Bile duct

Timing of cholecystectomy in biliary pancreatitis

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Q) What is true regarding timing of cholecystectomy in biliary pancreatitis ?

a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks

b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded

c) Early cholecystectomy has been shown to have more complications than interval cholecystectomy

d) Early cholecystectomy increases technical complications

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Questions on Bile ducts?

 Ans b

"Poncho trial " answers this question of timing of cholecystectomy in biliary pancreatitis 

Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces---

  1. The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
  2. low added risk of complications.

Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks

  • Cholecystectomy during the same admission is recommended for patients with mild biliary pancreatitis to prevent recurrent attacks.
  • In cases of severe pancreatitis, surgery is generally delayed until the inflammation subsides.
  • Studies have shown that early cholecystectomy during the same admission for mild to moderate biliary pancreatitis does not increase complications compared to delayed or interval cholecystectomy.

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Management of biliary strictures

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Q) Which of the following is false about management of benign biliary stricture?

a) After HJ,success rate of 80-90% for benign biliary stricture is achieved

b) Recurrent stricture in 5 years is 30%

c) MOst important factor for recurrent stricture is the initial level of injury

d) Liver failure after stricture repair is around 20% 

Bile duct injuries in cholecystectomy

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Q True about Bile duct injuries in cholecystectomy

a) Only 15% are recognized at the time of surgery

b)Routine  Operative cholangiography  definitely reduces the incidence of bile duct injury

c) In incomplete obstruction of bile duct,  jaundice occurs early

d) Surgical outcome depends on timing of surgery

Answer for premium members

After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams

Blood supply of CBD

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Q) Supraduodenal  CBD is supplied by all except (AIIMS NOV 18)
a Cystic art
b RHA
c LHA
d Anterosuperior pancreaticoduodenal artery

Ans c

The blood supply to the right and left hepatic ducts and upper portion of the CHD is from the CA and the right and left hepatic arteries.

The supraduodenal bile duct is supplied by arterial branches from the right hepatic, cystic, posterior superior pancreaticoduodenal, and retroduodenal arteries.

arteries to the supraduodenal bile duct run parallel to the duct at the 3 and 9 o’clock positions.

Approximately 60% of the blood supply to the supraduodenal bile duct originates
inferiorly from the pancreaticoduodenal and retroduodenal arteries

whereas 38% of the blood supply originates superiorly from the right hepatic artery and CD artery

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Choledochal cyst and malignancy

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Q) Choledochal cyst  and malignancy false statement is  (AIIMS 2018 nov)

a) Highest risk of malignancy in Type 3

b) Malignancy can occur even after removal of choledochal cyst

c) Malignancy can occur anywhere in the biliary tract

d) It can take upto 15 years for malignancy to develop after excision of choledochal cyst

Answer