Hepatobiliary

Question 1

Borders of hepatocystic triangle

Answer 1

Question 2

What are the components of Child-Pugh score?

Answer 2

Bilirubin
INR
Albumin
Ascites
Encephalopathy

A - 5-6
B - 7-8
C - 10-15

Question 3

Commonest hepatic artery variant

Answer 3

Replaced right hepatic a from SMA
Replaced left hepatic a from left gastric

Question 4

Stapler classification ERCP perforation

Answer 4

Type I - lateral or medial wall perforation (scope)
Type II - periampullary injury (sphincterotome)
Type III - biliary or pancreatic duct (wire/basket)
Type IV - retroperitoneal air (compressed air)

Question 5

Todani classification

Answer 5

Type 1 - fusiform dilation CBD, extrahepatic duct
Type 2 - diverticulum CBD
Type 3 - choledochocele, intraduodenal portion
Type 4
- a: intra and extrahepatic cysts
- b: multiple extrahepatic cysts
Type 5 - beading intrahepatic only , carollis disease

Question 6

Causes of portal hypertension

Answer 6

Pre hepatic
- splenic or portal vein thrombosis
- AV fistula
Hepatic - pre sinusoid, sinusoid, post sinusoid
- cirrhosis
- PSC
- infiltrative liver disease - haemachromatosis, Wilson’s disease
Post hepatic
- CCF
- budd chiari: obstruction of venous outflow
- constructive pericarditis

Question 7

What is the Cori cycle

Answer 7

Muscle - anaerobic conversion to lactate
Liver - lactate —gluconeogenesis—> glucose

Anaerobic - increases lactate from pyruvate, reduced ATP, increased fatigue