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Exam (elaborations)

ABSITE Questions and Answers

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The most common type of choledochal cyst - Tx?  :-- Type 1-cystic, fusiform or saccular dilation of CBD  CBD is abnormal, CHD is normal  TX with RenY hepaticojejeuenostomy with end to side anastamosis Origin of replaced right hepatic artery  :-- SMA Type 5 choledochal cyst - als...

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  • August 28, 2024
  • 82
  • 2024/2025
  • Exam (elaborations)
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  • ABSITE
  • ABSITE
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Elscores: Aug. 27, 24- 2024/2025

ABSITE Questions and Answers
The most common type of choledochal cyst

- Tx?


 :-- Type 1-cystic, fusiform or saccular dilation of CBD

 CBD is abnormal, CHD is normal

 TX with RenY hepaticojejeuenostomy with end to side anastamosis




Origin of replaced right hepatic artery


 :-- SMA




Type 5 choledochal cyst

- also called?

- tx?


 :-- Caroli's disease-intrahepatic ducts, lobectomy vs. transplant for tx




Common bile duct size


 :-- 6mm is normal, +1 for every 10 years over 40, 10mm can be normal in elderly people




Mirizzi's sydrome


 :-- compression of bile ducts by distended GB or gallstone




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, 2
Elscores: Aug. 27, 24- 2024/2025

MC bugs in cholangitis


 :-- E coli, klebsiella, Enterococcus




Pancreatitis severity prediction


 :-- APACHE-II




Ranson's criteria


 :-- Pancreatitis (prognosis), more appropriate for ETOH pancreatitis

1-3: mortality 1%

3-4: 15%

5-6: 40%

>7:100%




Gallstone ileus


 :-- Intestinal obstruction, pneumobilia, calcified stone distant from GB




Gallstone ileus tx


 :-- Enterotomy proximal to stone, extract stone, close enterotomy. +/- SBR, +/- chole

and fistula closure if stable




Gallstone ileus tx




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, 3
Elscores: Aug. 27, 24- 2024/2025

 :-- Enterotomy proximal to stone, extract stone, close enterotomy

- do not repair fistula




Gallbladder cancer


 :-- DO NOT biopsy as you can seed the tract




Klatskin tumor

- types?

- Tx?


 :-- cholangiocarcinoma located at the hepatic hilum

- @ junction of R. & L. hepatic ducts, intrahepatic dilation




I: common hepatic duct distal to bifurcation

II: involve bifurcation

IIIa: confluence of R & L (extends to R)

IIIb: confluence + extends to L

IV: extends to R & L




- TX: resection and RouxnY bilioenteric reconstruction




Cholangiocarcinoma


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, 4
Elscores: Aug. 27, 24- 2024/2025

- bili level?

- Dx?


 :-- Bili often >10 with average of 18, MRCP is imaging of choice




Cholecystectomy, post-op bile leak


 :-- HIDA to dx, ERCP with stent to tx. Perc drainage if large or uncontained




Strasberg classification


 :-- For bile leak, A-D

E is for CHD stricture/transection

• A - cystic duct leak, or luschka

• B - ligation of aberrant right hepatic duct

• C - transection of aberrant right hepatic duct

• D - lateral injury to major duct

• E - injury to main duct




Bismuth classification


 :-- For bile leak, A-D

E is for CHD stricture/transection




Middle hepatic vein drains to?


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