hepatobillary

Question 1

3 components of bile

Answer 1

bile salts
phospholipids
cholesterol

Question 2

types of gallstone

Answer 2

pure cholesterol 10% 
pure pigmenet 
   - black (h.A) 
   - brown (chronic cholangitis) 
Mixed 80%

Question 3

acute complications of acute cholecystitis

Answer 3

empyema or abscess of gallbladder
PERFORATION with biliary peritonitis
Gallstone ileus via a cholecystoenteric fistula (compaction of gallstone of SI)
Jaundice due to compression of adjacent common bile duct by pressure (Mirrizi syndrome)

Question 4

mucocele

Answer 4

large tense globular mass in the RUQ - stone in the neck of the gallbladder bile is absorbed but mucous in secreting

Question 5

risk of laprascope cholecystectomy

Answer 5

Conversion to open
Bleeding \infection
bile duct injury
Bile leak

Question 6

contraindications to laprascope cholecystectomy

Answer 6

• generalized abode sepsis
  major bleeding disorder
  LATE pregnancy
  intraabdominal malignancy

Question 7

causes of acute cholangitis

Answer 7

Principle: stone, neoplasm, stricture in binary system

Less common: chronic pancreatitis / pseudocyst/ ampullarf stenosis

Question 8

treatment of acute cholangitis

Answer 8

IV fluids and antibiotics
ERCP - to remove stone
PCI - if failed ERCP
choledochotomy - T tube is usually left in the duct to allow for repeat cholangiogram and extractions of residual stones