Hepatobiliary

Question 1

Triangle of calot

Answer 1

Cystic duct
Common hepatic duct
Liver margin

Question 2

Capacity of gb

Answer 2

30-50 ml but can contain up to 300ml

Question 3

Gallbladder innervation

Answer 3

Vagus and sympathetic branches of the celiac plexus

Question 4

Parts of gb

Answer 4

Fundus
Body
Infundibulum (hartmann’s pouch)
Neck

Question 5

Common bile duct enters what portion of the duodenum

Answer 5

2nd portion of the duodenum through the sphincter of oddi

Question 6

Average length of common bile duct

Answer 6

7-11 cm in length (if more than 10cm: dilated na common bile duct)

Question 7

Normal diameter of common bile duct

Answer 7

5-10mm

Larger than 10 means dilatation: probably by a stone

Question 8

Spiral valves of heisner

Answer 8

Variable number of mucosal folds at the segment of the cystic duct adjacent to the gall bladder

Question 9

Elevated in cholecystitis

Answer 9

Increased WBC

Question 10

Tests that will make you suspect cholangitis

Answer 10

Increased bilirubin: obstruction

Increased alkaline phosphate: obstruction

Then do UTZ

Question 11

Murphy sign

Answer 11

Inspiratory arrest with deep palpation in the right subcostal
Area

Question 12

Is leukocytosis present in acute cholecystitis?

Answer 12

Yes, mild to moderate

12,000-15, cells/ ml

Question 13

Tx of acute cholecystitis include

Answer 13

Hydration( IV fluids)
Antibiotics
Analgesia

Question 14

Charcot’s triad is for?

Answer 14

Cholangitis

Fever, epigastric/RUQ pain, jaundice

Moat important? Fever

Question 15

Reynold’s pentad indicates

Answer 15

Septicemia

Charcot triad + cns depression and shock

Question 16

Definitive dx treatment for cholangitis

Answer 16

ERCP

Question 17

Biliary cysts

Answer 17

Congenital dilatations of the extra/intra hepatic biliary tree

Question 18

Sclerosing cholangitis

Answer 18

Inflammatory strictures in the intra/extra hepatic biliary tree, puts patient at risk for cholangiocarconoma

Question 19

Gallbladder carcinoma prognosis

Answer 19

5% 5 year survival rate

5th moat common GI malignancy in the west

10mm polyp places patients at risk

80% adencarcinoma

Question 20

Most common organisms from bile

Bile from bladder or ducts are almost always sterile

Answer 20

E coli
Klebsiella pneumoniae
Streptococcus fecalis
Bacteroides fragilis

Question 21

Avearge length of the gall bladder

Answer 21

7-10 cm