Hepatobillary 🥞

Question 1

CT finding of Hepatic mass: encashment of the borders, with progressive filling?
A. hepatoma
B. Hemangioma
C. Mets
D. Hydatid cyst

Answer 1

B. Hemangioma ✅💛

Question 2

Patient obese, hx of jandace for 1 week with anaroxia and abdominal pain, o/e right upper quadrant tenderness, no hx of medication or disease
What initial step?
-MRCP
-abdominal us
-ct
-biobsy

Answer 2

Abdominal US is the initial study of choice in RUQ pain ✅💛

Question 3

Q: Pt with hepatic hemangioma for conservative management advise?
A:
1. Avoid competitive heavy exercise
2. Decrease weight
3. Stop smoking

Answer 3

Avoid competitive heavy exercise ✅💛

Question 4

Pt known to have Hepatitis b and chronic liver disease found to have liver nodule on ultrasound and CT was done
Showed 6 cm HCC with high vascularity with normal Portal vein and no invasion
He is well now with controlled ascites with medication
His labs
Albumin : 3.1
Blirubin : very high 40 normal was up to 2
INR :1.5
His ALT and AST were within normal
What is the most appropriate next step in management :
A) surgical resection
B) radiotherapy
C) trascatheter arterial embolization

Answer 4

surgical resection ✅💛

Question 5

Female did lap chole, 7d later she has abd pain very high total & direct bili Imaging showed sub hepatic biloma 10cm:
A. MRCP
B. Ct guided drainage
C. Open drainage
D. Conservative

Answer 5

Ct guided drainage ✅💛

UpToDate: As a general rule, collections remaining symptomatic after successful closure of the leak are better managed with percutaneous drainage.

Question 6

Smoker and obese female patient on combined OCP, at imagining there is 4x4 cm hepatic hemangioma. What is the most important thing to advise the pt ?
A. Decrease high carbohydrate and fatty meals
B. Stop smoking
C. Eat diet rich in fiber
D. Stop OCP

Answer 6

Stop OCP ✅💛
Bec. They are the one causing it to grow
The other options are for great health

Question 7

Female patient came to ER complaining of epigastric pain from 8h, the patient has jaundice with fever of 37.9
Elevated WBC.
1. A. pancreatitis
2. B. cholangitis
3. C. Cholecystitis

Answer 7

cholangitis ✅💛

Question 8

Better recall;
Case of RUQ pain and tenderness jaundice, fever elevated total
bilirubin not mention direct or indirect on US multiple GB stones no
peri cystic fluid CBD is dilated 1cm?
A-Ascending cholangitis
B-Acute cholecystitis
C-Choledocholithiasis
D-Acute pancreatitis

Answer 8

Ascending cholangitis ✅💛

Question 9

RUQ pain, for 12 hours, no fever, no jaundice. U.S findings “ non thickened G.B wall with multiple gall stones, CBD is obsecured “, what’s your diagnosis:
A. Acute Pancreatitis
B. Obstructive jaundice
C. Acute Cholecystitis
D. Ascending cholangitis

Answer 9

Acute Pancreatitis 💛✅

By exclusion

Question 10

Female obese with jaundice , pruritis and no fever all lab normal (i think) but increase WBCs + direct and indirect bilirubin, ALP (1000) AST and ALT increase little bit what the next step ?
MRCP
Liver biopsy
US abdomen
CT for liver

Answer 10

US abdomen 💛✅

Question 11

Ascending cholangitis case, what is the poor prognostic factor?
A- bilirubin
B- INR
C- liver enzymes
D- albumin

Answer 11

INR 💛✅

Note :
Prothrombin time-international normalized ratio >1.5

Question 12

✅️✅️
#hepatobiliary

Patient with right upper quadrant pain (manifestation of Entomebia histolitica) stated as well: Imaging findings Large size (10x15), septated, poorly defined What is the initial treatment?

Metronidazole

Percutaneous aspiration

Percutaneous drainage

Answer 12

Metronidazole 💛✅
Is the initial

Question 13

58 years old with 2 month history of right upper quadrant pain
Us show
Diffus calcified gall bladder without stone
Mangmment
1 cholecystectomy
2 percutaneous biobsy
3 cholecystomy tube

Answer 13

cholecystectomy 💛✅

Question 14

A young patient presented complaining of right upper quadrant pain. On examination there is RUQ tenderness and a palpable mass. Investigation showed Entamoeba histolytica, and there is abscess 12 x 14 cm with septation. What is your initial next step in management?
A. Percutaneous drainage.
B. Metronidazole.
C. Percutaneous aspiration.
D. Surgical removal

Answer 14

Metronidazole 💛✅

Initial

Question 15

25 sep

Male k/c of acute pancreatitis came with abdominal pain in RUQ
In US : gallbladder stone and dilated CBD
What is your management
A- laparoscopic cholecystectomy
B- ERCP
C- ABx
D-

Answer 15

ERCP ✅💛

Question 16

27 October
Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague abdominal pain.
On US there is fluid around the gallbladder (something like that) and the CBD is 9 mm. What is the
most likely diagnosis or cause?
A - CBD injury
B - Retained stone in CBD
C - Sub-hepatic collection
D- slipped clips

Answer 16

Retained stone in CBD ✅💛

Question 17

After ERCP for management of obstructive jaundice patient develop abdominal pain and examination reveals distended abdomen with nick, chest, and abdominal emphysema, which one most likely injured during this procedure:
A- esophagus
B- trachea
C- duodenum
D- stomach

Answer 17

duodenum 💛✅

Question 18

Male patient came from India RUQ pain .. on and off fever for 3 weeks . raised LFT , high WBC (Neurtrophol 70% Lymphocytes 20%) . image showed homogenous hypoechoic mass in the liver.
a) hydatid cyst
b) TB abscess
c) amebic abscess
d) pyogens abscess

Answer 18

amebic abscess 💛✅

Question 19

Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague abdominal pain. On US there is fluid around the gallbladder (something like that) and the CBD is 9 mm. What is the most likely diagnosis or cause?
A - CBD injury
B - Retained stone in CBD
C - Sub-hepatic collection

Answer 19

Retained stone in CBD 💛✅