32 Biliary System ANATOMY AND PHYSIOLOGY

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Questions and Answers

Which artery branches off the right hepatic artery?

  • Portal vein
  • Cystic artery (correct)
  • Common hepatic artery
  • Gastroduodenal artery

Where is the cystic duct located in relation to the triangle of Calot?

  • Superior
  • Inferior
  • Lateral (correct)
  • Medial

Which vessels supply the hepatic and common bile duct at the 9- and 3-o'clock positions during ERCP?

  • Gastroduodenal and retroduodenal arteries (correct)
  • Left and right hepatic arteries
  • Right hepatic and common bile duct arteries
  • Splanchnic and celiac ganglion arteries

Which veins drain into the right branch of the portal vein?

<p>Cystic veins (B)</p> Signup and view all the answers

From which trunk of the vagus do parasympathetic fibers come to the common bile duct?

<p>Left (anterior) trunk (B)</p> Signup and view all the answers

What causes relaxation of the sphincter of Oddi?

<p>Glucagon (A)</p> Signup and view all the answers

What is the primary pathology of Acalculous Cholecystitis?

<p>Bile stasis leading to distention and ischemia (D)</p> Signup and view all the answers

What is the most common route of dissemination for bacterial infection of bile?

<p>From the portal system (A)</p> Signup and view all the answers

What is the best treatment for common bile duct strictures due to chronic pancreatitis?

<p>Choledochojejunostomy (A)</p> Signup and view all the answers

What is the primary cause of late postoperative biliary strictures following laparoscopic cholecystectomy?

<p>Ischemia (B)</p> Signup and view all the answers

What is the primary treatment for emphysematous gallbladder disease?

<p>Emergent cholecystectomy (B)</p> Signup and view all the answers

What is the best initial treatment for gallstone ileus causing small bowel obstruction?

<p>Remove stone through enterotomy proximal to obstruction (A)</p> Signup and view all the answers

What is the most common site of obstruction in gallstone ileus?

<p>Terminal ileum (D)</p> Signup and view all the answers

When is hepaticojejunostomy preferred for bile duct injuries that cause early symptoms?

<p>&lt;= 7 days after injury (D)</p> Signup and view all the answers

What imaging study is preferred to define anatomy and look for mass in suspected bile duct strictures?

<p>MRCP (magnetic resonance cholangiopancreatography) (A)</p> Signup and view all the answers

What should be done if fluid collection is present and bilious after laparoscopic cholecystectomy?

<p>Percutaneous drainage into the collection (B)</p> Signup and view all the answers

What should be performed when persistent jaundice and cholangitis follow laparoscopic cholecystectomy?

<p>Percutaneous drainage of fluid collection followed by ERCP with temporary stent placement (C)</p> Signup and view all the answers

What is the most common site of metastasis for gallbladder adenocarcinoma?

<p>Liver (C)</p> Signup and view all the answers

Which condition is associated with abnormal reflux of pancreatic enzymes during uterine development?

<p>Choledochal cysts (D)</p> Signup and view all the answers

What is the first test for diagnosing HEMOBILIA?

<p>EGD (C)</p> Signup and view all the answers

What is the most common risk factor for gallbladder adenocarcinoma?

<p>Porcelain gallbladder (A)</p> Signup and view all the answers

Which symptom is most commonly associated with BILE DUCT CANCER (CHOLANGIOCARCINOMA) in its early stages?

<p>Painless jaundice (C)</p> Signup and view all the answers

Which condition can lead to portal hypertension and hepatic failure due to progressive fibrosis of intrahepatic and extrahepatic ducts?

<p>Primary sclerosing cholangitis (C)</p> Signup and view all the answers

What is the #1 serious complication of cholangitis, related to sepsis?

<p>Renal failure (C)</p> Signup and view all the answers

Which procedure is generally needed if ERCP fails in treating cholangitis?

<p>PTC tube placement (D)</p> Signup and view all the answers

What is the first step in the treatment of cholangitis?

<p>Fluid resuscitation and antibiotics (C)</p> Signup and view all the answers

What is the most common organism causing cholangitis?

<p>E. coli (B)</p> Signup and view all the answers

Which condition can be associated with ulcerative colitis, pancreatitis, and diabetes?

<p>Primary sclerosing cholangitis (B)</p> Signup and view all the answers

Which disease can be discovered incidentally after cholecystectomy?

<p>Gallbladder adenocarcinoma (D)</p> Signup and view all the answers

What is the primary function of gallbladder bile?

<p>Excretion of bilirubin and cholesterol (D)</p> Signup and view all the answers

Which hormone causes steady, tonic contraction of the gallbladder?

<p>CCK (B)</p> Signup and view all the answers

What is the color of bile mostly due to?

<p>Conjugated bilirubin (A)</p> Signup and view all the answers

What percentage of bile salts is actively resorbed in the terminal ileum?

<p>50% (B)</p> Signup and view all the answers

Which type of gallstone is characterized by stasis, calcium nucleation, and increased water reabsorption from the gallbladder?

<p>Nonpigmented stones (A)</p> Signup and view all the answers

What is the most common type of stone found in the United States?

<p>Nonpigmented stones (B)</p> Signup and view all the answers

What is the highest sensitivity lab test for choledocholithiasis?

<p>GGT (C)</p> Signup and view all the answers

Which finding on ultrasound is suggestive of acute cholecystitis?

<p>&gt; 6 mm CBD diameter (B)</p> Signup and view all the answers

What is the most sensitive test for cholecystitis?

<p>HIDA scan (B)</p> Signup and view all the answers

When is cholecystectomy indicated after a CCK-CS test?

<p>If gallbladder is not seen (B)</p> Signup and view all the answers

What are the indications for emergent ERCP?

<p>Jaundice and dilated CBD without gallstone pancreatitis (D)</p> Signup and view all the answers

What percentage of patients undergoing cholecystectomy will have a retained CBD stone?

<p>&gt;5% (B)</p> Signup and view all the answers

Which type of shock is more likely to occur within the first 24 hours following laparoscopic cholecystectomy?

<p>Hemorrhagic shock from clip that fell off cystic artery (A)</p> Signup and view all the answers

What is the high-risk criteria that necessitates cholecystectomy regardless of the size of gallbladder polyps?

<p>Sessile (wide base) polyps (C)</p> Signup and view all the answers

What is the management approach for gallbladder polyps in the size range of 6–9 mm?

<p>Annual ultrasound monitoring (A)</p> Signup and view all the answers

What is the benign type of tumor associated with the gallbladder, which carries a risk of causing cholecystitis?

<p>Granular cell myoblastoma (D)</p> Signup and view all the answers

What is the syndrome characterized by compression of the common hepatic duct, often requiring cholecystectomy?

<p>Mirizzi syndrome (A)</p> Signup and view all the answers

What medication has been associated with gallbladder sludging and cholestatic jaundice?

<p>Ceftriaxone (B)</p> Signup and view all the answers

Which condition is NOT a high-risk criterion that necessitates cholecystectomy regardless of the size of gallbladder polyps?

<p>Hyperplastic polyps (A)</p> Signup and view all the answers

Which type of bilirubin has a half-life of 18 days and takes a while to clear after long-standing jaundice?

<p>$eta$ bilirubin (D)</p> Signup and view all the answers

What condition is NOT caused by adenomyomatosis, despite its association with the gallbladder?

<p>$ ext{LLQ}$ pain (A)</p> Signup and view all the answers

"Cholesterol polyps" and "hyperplastic polyps" are examples of what type of gallbladder condition?

<p>$ ext{Benign}$ polyps (A)</p> Signup and view all the answers

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