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Recurrent Pyogenic Cholangitis (RPC)

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Q) Which statement is not true about  recurrent pyogenic cholangitis :

a) Mostly there are intrahepatic strictures with involvement of the left side duct

b) It can present as choledocho duodenal fistula

c) There is complete biliary obstruction which  leads to marked jaundice and pruritis

d) MRCP and other other cholangiography can be diagnostic

Answer c

In recurrent pyogenic cholangitis (RPC)  complete obstruction does not occur and jaundice and pruritis is not marked. 

RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.

Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes. 

Cause for recurrent pyogenic cholangitis

Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.

Stones and strictures

Clinical Presentation  of Recurrent pyogenic Cholangitis 

It can present as choledocholithiasis  with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.

Radiology for Recurrent Pyogenic Cholangitis 

MRCP can be diagnostic and is preferred because of its non invasive nature.

Surgical treatment 

Goal is to clear the biliary tree and to bypass or resect the strictures

Options are 

CBD exploration

Hepaticojejunostomy

Partial liver resections

Relapse in colon cancer

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Q) All of the following colon cancers have high rate of relapse except? (# colon 1) 

a) Obstruction/Perforation

b) Venous invasion

c) Mucin production

d) High microsatellite instability

Flaps in Plastic Surgery

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Q) Z-plasty is an example of which type of surgical flap?
a) Advancement flap
b) Delayed flap
c) Transposition flap
d) Rotation flap

Answer for all 

Correct answer: c) Transposition flap

Explanation (optional):
Z-plasty is a type of transposition flap where triangular flaps are rearranged to reorient and lengthen a scar or contracted tissue. The central limb of the “Z” is aligned with the scar, and the lateral limbs are transposed to redistribute tension.

Beger Procedure for Chronic Pancreatitis

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Q) True about Beger procedure for chronic pancreatitis

a) Posterior branch of gastro duodenal artery is preserved.

b) Beger procedure is  a pancreatic head mass resection that can be done for small pancreatic tumors.

c) Intra pancreatic, choledochal and ampullary structures are removed.

d) Neck of the pancreas is not  transected

Answer a) Posterior branch of GDA is preserved

Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this  for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.

The difference from  similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted where as in Frey, neck of the pancreas is not cut.

This procedure is not recommended if there is suspicion of carcinoma  head of pancreas and Whipple is the procedure for that For Small tumors it can be used

Posterior branch of GDA is preserved in Beger Procedure.

Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.

Free Questions on Pancreas

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