Biliary System

Question 1

Gallbladder cancer

Answer 1

5th MC GI malignancy
95% of pts also have cholelithiasis - 2/2 chronic inflammation, Larger stones and longer duration has increased risk.

Helicobacter bilis assoc w/ chronic inflammation, increased risk of cancer

Question 2

Adenomyomatosis

Answer 2

Sessile lesion
MC in fundus
Contain microcysts
Usually > 1cm
Considered benign

Question 3

Indications for prophylactic cholecystectomy

Answer 3

Hemolytic disorders
Large stones (>3cm)
Porcelain GB
Concurrent GB polyps
Anomalous pancreatic ductal drainage
Surgical management of NETs that will require octreotide tx
Transpant liver allograft

Question 4

Causes of Neonatal Conjugated Hyperbilirubinemia

Answer 4

Anatomic:

• Biliary atresia
• Choledochal cyst
• Alagille syndrome

Metabolic

• Tyrosinemia
• Galactosemia
• Hypothyroidism

Infectious

• TORCH (Toxoplasmosis, other, rubella, CMV, herpes)
• UTI
• Syphilis

Other

• Idiopathic neonatal hepatitis
• Neonatal sclerosino cholangitis
• alpha-1-antitrypsin deficiency
• Parenteral nutrition-associated cholestasis

Question 5

Biliary atresia

Answer 5

MC indication for liver transplant in kids
Sclerosing cholangiopathy of unknown causes

Type I: Distal type; atresia of CBD; tx: RnY hepaticojej
Type II: Proximal type; atresia of CHD, tx: RnY hepaticojej
Type III: Atresia up to and including porta hepatis, tx: Kasai

Question 6

MC polypoid lesions of GB

Answer 6

cholesterolosis

Question 7

Cholesterolosis

Answer 7

multiple polyps
cholesterol-rich MPs in lamina propria

Not pre-malignant

Question 8

MCC emphysematous cholecystitis

Answer 8

Clostridia (anaerobic, gram positive)

Question 9

Bile salt absorption

Answer 9

Primary bile salts (cholate and chenodeoxycholate) made in liver. Conjugated in liver w/ glycine & taurine

Conjugated bile salts secreted into bile, and into lumen of intestines.

help with digestion of fat.

80% absorbed in TI. rest deconjugated by bacterial in colon and absorbed passive transport.

5% excreted in stool