDDM, SCD has US with 0.2cm polyp in gallbladder , labs wnl. what is an indication for prophylactic chole?

Answer 8

Sickle cell disease;

Question 9

what are the indications for ppx cholecystectomy?

Answer 9

1. hemo;ytic disorders
2. large stones >3cm
3. porcelain gallbladder
4. concurrent GB polyps
5. surgical mgmt of NE tumors that will require octreotide tx
6. transplant of liver allograft

Question 10

s/p lap chole with RUQ pain and elevated WBC with US showing dilated intra and extra hepatic ducts. next best step in mgmt?

Answer 10

MRCP to evaluate the ductal anatomy