Welcome! This is a free MCQ page covering Q1–Q6 on Common Bile Duct (CBD). All other bile duct questions are available for premium members.
Q1. Endoscopic stone extraction from Common Bile Duct (CBD) is possible only in
a) Multiple bile duct stones
b) Intrahepatic bile duct stones
c) Multiple Gallstones
d) Prior Gastrectomy
1.a
Approximately 7% to 15% of patients undergoing cholecystectomy have common bile duct stones.
1% to 2% of patients managed with laparoscopic cholecystectomy without a cholangiogram for gallstones present after the cholecystectomy with a retained stone.
Endoscopic sphincterotomy and stone extraction was introduced more than 20 years ago and permits common bile duct stones to be removed without the need for conventional surgery.
Endoscopic stone extraction is difficult in multiple gallstones, intrahepatic stones, large gallstones, impacted stones, duodenal diverticula, prior gastrectomy, bile duct stricture.
Approximately 7% to 15% of patients undergoing cholecystectomy have common bile duct stones.
1% to 2% of patients managed with laparoscopic cholecystectomy without a cholangiogram for gallstones present after the cholecystectomy with a retained stone.
Endoscopic sphincterotomy and stone extraction was introduced more than 20 years ago and permits common bile duct stones to be removed without the need for conventional surgery.
Endoscopic stone extraction is difficult in multiple gallstones, intrahepatic stones, large gallstones, impacted stones, duodenal diverticula, prior gastrectomy, bile duct stricture.
Q2. Which of the following is not the functions of bile?
a) Excretion of toxins and normal cellular metabolites
b) Absorption of lipids
c) Cholesterol excretion
d) Absorption of water soluble vitamins
2.d
Bile functions in two important ways in the human body.
1st--- Liver is the major site of detoxification. Bile transport allows excretion of toxins and normal cellular metabolites.
2nd important function of bile is to form micelles which helps in absorption of lipids. In deficiency of bile, there is malabsorption of fat-soluble vitamins.
Bile also functions to remove excessive cholesterol.
Bile has no role in absorption of water soluble vitamins like vitamin B.
Bile functions in two important ways in the human body.
1st--- Liver is the major site of detoxification. Bile transport allows excretion of toxins and normal cellular metabolites.
2nd important function of bile is to form micelles which helps in absorption of lipids. In deficiency of bile, there is malabsorption of fat-soluble vitamins.
Bile also functions to remove excessive cholesterol.
Bile has no role in absorption of water soluble vitamins like vitamin B.
Q3. What is the management of choledochal cyst (bile duct cyst) adherent to portal vein?
a) Excision and Roux en y hepaticojejunostomy
b) Internal drainage into Roux en y jejunal limb
c) Hepatic lobectomy
d) The internal lining of the cyst can be excised, leaving the external portion of the cyst wall intact
3.d
Total cyst excision with Roux-en-Y hepaticojejunostomy is the definitive procedure for management of types I and II choledochal cysts.
In cases with significant inflammation, it may be impossible to safely dissect the entire cyst away from the anterior surface of the portal vein. In these circumstances, the internal lining of the cyst can be excised, leaving the external portion of the cyst wall intact.
Type I cysts represent 80% to 90% of cases and are simply cystic dilations of the common bile duct. Type II cysts are represented as a diverticulum arising from the common bile duct.
Type III cysts are also referred to as choledochoceles.
Type IV cysts represent dilation of both intrahepatic and extrahepatic bile ducts.
Type V cysts: only intrahepatic ducts are dilated.
Total cyst excision with Roux-en-Y hepaticojejunostomy is the definitive procedure for management of types I and II choledochal cysts.
In cases with significant inflammation, it may be impossible to safely dissect the entire cyst away from the anterior surface of the portal vein. In these circumstances, the internal lining of the cyst can be excised, leaving the external portion of the cyst wall intact.
Type I cysts represent 80% to 90% of cases and are simply cystic dilations of the common bile duct. Type II cysts are represented as a diverticulum arising from the common bile duct.
Type III cysts are also referred to as choledochoceles.
Type IV cysts represent dilation of both intrahepatic and extrahepatic bile ducts.
Type V cysts: only intrahepatic ducts are dilated.
Q4. In the classification of cholangiocarcinoma of hepatic duct hilum (Klatskin tumor) by site, Type II is
a) Confined to the common hepatic duct
b) Involve the bifurcation without involvement of secondary intrahepatic ducts
c) Tumors extend into either the right or left secondary intrahepatic ducts, respectively
d) Involve the secondary intrahepatic ducts on both sides
4.b
Bismuth classification of perihilar cholangiocarcinoma:
Type I tumors confined to common hepatic duct.
Type II tumors involve the bifurcation without involvement of secondary intrahepatic ducts.
Type IIIa and IIIb tumors extend into either right or left secondary intrahepatic ducts, respectively.
Type IV tumors involve secondary intrahepatic ducts on both sides.
Bismuth classification of perihilar cholangiocarcinoma:
Type I tumors confined to common hepatic duct.
Type II tumors involve the bifurcation without involvement of secondary intrahepatic ducts.
Type IIIa and IIIb tumors extend into either right or left secondary intrahepatic ducts, respectively.
Type IV tumors involve secondary intrahepatic ducts on both sides.
Q5. What is not true regarding laparoscopic bile duct injuries?
a) As surgeon experience goes beyond twenty cases, rate of bile duct injury decreases
b) The rate of laparoscopic bile duct injury is approximately 0.8%
c) Most of the injuries are due to errors of judgement and skill
5.c
All are true but most of the injuries are due to visual perceptual illusion and not error of skill.
All are true but most of the injuries are due to visual perceptual illusion and not error of skill.
Q6. Brown pigment stones, true is
a) They are earthy
b) Stones seen in Asian population
c) Easily breakable
d) All the above
6.d
Brown pigment stones are earthy in texture and are typically found in the bile ducts.
Brown stones often contain more cholesterol and calcium palmitate and occur as primary common duct stones in Western patients with disorders of biliary motility and associated bacterial infection.
Brown pigment stones are earthy in texture and are typically found in the bile ducts.
Brown stones often contain more cholesterol and calcium palmitate and occur as primary common duct stones in Western patients with disorders of biliary motility and associated bacterial infection.