general biliary

Question 1

initial management of benign biliary strictures

Answer 1

serial endoscopic balloon dilations

Question 2

Most likely complication of spilled gallstones during cholecystectomy?

Answer 2

abscess formation

Question 3

what are management options for choledocholithiasis that cant be cleared by ERCP or open common duct exploration?

Answer 3

biliary-enteric anstomosis (choledochoduodenostomy or roux en y hepaticojejunostomy)
T tube drainage with percutaneous extraction through t tube later
transdudoenal exploration and sphincteroplasty

Question 4

do patients with acalculous cholecystitis require definitive operative management with cholecystectomy after resolution?

Answer 4

no

Question 5

management of proximal bile duct injury or injury involving more than 1 cm of the bile duct

Answer 5

Roux en y hepaticojejunostomy

Question 6

risk of recurrence in 6 weeks after an episode of gallstone pancreatitis?

Answer 6

25%

Question 7

relative contraindications to transcystic common bile duct exploration:

Answer 7

common hepatic duct stones
cystic duct <3mm or friable cystic duct
>8 common bile duct stones
common duct stones >8mm in size

Question 8

What is Mirizzi syndrome?

Answer 8

external compression of the common hepatic duct from a stone in the cystic duct

Question 9

steps of transduodenal sphincteroplasty:

Answer 9

1. extensive kocher
2. transverse or longitudinal duodenotomy at the junction of the lower 1/3 and upper 2/3 of duodenum
3. cut ampullary papilla at the 11 oclock position
4. extract stones
5. sew wall of CBD to duodenal mucosa with absorable sutures
6. close duodenotomy

Question 10

Indications to proceed directly to ERCP for suspected choeldocholithiasis?

Answer 10

total bilirubin >4
clinical cholangitis
dilated CBD (>6mm) with tbili 1.8-4

Question 11

where are the majority of conjugated bile salts absorbed?

Answer 11

terminal ileum via active transport

Question 12

what test is used to identify patients with sphincter of Oddi dysfunction?

Answer 12

morphine-neostigmine test (Nardi)

Question 13

characteristics of type 1 sphincter of oddi dysfunction:

Answer 13

abnormal LFTs or pancreatic enzymes and dilated common bile duct or pancreatic duct

Question 14

characteristics of type 2 sphincter of oddi dysfunction:

Answer 14

either abnormal LFTs/pancreatic enzymes or dilated common bile duct/pancreatic duct

Question 15

characteristics of type 3 sphincter of oddi dysfunction:

Answer 15

neither abnormal LFTs/pancreatic enzymes or dilated CBD/pancreatic duct

Question 16

most common organisms found in the GB or bile duct:

Answer 16

E. coli (number 1), klebsiella, enterobacter

Question 17

type 1 choledochal cyst:

Answer 17

fusiform dilation of CBD

Question 18

type 2 choledochal cyst:

Answer 18

diverticulum off CBD

Question 19

type 3 choledochal cyst:

Answer 19

choledochocele

Question 20

type 4a choledochal cyst:

Answer 20

intrahepatic and extrahepatic fusiform ductal dilation

Question 21

type 4b choledochal cyst:

Answer 21

extrahepatic ductal dilation

Question 22

type 5 choledochal cyst:

Answer 22

intrahepatic bile duct dilation (Carolis disease)

Question 23

transduodenal sphincteroplasty has a ___ rate of restenosis than ERCP with sphincterotomy

Answer 23

lower

Question 24

treatment of a bile duct injury greater than 50% circumference adjacent to the hepatic bifurcation:

Answer 24

roux en y hepaticojejunostomy

Question 25

high risk features of gallbladder polyps for malignancy:

Answer 25

>1cm
rapid growth
solitary 
sessile
patient >50 years old

Question 26

What subset of patients benefits from early ERCP with stone extraction and sphincterotomy for gallstone pancreatitis?

Answer 26

patients with obstructive jaundice and/or cholangitis

Question 27

Most common organism causing emphysematous cholecystitis?

Answer 27

Clostridia species (anaerobic, gram positive rod)