Biliary

Question 1

Most common cause benign biliary stricture

Answer 1

Previous surgery

Question 2

Cholangitis s/p liver txp, dx and tx

Answer 2

Anastomotic biliary stricture, ERCP stent

Question 3

Meperidine metabolism and toxic metabolite

Answer 3

Renal, normeperidine

Question 4

Asymptomatic GB polyp <1cm, tx

Answer 4

Surveillance US yearly

Question 5

Asymptomatic GB polyp >1cm, tx

Answer 5

Lap chole

Question 6

Asymptomatic GB polyp >2cm, tx

Answer 6

Cancer workup prior to sx

Question 7

GB ca limited to laminate propria, tx

Answer 7

T1a, Simple cholecystectomy

Question 8

GB ca invading muscle or perimuscular connective tissue, tx

Answer 8

T1b/T2, chole with en bloc IVb/V resection and portal/hepatoduodenal lig lymphadenectomy

Question 9

GB ca invading visceral peritoneum/adjacent liver or 2+ adjacent organs, tx

Answer 9

T3 and T4, consider extended right hepatectomy

Question 10

Risk factors cholangiocarcinoma

Answer 10

PSC, choledochal cysts, UC, bil tract infxns

Question 11

Absolute contraindications to lap chole

Answer 11

Uncorrected coagulopathy, inability to tolerate pneumo

Question 12

Recent trauma, tachy with blood from ampulla of Vater, dx and tx

Answer 12

Hemobilia, angioembolization

Question 13

Black gallstones, dx

Answer 13

Sickle cell or hereditary spherocytosis

Question 14

Several small gallbladder polyps with cholesterol laden macrophages, dx

Answer 14

Cholesterolosis

Question 15

Fever, jaundice, abd pain, dx and tx

Answer 15

Acute cholangitis, fluids, IV abx and ERCP for decompression

Question 16

Aberrant duct during lap chole, next step

Answer 16

IOC

Question 17

Future liver remnant volume

Answer 17

20% healthy, 30% liver dysfunction, 40% cirrhosis

Question 18

Gold standard test to determine Future Liver Remnant

Answer 18

CT Volumetry

Question 19

Gold standard tx for inadequate future liver remanant

Answer 19

Portal vein embolization

Question 20

Absolute contraindication portal vein embolization

Answer 20

Portal hypertension

Question 21

Painless jaundice, elevated C19-9, CBD stricture; dx

Answer 21

Lower duct cholangiocarcinoma

Question 22

IOC without contrast in duo; next step

Answer 22

1.0mg glucagon

Question 23

Gallbladder Ca first metastasis

Answer 23

Cystic duct lymph nodes

Question 24

Nonop management of gallstones

Answer 24

Ursodeoxycholic acid

Question 25

Types choledochal cysts

Answer 25

I: fusiform extrahepatic II: saccular CBD III: distal CBD IV: intra & extra hepatic V: intrahepatic only

Question 26

Type I choledochal cyst; tx

Answer 26

Resection, cholecystectomy, RYHJ

Question 27

Type II choledochal cyst; tx

Answer 27

Cyst excision

Question 28

Type III choledochal cyst; tx

Answer 28

Endoscopic sphincterotomy and cyst unroofing

Question 29

Type IV choledochal cyst; tx

Answer 29

Excision extrahepatic cyst, chole, RYHJ, liver resection

Question 30

Type V choledochal cyst; tx

Answer 30

Hepatic resection w/w/o RYHJ

Question 31

Bouveret syndrome

Answer 31

Gastric outlet obstruction by impacted stone in pylorus or prox duo

Question 32

Gallbladder Ca tx

Answer 32

T1a - simple chole T1b - radical chole (segment IVB and V with portal lymphadenectomy)

Question 33

Indication for radical chole

Answer 33

T1b GB Ca (invades muscle layer)

Question 34

SAS in ICU with GB distention, elevated TB, no stones

Answer 34

Acalculous cholecystitis

Question 35

S/p lap chole, n/v, abd pain, tachy; dx and next step

Answer 35

Biloma and RUQUS

Question 36

Obstructive jaundice and periampullary mass; dx and tx

Answer 36

Likely adenoma and needs resection for risk of malignancy

Question 37

Portal triad structures and their orientation

Answer 37

CBD lateral Portal vein posterior Hepatic artery medially

Question 38

Gallstone pancreatitis, tx

Answer 38

ERCP with stone extraction, lap chole same admission

Question 39

How is bile concentrated

Answer 39

Active secretion of NaCl

Question 40

Most potent stimulator of bile secretion

Answer 40

Secretin

Question 41

Abdominal pain and elevated LFTs/bili s/p cholecystectomy; next step

Answer 41

ERCP (missed bile duct injury)

Question 42

Hx UC with nausea, itching and multiple biliary strictures resulting in sepsis requiring stents; dx and tx

Answer 42

PSC, liver txp

Question 43

Resectable lower duct extrahepatic cholangiocarcinoma; tx

Answer 43

Pancreaticoduodenectomy

Question 44

Bismuth-Strasberg Bile Duct Injury

Answer 44

A - cystic or luschka leak B - aberrant right hepatic C - leak from aberrant right hepatic D - lateral CBD injury E1 - 2+ cm E2 - <2cm E3 - bifurcation E4 - above bifurcation E5 - aberrant right and stricture main duct