51 Questions
Which artery branches off the right hepatic artery?
Cystic artery
Where is the cystic duct located in relation to the triangle of Calot?
Lateral
Which vessels supply the hepatic and common bile duct at the 9- and 3-o'clock positions during ERCP?
Gastroduodenal and retroduodenal arteries
Which veins drain into the right branch of the portal vein?
Cystic veins
From which trunk of the vagus do parasympathetic fibers come to the common bile duct?
Left (anterior) trunk
What causes relaxation of the sphincter of Oddi?
Glucagon
What is the primary pathology of Acalculous Cholecystitis?
Bile stasis leading to distention and ischemia
What is the most common route of dissemination for bacterial infection of bile?
From the portal system
What is the best treatment for common bile duct strictures due to chronic pancreatitis?
Choledochojejunostomy
What is the primary cause of late postoperative biliary strictures following laparoscopic cholecystectomy?
Ischemia
What is the primary treatment for emphysematous gallbladder disease?
Emergent cholecystectomy
What is the best initial treatment for gallstone ileus causing small bowel obstruction?
Remove stone through enterotomy proximal to obstruction
What is the most common site of obstruction in gallstone ileus?
Terminal ileum
When is hepaticojejunostomy preferred for bile duct injuries that cause early symptoms?
<= 7 days after injury
What imaging study is preferred to define anatomy and look for mass in suspected bile duct strictures?
MRCP (magnetic resonance cholangiopancreatography)
What should be done if fluid collection is present and bilious after laparoscopic cholecystectomy?
Percutaneous drainage into the collection
What should be performed when persistent jaundice and cholangitis follow laparoscopic cholecystectomy?
Percutaneous drainage of fluid collection followed by ERCP with temporary stent placement
What is the most common site of metastasis for gallbladder adenocarcinoma?
Liver
Which condition is associated with abnormal reflux of pancreatic enzymes during uterine development?
Choledochal cysts
What is the first test for diagnosing HEMOBILIA?
EGD
What is the most common risk factor for gallbladder adenocarcinoma?
Porcelain gallbladder
Which symptom is most commonly associated with BILE DUCT CANCER (CHOLANGIOCARCINOMA) in its early stages?
Painless jaundice
Which condition can lead to portal hypertension and hepatic failure due to progressive fibrosis of intrahepatic and extrahepatic ducts?
Primary sclerosing cholangitis
What is the #1 serious complication of cholangitis, related to sepsis?
Renal failure
Which procedure is generally needed if ERCP fails in treating cholangitis?
PTC tube placement
What is the first step in the treatment of cholangitis?
Fluid resuscitation and antibiotics
What is the most common organism causing cholangitis?
E. coli
Which condition can be associated with ulcerative colitis, pancreatitis, and diabetes?
Primary sclerosing cholangitis
Which disease can be discovered incidentally after cholecystectomy?
Gallbladder adenocarcinoma
What is the primary function of gallbladder bile?
Excretion of bilirubin and cholesterol
Which hormone causes steady, tonic contraction of the gallbladder?
CCK
What is the color of bile mostly due to?
Conjugated bilirubin
What percentage of bile salts is actively resorbed in the terminal ileum?
50%
Which type of gallstone is characterized by stasis, calcium nucleation, and increased water reabsorption from the gallbladder?
Nonpigmented stones
What is the most common type of stone found in the United States?
Nonpigmented stones
What is the highest sensitivity lab test for choledocholithiasis?
GGT
Which finding on ultrasound is suggestive of acute cholecystitis?
> 6 mm CBD diameter
What is the most sensitive test for cholecystitis?
HIDA scan
When is cholecystectomy indicated after a CCK-CS test?
If gallbladder is not seen
What are the indications for emergent ERCP?
Jaundice and dilated CBD without gallstone pancreatitis
What percentage of patients undergoing cholecystectomy will have a retained CBD stone?
>5%
Which type of shock is more likely to occur within the first 24 hours following laparoscopic cholecystectomy?
Hemorrhagic shock from clip that fell off cystic artery
What is the high-risk criteria that necessitates cholecystectomy regardless of the size of gallbladder polyps?
Sessile (wide base) polyps
What is the management approach for gallbladder polyps in the size range of 6–9 mm?
Annual ultrasound monitoring
What is the benign type of tumor associated with the gallbladder, which carries a risk of causing cholecystitis?
Granular cell myoblastoma
What is the syndrome characterized by compression of the common hepatic duct, often requiring cholecystectomy?
Mirizzi syndrome
What medication has been associated with gallbladder sludging and cholestatic jaundice?
Ceftriaxone
Which condition is NOT a high-risk criterion that necessitates cholecystectomy regardless of the size of gallbladder polyps?
Hyperplastic polyps
Which type of bilirubin has a half-life of 18 days and takes a while to clear after long-standing jaundice?
$eta$ bilirubin
What condition is NOT caused by adenomyomatosis, despite its association with the gallbladder?
$ ext{LLQ}$ pain
"Cholesterol polyps" and "hyperplastic polyps" are examples of what type of gallbladder condition?
$ ext{Benign}$ polyps
Test your knowledge on cholecystostomy tube placement, interval cholecystectomy, ERCP treatment for common bile duct stone, sphincterotomy, and biliary colic. Learn about the management and risks associated with these procedures.
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