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congenital anomaliesCholedochal cystbiliary atresia

Biliary atresiawritten

biliary atresiawrittencase presentation

Choledochal CystCholedochal cyst

MCQ

choledochal cyst

rare condition

rare conditionIncidence

rare

MCQCholedochal cystrare

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Choledochal cystdilatationwallbile duct

Choledochal cystrare

More common in femalesfemale predominance

MCQ

More common in females

bile duct

theory

congenital weaknesswallbile ductcongenitally loose

intra uterine infection

pancreatic juicecommon bile duct

pancreatitisbilebile

Congenital weaknessViral infection

Pancreatic enzymewallAutonomic disturbance

MCQcommonest form of Choledochal cyst

diffuse dilatation

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MCQMCQ

writtenMCQ

Limited

sourcesMCQsources

MCQ

Choledochal cystrarewritten

biliary atresiawrittenMCQ

choledochal cystMCQIncidence

More common in females

incidenceMCQ

MCQcommonest form

diffuse dilation

MCQcommonest formdiffuse dilatation

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Liverbile ductdilatedIntra hepaticextra hepatic

dilated bile duct

Intra hepatic

extra hepaticCaroli's disease

diseasedilatationIntra hepatic

extra hepatic

clinicalobstructive jaundice

Investigations

liver functionbilirubindirect

alkaline phosphataseProthrombin timeprolonged

hepato-renal

urine analysis

urinedarkdarkdirect bilirubin

Frothybile salts

stoolClay

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Obstructive jaundiceIntra hepatic bile duct dilatation

extra hepatic bile duct dilatationsonarcommon bile duct

accurateLiver

common bile duct

stonecommon bile ductIntra hepaticextra hepatic

stonecommon bile ductbile duct

Intra hepaticextra hepatic

dilatationintra hepatic bile ductextra hepatic

Caroli's disease

Porta hepatisIntra hepaticextra hepatic

full mark

full markoriented to time place and time

dilated intra hepatic bile duct

extra hepaticCaroli's diseasecholangio carcinomaPorta hepatis

chalngio carcinomaPorta hepatis

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choledochal cyst

Jaundicechildhood

biliary atresiaJaundiceNeonates

choledochal cystJaundicechild

biliary atresia jaundiceneonates

Obstructive jaundiceneonates

choledochal cystObstructive jaundicechildhood

Later on in life

choledochal cystInvestigations jaundice

obstructive jaundice

Liver functions,, kidney function,, urine,, stool,, ultra sound,, ERCP

jaundice

choledochal cyst

choledochal cystLiverliver

choledochal cystLiver

Liver

liver

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cyst

partial hepatectomyLiver

HepatectomyheapOmaHepatoma

hepatectomyleft hepatectomyright hepatectomy

Liver

dilated intra hepatic bile ductpartial hepatectomy

caroli's diseaseDilated intra hepatic bile duct

liverintra hepatic bile ductdilatedLiver transplantation

bile ductsdilatedLiver transplantation

segmental

segment

Jaundice

segmental liver transplantation

segmental liver transplantation40,000

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40,000


kidney transplantation

liver transplantationLiver

Livercirrhotic


choledochal cystPartial hepatectomy

dilatationliverLiver transplantation

bile ductdilated

choledochal cyst

choledochal cyst jejunumbile duct

jejunumdistal end

hepatico-jejunostomy Roux -en - Y

anastomosisRoux

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RouxHepatico-jejunostomy Roux en Y

en Y

anastomosisY

talentbile duct

cholecystectomycommon bile ducthealedstricture

jaundicehepatico-jejunostomy Roux-en- Y operation

cholangio carcinomaresectablehepatico-jejunostomy Roux-en Y

Bile ducthepatico-jejunostomycholedcho jejunostomyRoux-en-Y

Liverhepatectomy

liver transplantation

Partial hepatectomyLiver transplantation

anastomsis

Biliary atresiaatresiaatresia

Failure of re-canalization

biliary atresiaincidence10,000Incidence

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MCQincidence of biliary atresia

a10,000

b5,000

c1,000

d

eNon of the above

biliary atresiabiliary atresiafailure of re-canalization

biliary atresia

jaundice


generalscratch marks

Local examinationgall bladder

atresia

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atresiagall bladdergall bladderatresiagall bladdergall bladder

atresiagall bladdergall bladder

atresiagall bladdergall bladder

obstructive jaundicegeneral examinationscratch marks

Courvoisier

Virchow'sstonegall bladdercontracting

obstructive jaundicescratch marksCourvoisier

calcularmalignant

biliary atresiainvestigations Liver functions

biliary atresiainvestigations

biliary atresialiver functiondirect bilirubinalkaline phosphates

prothrombin timeprolonged

liver functionkidney function

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kidney function

Urinestoolurinedarkfrothy

DarkDirect bilirubin

Frothybile salts

frothytestSulpher t est

sonardilated intra hepatic bile duct

atresiaintra hepatic

dilated intra hepatic bile ductUnlessatresiaIntra hepatic

investigationbiliary atresia

HIDA scanERCPHIDA scan

Iso-toping scanningLiver

biliary atresiaiso tope

duodenum

hepatitisiso-topes

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HIDA scanbiliary atresiaHIDA scanIso-tope scanliver

Hydroxy Imedinodiacetic AcidIso-tope scanningLiver

biliary atresiasonar

Dilated intra hepatic bile duct, unlessatresiaintra hepatic

HIDA scanLiver

iso-topeduodenum

biliary atresialiverliver

iso-topeduodenum

neonatal hepatitisneonatal hepatitisLiveriso-tope

neonatal hepatitisNon visualization of the liverbiliary atresiavisualization of the liver but, no visualization of the duodenum

NormalVisualizationliverduodenum

iso-topeduodenum

HIDA scaniso-tope scanningLivernormalLiverduodenum

biliary atresiaLiverduodenum

neonatal hepatitisLiverduodenum

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Gall bladder stoneswritten

Gall bladder stoneswritten

3progressive jaundicedarkstoolclay

clinical diagnosisBiliary atresia

differential diagnosisneonatal hepatitis

physiological jaundicephysiological jaundicedifferential diagnosis

neonatal jaundicedifferential diagnosis

diagnosisdifferential diagnosis

investigations of choicehow to investigate him

Liver functionKidney functionurinestoolsonarHIDA scan

investigation of choiceHIDA scan

investigation of choiceHIDA scan

8 jaundicedark urineclay stoolitchingcholedochal cyst

Positive family history

positive family history

differential diagnosisbiliary atresia

8biliary atresianeonatal

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parasite

hepatitisblood transfusionhemolytichemolytic jaundice

Hemolytic jaundice

congenital

jaundicehemolytic

HepatitisHepatocellular

obstructive

choledochal cystHow to investigate him

Liverliver

Kidney

Urinestoolultra soundERCPERCP

biliary atresiaNeonates

HIDA scan

ERCP

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biliary atresiaCholedochal cyst

Gall stones

Gall stoneswritten

gall stonesstone

stone

stones

complications of stones

clinical picturesInvestigationstreatmentclinical picturesInvestigationstreatment

clinical pictures of gall stones

cholecystitis

common bile duct jaundice

common channelPancreatitis

clinical pictures

investigationsInvestigationssonarobstructive jaundiceERCP

pancreatitisamylaseCT

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complications

stones

stones

pathologycomplications

gall stones

complications

stonesgall bladderstones

Primarysecondary

stonekidneystonegall bladderstonesalivary gland

stonePrimarysecondary

secondaryInfectionInfection

Stones

secondary stoneStasis

InfectionStone

secondary stone

secondary stoneinfection

Infectionstasisstone

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infectionbile

provide nidusnidus

Nidus

PHPH

stoneurinary systemPrimarysecondary

secondaryinfection

Infectionstones

infectionstoneProvide nidusPH

PH

gall bladderInfectionInfectionstones

Infection

infection

Predisposing factorstonestonestonechronic inflammation

I can't eradicateinfection

stoneeradication of infectionstonechronic infection

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chronic infectionacuteInfectionstones

stonesinfectionVicious circleinfectionstone

stoneInfectionmultipleEpisodes, episodes, episodes of infection

primary stonesprimary stoneMetabolic error

metabolic errorbile

bilebile saltsbile pigmentscholesterolMucous

bile saltsbile pigmentcholesterolbile

bile saltsbile pigmentsbile pigmentRBCs

RBCsHemoglobinhaemglobinglobinbilirubin

bile pigment

bile saltsbile saltsfat

emulsion

bile saltsbile pigment



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balanceBalancebile salts

bile salts

bilebile saltsbile pigmentcholesterol

stones

bile pigmentbile pigment

Hemolytic anemiabile pigment

bilirubinRBCs

spherocytosissickle cell anemiathalassemia majorthalassemia intermedia

Hemolytic anemiaRBCsBilirubin

bilirubin

bile

Liverbilirubin

conjugationbile

bilirubin

capacityLiver

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bilirubinconjugatedbile

bilirubinUnconjugated bilirubin

conjugated bilirubinbilestooldark

hemolytic anemiaUnconjugatedconjugated

UnconjugatedJaundiceconjugated bilirubinbilestool

hemolytic anemiastool

bilirubincapacityLiver

bilirubinconjugated

bileconjugated bilirubin

conjugated bilirubinMudstones

Pigment stonemetabolicInfection

hemolytic anemia

X syndromeX syndrome

metabolic syndrome

goutischemic heart diseasediabetes

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X syndrome

X syndrome

X syndromeMetabolic errorhyper cholesterolemia

Hyper cholesterolemiabile

bile

bilecholesterol

stonecholesterol stones

Metabolic errorsCrohn's diseaseright hemicoloectomy

terminal ileum

terminal ileumterminal ileumentero-hepatic circulation

entero-hepatic circulationbile salts

entero-hepatic circulationbile salts

cholesterol

bile salts

bile saltscholesterol stones

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cholesterol stones

bile saltsThe same

bile saltscholesterol

1: 2513

2513

stonegall bladder

stonePrimary

secondary

secondaryInfection

infectionstone


metabolic errorsstonescholesterol


Liver diseaseLiver cirrhosisLiverbile salts

stonesgall bladdercholesterolpigmentmixed

Cholesterol stonePigment stonemixed stone

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Pigment stonepigment stone

hemolytic anemia

bilirubin

uncojugated bilirubinIndirect

direct bilirubinbile

bilemud

bileMudDark in color

Pigment stone

cholesterol stonehypercholesterolemia

hyper cholesterolemiaX syndrome

hyper cholesterolemiabile

stones

cholesterol crystals

Solitaire

Solitairesolitarycrystals

cut surfaceradiating

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Fatfat

cholesterol

cholesterol stonessingle

Whitish in color

cut surfaceRadiating

surfacemamilated

MamilatedMamilated

mamilated

mamilatedcut surfaceradiating

single

basics

crystals

cholesterol crystalsradiating

In radial manner

stone

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cholesterol stone

gall bladder healthyinflamedHealthy

Healthyprimaryinfection

cholesterol stoneInfection

stonestoneinfection

stonehealthy gall bladder

cholesterol stoneInflammation

Inflammationstone

stoneInflammation

Mixed stonesMixed

Mixedbile pigmentbile salts

bile

Mixedcholesterolbile pigmentbile saltsbile

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Mixed stoneInfection

infection

Provide nidusPH

Mixed stonegall bladderstone

stone

stonesNiduslaminated

PHPH

Niduslaminated

gall bladdergall bladdershrunkenfibrotic

stonesstonesstones

gall bladdershrunkenfibroticstonesstones

stones

episodes of infection

Laminaeepisodes of infection

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two laminaetwo episodes of infection

episode

Laminae

groupsgroupNiduslaminaeepisode of infectionPHlaminae

Mixed stonesFaceted

faceted

faceted

cholesterol stonesingleroundedMixed stonemultiplefaceted

single faceted stonecommon bile duct

single faceted stonecommon bile ductfaceted

common bile duct

stonesstonestones

gall stones

complicationsgall stonescomplicationsgall stonesOMUMI

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OMUMIObstruction

MigrationUlceration

Metaplasia

Infection

Obstructionobstruction

Chronic calcular cholecystitis

chronic cholecystitisShrunkenfibrotic

calcularstones

start pointnormal

X syndromehyper cholesterolemia

cholesterol stones

hyper cholesterolemia

Hyper cholesterolemia

Hyper cholesterolemiacomplications

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petit mal epilepsy

hyper cholesterolemiacholesterol stones

cholesterol stones

cystic ductgall bladder

cholesterol stone

hyper cholesterolemiafatty meal

Pain

Biliary colic

biliary colic12stasisfollowed by infection

gaurdingrigidityrebound tendernessacute cholecystitis

biliary colicacute cholecystitisrenal colicpyelonephritis

biliary colicgaurdingrigidityrebound tenderness

biliary colic

biliary colicstasisacute cholecystitis

common bile duct

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Obstructive jaundicegall bladderbiliary colicacute cholecystitis

common bile ductcalcular obstructive jaundice

common channel

Acute pancreatitis

common channelreflex of bilepancreatitis

Obstructive manifestations

cystic ductbiliary colicacute cholecystitis

common bile ductobstructive jaundicepancreatic ductpancreatitis

cystic ductbiliary colicacute cholecystitis

Catarrhalsuppurativegangrenous

catarrhalmucousMcuocele

pusPyocele

gangrenousfundus

blood supply

case of the appendixfundus

appendixcatarrhal inflammation

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MucousMucoceleSuppurative inflammationpuspyocele

Ganagrenoustipbase

base

Frictureobstructive

Harmanns pouchFriction and obstructive agent

gall bladderGIT

stonecystic ductBiliary colic

acute cholecystitiscomplicatedMucocelepyocele

common bile ductObstructive jaundice

Obstructive jaundicebiliary cirrhosisLiver

Liverbilebile

liverbilebile

white bilewhite bilebile

ObstructionMigration

Migration

gall bladdercystic duct

Biliary colicMigration

Colic

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common bile ductcolicgall bladdersmooth muscle

common bile ductsmooth muscle

common bile ductdull aching pain

gall bladdercolicygall bladdersmooth muscles

common bile ductsmooth muscles

gall bladdercoliccommon bile ductdull aching pain

Ulcerationgall bladdercommon bile duct

Bile

common bile duct

bileUrine

Hematuriabile

Hemobilia

Urinary systemhematuriabiliary systemhemobilia

hematuriabile

bileurinestool

bilestool

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stoolbleeding per rectum

melena

bleeding per rectumMelena

Obstruction, ulceration, migrationMetaplasia

Metaplasiaepithelium

epitheliumbile ductColumnar

GITGITcolumnar

lining epitheliumbile ductioncolumnarfriction

Squamous

Metaplasia is dysplasia anaplasiaMetaplasiadysplasiaanaplasia

InfectionInfection

inflammation of the liverHepatitis

Inflammation of the bile ductCholangitis

inflammation of the liver and bile ductCholangio-hepatitis

inflammation of the gall bladderCholecystitis

Inflammation of the pancreasPancreatitis

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Liverhepatitisbile ductcholangitisbile ductlivercholangio-hepatitis

pancreatitis

gall bladdercholecystitis

Obstruction, migration, ulceration, metaplasia and infection

fistulacomplicatoinsfistula

fistula formationgall bladderdistensible structure

appendix

appendixnon distensible

gall bladderdistensible

Distensiblegall bladder

omentumMassfistula

generalized peritonitisOmentum

fistulagall bladderappendixappendixnot distensible

gall bladdergall bladderdistensible structure

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OmentumMass

massgeneralized peritonitis

fistula

fistula

fistulaanatomically

appendicitisfistulanon distensible

gall bladderdistensible

48omentum

fistula

near by structure

gall bladderstructuresfistula

gall bladdergall bladdercommon bile duct

fistulagall bladdercommon bile duct

gall bladdercommon bile duct

Fistulacommon bile duct

Mirizzi syndromefistulacommon bile ductMirizzi syndrome

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Mirizzi syndromeFistula

common bile duct

Mirizzi syndromestonecommon bile duct

fistula

stonecommon bile ductMirizzifistulaMirizzi

stonecommon bile ductMirizzifistulaMirizzi

gall bladdercommon bileMirizzi

fistuladuodenumstonegall bladderduodneum

stonegall bladderduodenumduodenum

stonegall bladderduodenumgall bladderduodenum

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duodenum

Meckels diverticulm

ileo-cecal junction

Meckels divert iculumileo-cecal junction

gall stone ileus

gall stone ileusfistulacommon bile ductMirizzi

Fistuladuodenumgall stone ileus

gall bladderduodenumbileperiton

omentum

fistulageneralized pertonitis Omentummass

Gall bladder mass

stoneduodenumgall stone ileus

acute cholecystitisgall stone ileus

Intestinal obstructionclinically

Intestinal obstructionPainvomitingconstipationdistention

alreadypainvomitingconstipationacute cholecystitispain

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vomitingconstipation

acute choleycystitisgall stone ileussevere distention

distentionhow to confirminvestigationgall stone ileusPalin X-ray abdomen erect and supine

erectMultiple fluid level

supineAir in biliary tree

biliaryIntestinebiliary tree

biliary tree

40Multi para

Femalefatty

data

Painright hypochondriumRadiating to the back and the right should

gaurdingrigidity

severe abdominal distentionWhat is your diagnosis

Acute cholecystitisinvestigations of choice

Ultra soundtreatment

urgent choelcystecotmy

acute cholecystitis complicated by gall stone ileus

Investigations of choiceplain x ray abdomentreatmentresuscitationLaparotomyobstructionmass

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massobstructionstonemass

conservativeomentumgall bladder

N.B.

acute cholecystitissevere abdominal distentiongall stone ileus

gall stone ileusInvestigation of choiceultra sound

Intestinal obstructionUltra soundInvestigation of choiceplain x-ray abdomen

cholecystitisacute cholecystitisinvestigation of choiceultra sound

plain x ray

acute cholecystitisacute cholecystitis complicated by gall stone ileus

gall stone ileus

stonemass

Massomentumstone

rylelinecatheterfluidomentumgall bladder

mass

acute cholecystitisfatty , fertile, fortyPainright hypochondrium

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Radiating to the back and to the right shoulder39gaurdingrigidityrebound tenderness

jaundiceMirizzi syndrome

cholangitis

gall bladdercommon bile ductcholangitis

acute cholecystitiscomplicated by Mirizzi syndrome or cholangitis

acute cholecystitis jaundiceunless cholangitis or Mirizziacute cholecystitis jaundice unless cholangitisMirizzi

acute cholecystitis jaundiceUnlesscholangitisMirizzi

Mirizzistonecommon bile ductfistula

acute cholecystitisinvestigation of choice

ultra soundMirizzi syndromeInvestigation of choice

ERCPObstructive jaundice

acute cholecystitisInvestigation of choice

Ultra sound

Mirizzi Synddromeacute cholecystitisobstructive jaundiceinvestigation of choice

ERCP

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as regard dermoid cystsequestrated dermoid cyst

dermoid cystSequestrationinclusiontubuo dermoidimplantationteratomatous

female, fatty, fertile , fortypainright hypochondriumradiating to the back and the right shoulder

37gaurdingrigidityMild gaurdingbiliary colic

biliary colic

acute cholecystitis40

gaurdingrigidityrebound tendernessbiliary colicacute cholecystitis

casescolic

acute cholecystitis

fevergaurdingrigidityrebound tenderness

fistulacoloncholecysto colic fistula

gall bladderfistulagall bladderdistensible

omentum

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complications

gall stonePrimary

secondary

primaryMetabolic errors

secondaryInfection


stonesCholesterol, pigment and mixed

commonestMixed

MCQ

commonest stonemixedInfectiongall bladdercommonstones

infectionstonestoneinfection

mixed stone

Mixed stoneInfectionstone

cholesterol stoneinfectionMixed stonecommonest stonemixed

complicationsstone formationOMUMI

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ObstructionMigration

UlcerationMetaplasia

Infection

clinical pictures of gall stonestone

cholesterol stonehealthy gall bladderasymptomatic

cholesterol stonehealthy gall bladderasymptomaticStonecystic duct

biliary colicacute cholecystitis

Feverrigiditygaurdingrebound tenderness

Stonecommon bile ductCalcular obstructive jaundice

Stonecommon channelAcute pancreatitis

clinical pictures

asymptomaticpancreatitis

Investigations of choicegall stone

asymptomatic gall stone

Urinary tract infection sonargall stone

biliary colic

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Investigation of choiceUltra sound

gall bladder

99

ultra soundERCP

ultra soundERCP

Investigation of choiceUltra soundbiliary colicacute cholecystitis

chronic cholecystitis

asymptomaticbiliary colicacute cholecystitischronic cholecystitis

ultra sound


Ultra sound

common bile ductERCP

accuracyultra soundcommon bile duct70 %

accuracyultra soundcommon bile duct

Investigation of choice

ERCPERCPPTC

obstructive jaundiceroledilated intra hepatic bile duct

sonarobstructive jaundiceroleDilated intra hepatic bile duct

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Investigation of choiceobstructive jaundiceERCP

failedPTC

Investigation of choicePancreatitisserum amylaseCT scan

serum amylase3001000

Pancreatitisarterial blood gaseschest x raycomplications

gall bladder



common bile ductequalObstructive jaundice

common channelAcute pancreatitis

gall bladder

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stasisbad hygiene

bad hygiene

predisposing factorstasis

90 %acute cholecystitiscalcular obstructive

2/3acute appendicitisobstructive

predisposing factorObstruction

obstructionstasis

2/390 %acute cholecystitisobstructive

Non obstructive acute cholecystitisrare

obstructive acute cholecystitispredisposing factoracute cholecystitisobstruction

predisposing factorbad hygiene

pathologicallyacute cholecystitis

Catarrhal, suppurative and gangrenous

catarrhalMucous

Mucocele

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suppurativepus

Pyocele

gangrenousfundusHartmanns pouch

fundusblood supply

Hartmanns pouchfrictionobstructing agent

Peritoneal lasterLost

cystic lymph node of

lymph nodeHottender

Pathology

pathologyPathology

complications of acute cholecystitiscomplications

General and localGeneralFAHMsepticemia , pyemia and bacteremia

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Local complicationsacute cholecystitisstonecommon bile duct

Obstructive jaundice

common channel

Pancreatitis

fistulafistulacommon bile duct

MirizzifistuladuodenumGall stone ileusfistulacolon

cholecysto colic fistula

complications of acute cholecystitis

clinical pictures of acute cholecystitis

Symptoms and signsGeneral and local

symptomsGeneralFAHMlocalpain, swelling, disturbance of function

painPainright hypochondrium

Radiating to the back and to the right shoulder

right shoulderPhrenic

phrenic C 3, 4

L 3, 4

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C3,4phrenicL

L

PhrenicC3,4

Pain

swelling

disturbance of functionvomitingconstipation

PeritonitisPeritonitis

peristalsis

GIT

PeritonitisnauseavomitingPeristalsis

signs

Generalfevertachycardia Localinspectionrigidity

superficial palpationgaurdingdeep palpationtendernessrebound tenderness

auscultationdecreased intestinal soundspercussionnegative

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PRNegativegall bladderappendixPR

Unless, left appendixgall bladder

Special signHyperesthesiaback

Boass signappendicitis

appendicitisappendicitisgall baldderright hypochondrium

Hyperesthesia

appendicitisgall bladderback

acute cholecystitisedemaacute appendicitisgall bladderfundusanterior abdominal wall

appendix

gall bladderanterior abdominal wall appendixhyperesthesiaappendix

Boass

edemagall bladderappendix

anatomy

acute cholecystitisinvestigation of choice

Ultra sound

plain x ray

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Plain x ray

Investigation10 %

Plain X rayplain x rayultra sound

Investigation of choiceUltra soundgall bladder

90 %98 %

Gall bladderultra soundGall bladderultra sound

acute cholecystitisUltra soundultra soundgall stone

thickeningwall

stonecystic ductgall bladderdistendedgall bladderdistended

gall bladderdistended

90 %wall edematous

Investigation of choiceUltra sound

Ultra soundUltra sound

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sonar

90 %gall bladderobstructeddistendedwall edemaotus

gall bladder

Obstructeddistendededematous

X ray90 %

What is the major role of X ray in acute cholecystitisTo detect airbiliary tree with gall stone ileus

Main valueplain X - ray

Main valueplain X - rayacute cholecystitisTo detect gall stone ileus

airbiliary tree

Main valueplain X-rayacute cholecystitisTo detect gall stone ileus

airbiliary tree

HIDA scanLivercommon bile duct

duodenumgall bladder

gall bladder

HIDA scanLivercommon bile ductduodenum

gall bladder

Investigation

writteninvestigations

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InvestigationsUltra soundCBC

investigations

acute cholecystitis

acute cholecystitis48urgent cholecystectomy

acute cholecystitis48Urgent cholecystecotmy

acute cholecystitis48Conservative

omentum

acute cholecystitisCholecystectomy

MassConservative

massconservative

ConservativeRylelinecatheterfluid

conservative treatmentacute cholecystitisanalgesic

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antibiotic

analgesicmorphinespasmsphincter of oddi

acute cholecystitismorphine

spasmsphincter of oddi

spasm

gall bladderbilegall bladdersphincter of oddi

duodenumgall bladderliverbile

gall bladderduodenumLiver

acute cholecystitis

acute cholecystitisanti bioticbile

gall bladderbile

gall bladder

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bilebile

gall bladder

gall bladder

90 %antibioticbile

antibioticserum

acute cholecystitis48Urgent cholecystectomy

48Conservative

Semi-sitting positionryleLinecatheterfluid

analgesicanti biotic

analgesicantibioticserum

conservative treatmentOschner Sherrens

Oschner Sherrensanalgesic


Chronic cholecystitischronic cholecystitis

chronic cholecystitismanagement

Management of chronic calcular cholecystitismangement

Clinical pictures, investigations and treatment

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Mangement of chronic calcular cholecystitisgall bladdershrunkenfibrotic

Loss of lusterLymph node of

multiple stones

gall bladdergall bladder

clinical pictureschronic cholecystitischronic cholecystitis

Target

chronic cholecystitisFat dyspepsiaMurphys sign

complications

complications

chronic cholecystitisFat dyspepsiaMurphys sign


female, fatty, fertile, forty

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fat dyspepsiachronic cholecystitis

Murphys sign

chronic cholecystitisFat dyspepsiapositive Murphys sign

biliary colicFollowed by acute cholecystitis

clinical pictures of complications

clinical pictures of complications

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chronic cholecystitisFat dyspepsia

positive Murphys sign

Choronic cholecys titisgall bladdershrunkenfibrotic

multiple stones

Multiple stonesgall bladderacutechronic

acutestonegall bladderchronicstonesgall bladder


gall bladdershrunkenfibroticstonesgall bladder

dynamic ultra soundultra sounddynamic ultra sound

ultra sounddynamic ultra sound

sonargall bladdershrunkenfibrotic

gall bladder

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fibroticdynamic ultra sound

ultra sounddynamic ultra sound

ultra soundUltra sound

gall bladdershrunkenfibroticstones

dynamic ultra soundgall bladder

ultra sounddynamic ultra soundInvestigation

investigations for complicationsobstructive jaundiceERCP

pancreatitisserum amylaseCT scan

Investigations

investigations for complications


chronic calcular cholecystitischolecystectomychronic calcular cholecystitischolecystectomy

Non calcular cholecystitismedicalconservative

chronic calcular cholecystitischolecystectomy

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Mangement of obstructive jaundice

Management of calcular obstructive jaundice

data

calcular obstructive jaundicefemale, fatty, fertile, fort yepisodes of biliary colic

fat dyspepsiapositive Murphys sign

calcular obstructive jaundice

Female, fatty, fertile, fortyfat dyspepsiaMurphys sign


Female, fatty, fertile, forty

dataobstructive jaundice

type of patient

female, fatty, fertile, fortyfat dyspepsia

Urinestool

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general examinationscratch marks

Virchowsmalignant

local examinationgall bladder

calcular obstructive jaundicecommon bile ductcholesterolmixed

Mixed

cystic duct

MixedInfection

common bile ductascending cholangitis

Charcots triadCharcots tria d

Triad

painbiliary colic jaundice

Feverinfective calcular obstructive jaundice

Equal Charcots triad

Infective calcular obstructive jaundice = Char cots Triad

Infectionstonemalignancystoneinfection

common bile duct

Charcots triadcalcular obstructive jaundice

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painpainbiliary colic

JaundicecholecystitisObstructive jaundice

PainJaundice

complicated by infectionCharcots triad

ascending cholangitischolangio-hepatitis

septicemiaseptic shock

Hypotensiondisorientationrenal failure

Reynolds pentad

chronic calcular cholecystitis

fat dyspepsia

fat dyspepsia

cholecystectomyfat dyspepsia


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InfectionCharcots triadReynolds pentad

fat dyspepsia

calcular obstructive jaundiceReynolds pentad

Charcots triadcalcular obstructive jaundiceascending cholangitis

Charcots triad

cholangitisseptic shockReynolds pentad

calcular obstructive jaundicefluctuating in course jaundice

common bile ductbile

ball valve effect

ball valve effect jaundice

calcular obstructive jaundiceCharcots triadReynolds pentadIntermittent jaundice

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Charcots triadReynolds pentad jaundicefluctuating

Reynolds pentadCharcots triadaltered mental state and shock


type of patient

Female, fatty, fertile, fortyJust

Biliary colicpain


InfectedCharcots triad

Reynolds pentad

Charcots triadReynolds pentad

stoneball - valve effectIntermittent obstructive jaundice

malignant obstructive jaundiceMale

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general examinationScratch marksVirchows

Local examinationGall bladderCourvoisier

CourvoisierCourvoisiers lawmalignant obstructive jaundicegall badder

healthy

Malignant obstructive jaundicegall bladderhealthydistensible

gall bladderhealthydistensible

Malignant obstructive jaundicegall bladder

myocardial infarctiongall bladder congenitally absent

surgically removedfibroticshrunken

Malignant obstructive jaundicegall bladdercongenitally absent

Surgically removedInflamedfibrotic

Klatskin tumorcarcinomaPorta hepatis

Klatskin tumor

Open the doo r

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calcular obstructive jaundicegall bladder

shrunkengall bladdercalcular obstructive jaundicegall bladder

rarestonecholesterolgall bladderHealthy

stonecholesterol stonegall bladderHealthy

Mucocelepyocelemucocelepyocele

mucocelePyoceleMirizzi syndrome

Mirizzi syndromegall bladderMucocelePyocele

fibrotic

gall bladderdistendedcalcular obstructive jaundicecholesterol stoneHealthy gall bladderMirizzi syndrome

cholesterol stoneMirizzi syndrome

Mirizzi syndromecommon bile ductfistula

MucocelePyocelegall bladder


fatty, fertile

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biliary colic

equalCharcots triadReynolds pentad

ball valve effect

malignant obstructive jaundice

scratch marks

VirchowsCourvoisier

malignant obstructive jaundiceCourvoisier

Malignant obstructive jaundicepainless except latelate

Malignant obstructive jaundicepainless condition except late

Malignant jaundicepainless except lateMalignant obstructive jaundiceProgressive

progressive

Rareperi ampulla carcinoma

slaughingnecrosis

Malignant obstructive jaundicepainlessperi ampulla carcinomaslaughing

Painlessperi ampulla carcinomaslaughing

Investigationsobstructive jaundice

Liver function

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direct bilirubinalkaline phosphataseprothrombin timeProlonged

liverKidney

LiverKidneyUrine

UrineDarkfrothy

darkdirect bilirubin

frothyBile salts

frothysluphar test

stoolClaystercobilin

Ultra soundDilated intra hepatic bile ducts

idiot19

Ultra soundDilated intra hepatic bile ducts

stonesgall bladder

Investigation of choiceERCP

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ERCP

stonefilling defectcancerstricturebiopsy

stonefilling defectcancerstricturebiopsy

ERCPfailed canulation

PTCPercutaneous transhepatic cholangiography

commonest complicationsERCPAscending cholangitis

Most serious complicationsPTCBiliary peritonitis

ERCPascending cholangitis

ERCPascending cholangitis

ERCPprophylactic antibiotic

prophylactic antibiotic

commonest complicationsERCPascending cholangitis

ERCPPTCPTC

needlebile ductNeedlebile

biliary peritonitisERCPPTC

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ERCPPTCbiliary peritonitis

data

InvestigationERCPPTCMRCPMagnetic Resonance Cholangio Pancreatography

diagnostictherapeutic

MRCPMagnetic Resonance Cholangio PancreatographyMRIbiliary tree

ERCP qualitybilewallstricturestone

ERCPPTCInvasiondiagnostictherapeutic

ERCPstonediagnostictherapeutic

PTCstonebile

Jaundice

ERCPPTCdiagnostic valuetherapeutic value

MRCPdiagnostictherapeutic value

CT scanMalignantstone

StoneERCPmalignantCT scanIs a must

Staging

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cancer head pancreasCT is very importantstaging

CT scanFollow up

follow uptumor marker

Carcino-embryonic antigen (CEA)Pancreatic onco fetal antigen (POFA)

Pancreatic cancer associated antigen (PCAA)

carcino embryonic antigen

malignant obstructive jaundiceOperable

Inoperable

OperableWhipp les operationWhipple

Pancreatico duodenoectomyduodenumhead

blood supply

cancer head pancreasInoperableStent

technique

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Pre operative preperationcalcular obstructive jaundice

RyleLinecatheterfluidmannitolvitamin Kantibiotic

mongolSemian creaseprolonged prothrombin time

jaundicerenal failurepreparationHowPerparation

calcular obstructive jaundicePreparation

RyleLinecatheterfluidvitamin Kmannitolantibiotic

vitamin KProthrombin time

mannitol

hepato-renal failure

antibioticascending cholangitis

Preparation

ryleLinecatheterfluidvitamin KMannitolantibiotic

pre operative preparation

supra chondylar fracturePulseartery

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reductionfracture

Pre operative preparation

preparationRyleLinecatheterfluidMannitolantibiotic

ERCPsphincterotomy

ERCPsphincterdormia basketstone

sphincterotomysphincter

sphincterotomy

stonesphincterstone

stone

stonesphinctersphincterstone

sphincterotomysphincterotomy

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stonedormia basket

Chronic calcular cholecystitis

Obstructive jaundicestonecommon bile ductCharcots triad

anti bioticobstructive jaundice

stonecommon bile duct

chronic calcular cholecystitis

laparoscopecholecystectomy

chronic cholecystitischolecystectomy

obstructive jaundiceascending cholangititis

antibioticobstructive jaundice

stonecommon bile ductchronic calcular cholecystitis

laparoscopic cholecystectomy

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gall bladdercommon bile ductstone forecepsstone

calcular obstructive jaundicepreoperative preparation

stones

common bile ductstones


chronic calcular cholecystitischolecystectomy

common bile ductstonecommon bile ductstone

chronic calcular cholecystitis jaundice

chronic calcular cholecystitisCholecystectomy


chronic calcular cholecystitisobstructive jaundice

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chronic calcular cholecystitisCholecystectomy

calcular obstructive jaundicecholecystectomy

common bile ductstoneJaundice

calcular obstructive jaundicecommon bile ductstone

stoneanus

common bile duct

T tubeIntra operative T tube cholangiography

Intra operative T tube cholangiography

T tube

T tubecommon bile duct

biletube

400400 ml ringer lactate

bilebile

ringer lactateelectrolyte imbalance

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10omentumT tube

omentum48

gall bladder

T tubeInertomentum

10T tube

T tubepatent

T tube

bileOmentumheal by fibrosis

T tubeT tube

T tubetrackfibrosis

T tubebileperitoneal cavity

generalized peritonitisexaminer

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T tubeexaminer

T tuberadiographypatent

T tubeT tube

T tube

OmentumT tube

Missed stoneretained stone

Missed stoneretained stone

common bile duct

stoneduodenumcommon bile ductduodenum

choledochoduodenstomycommon bile ductduodenum

choledochoduodenostomy

bileduodneum

stone

common bile duct

bilepassive

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common bile ductduodenum

bileduodenum

bileduodenumcommon bile duct

choledochoduodenostomybilebileduodenum

ascending cholangitis

choledochocommon bile ductcholedochal

common bile ductduodenumcholedochoduodenostomy

stricutremultiple stonescommon bile ductdilated

common bile ductdilatedHealing by fibrosis

common bile ductdilatedhealing

Healingfibrosischoledochoduoenstomydilated common bile duct

choledochoduodenostomydilated common bile duct

common bile ductdilatedcholedochoduodenostomycholedochoduodenostomyHealing by fibrosisstricture

duodenumsphinctersphincterpatulous

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sphinctersphincter

Sphincter of oddi

patuloussphincterpatulous

transduodenalduodenum

Sphincteroplasty

transduodenal sphincteroplasty

bilepancreas

Pancreatitis

choledochoduodenstomytransduodenal sphincteroplasty

20

calcular obstructive jaundiceinvestigationERCP

calcular obstructive jaundicecalcular obstructive jaundiceaggressive

by surgery

choledochocholedochocholedocho

Choledocho

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cholecystectomy

cholecystectomystone

calcular obstructive jaundicepre operative preparation

ryleLinecatheterfluidvitamin KMannitolantibioticProthrombin timeprolongedvitamin K

antibioticascending cholangitisMannitolwashto avoid hepato-renal failure

according to technical supportERCP with sphincterotomystonedormia basket

Later on,Laparoscopic cholecystectomy

laparoscopic cholecystectomyOpenERCPsphincterotomystonedormia basket

technical supportlaparoscopic cholecystectomy

technical supporttechincal supportcholecystectomyduct

T tube

common bile ductstonesdilatedcommon bile ductdilated

stricuture

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choledochoduodenostomyend to sideside to side

choledochoduodenostomyend to sideside to side

common bile duct

duodenumendcommon bile ductsideduodenum

end to side

common bile duct

duodenumside to side

choledochoduodenostomysidecommon bile ductsideduodenum

endcommon bile ductsideduodenum



side to sideend to side

Preparationvitmain Kmannitolantibiotic

ERCPstonedormia basketLater on, laparoscopic cholecystectomy

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cholecystectomycholedochoduodenstomy

discussionT tube

discussionT tubeT tube

10Omentum

T tubeBile

bileringer lactate

discussionT tube

common bile ductdilatedMultiple stonescholedochoduodenostomy

common bile ductdilatedmultiple stonestrans duodenal sphincteroplasty

treatment

treatmentcalcular obstructive jaundice

Cancer head of pancreasOperableinoperable

system

operableOperation

Whipples operationpancreatico duodenoectomy

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duodenumheadpancreassame blood supply

blood supplySuperior and inferior pancreatico duodenal artery

OperableWhipples operation

inoperablestent

triple anastomosis

Minimal invasive surgerystent

stentInoperable

Cancer head of pancreasinoperable

inoperable cancer head of pancreasInferior vena cava

cancer head of pancreasInoperablestent

stentcancer head of pancreasinoperableNot resectable

stent

stent

duodenumwaiting for death to palliate the patient

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duodenum

gastro jejunostomy

cancer head of pancreasInoperableJaundice

JaundiceJejunum

gall bladdercommon bile duct

cholecysto-jejunostomycholedochojejunostomybile

bile

gall bladder

JejunumJejunumgall bladder

gall bladder

gall bladder jejuno-jejunostomy

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Jejuno-jejunostomy

gastro jejunostomy jejunumgall bladder

cholecysto jejunostomy

gall bladdercholangitis

Jejunum jejuno-jejunostomy

gall bladderJejuno-jejunostomy

anastomosisGasto-jejunostomy

Cholecysto jejunostomycholedocho jejunostomy jejuno jejunostomy

Whipples operationWhipples operationduodenum

Whipples operationOperableoperableWhipples

duodenum

inoperable

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stenttriple anastmosis

Stent

triple anastmosis

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9 - 10 - 11 Gall Bladder