{"id":630,"date":"2020-02-17T15:39:45","date_gmt":"2020-02-17T15:39:45","guid":{"rendered":"http:\/\/app.rguc.co.uk\/?p=630"},"modified":"2024-11-18T07:54:22","modified_gmt":"2024-11-18T07:54:22","slug":"biliary-tree","status":"publish","type":"post","link":"https:\/\/vapp.rguc.co.uk\/?p=630","title":{"rendered":"Biliary Tree"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[44],"tags":[],"class_list":["post-630","post","type-post","status-publish","format-standard","hentry","category-innovative-anatomy","entry"],"youtubeVideo":"433611543\/597a7be8a6","question1":"The gallbladder is involved in the synthesis and storage of bile.","answers1":"True | False","correctAnswer1":"1","correctAnswerText1":"The gallbladder is involved in the storage of bile. The liver is involved in its synthesis.","question2":"Blood supply to the gallbladder is by means of the cystic artery.","answers2":"True | False","correctAnswer2":"0","correctAnswerText2":"The blood supply of the gallbladder is the cystic artery, this is a branch of the right hepatic artery which derives from the common hepatic branches (one of the three major vessels from the coeliac trunk).\r\n","question3":"The gallbladder lies within the gallbladder fossa.","answers3":"True | False","correctAnswerText3":"The gallbladder is located in the right upper quadrant of the abdomen; it is intraperitoneal organ lying within the fossa that is formed by the inferior aspects of the right and quadrate lobes of the liver. \r\n\r\nThe anatomical relations of the gallbladder are as follows:\r\n\r\n- Anteriorly and superiorly: Inferior border of the liver and the anterior abdominal wall\r\n\r\n- Posteriorly: Transverse colon and the proximal duodenum \r\n\r\n- Inferiorly: Biliary tree and duodenum.\r\n\r\n","correctAnswer3":"0","question4":"Biliary colic involves inflammation of the gallbladder secondary to impaction of a stone within the neck of the gallbladder or cystic duct.","answers4":"True | False","correctAnswer4":"1","correctAnswerText4":"Biliary colic does not (predominantly) involve inflammation. It can however lead to acute cholecystitis if the gallbladder becomes infected and inflamed.","question5":"The male gender is a recognised risk factor for biliary disease.","answers5":"True | False","correctAnswer5":"1","correctAnswerText5":"Risk factors for biliary disease include the 5 F\u2019s: Fat, forty, female, fertile and fair.","question6":"Murphy\u2019s sign is elicited whilst asking the patient to deeply expire. This process lowers the diaphragm and subsequently the gallbladder.","answers6":"True | False","correctAnswer6":"1","correctAnswerText6":"The diaphragm, and thus the gallbladder move down during inspiration, not expiration. A positive Murphy\u2019s sign is associated with pain secondary to palpation in the right upper quadrant during inspiration. \r\n\r\nA positive murphy sign is described as pain in the RUQ on deep inspiration (and not expiration) this is because the diaphragm moves the gallbladder down. ","question7":"Acute cholecystitis is associated with a significant derangement in bilirubin levels.","answers7":"True | False","correctAnswer7":"1","correctAnswerText7":"Cholecystitis is defined as inflammation of the gallbladder this can be in the absence of infection. Typically, cholecystitis does not present with jaundice (raised bilirubin) It is important to consider an alternative diagnosis i.e. ascending cholangitis if the patient is significantly jaundiced. ","question8":"Ascending cholangitis classically presents with Charcot\u2019s triad.","answers8":"True | False","correctAnswer8":"0","correctAnswerText8":"Charcot\u2019s triad includes right upper quadrant pain\/tenderness, fever and jaundice (secondary to a rise in bilirubin). 10-20% of patients present with additional features of shock and altered mental state. This is referred to as Reynold\u2019s pentad. ","question9":"Patients with suspected biliary disease should initially be investigated with a CT scan.","answers9":"True | False","correctAnswer9":"1","correctAnswerText9":"An ultrasound scan is the preferred first-line radiological mode of investigation in biliary disease.","question10":"Gallstones and alcohol excess are the most common causes of pancreatitis in the UK.","answers10":"True | False","correctAnswer10":"0","correctAnswerText10":"Causes of pancreatitis are commonly remembered with the  I GET SMASHED mnemonic: \r\nI: idiopathic \r\nG: Gallstones \r\nE: Ethanol \r\nT: trauma \r\nS: Steroids\r\nM: Mumps \r\nA: Autoimmune \r\nS: scorpion \/ spider bites \r\nH: hyperlipidemia, hypercalcemia (or other metabolic disorders) \r\nE: ERCP \r\nD: Drugs i.e. furosemide, azathioprine, thiazide etc. \r\nThe first four letters represent the commonest causes of pancreatitis \r\n","question11":"","answers11":"","correctAnswer11":"","correctAnswerText11":"","question12":"","answers12":"","correctAnswer12":"","correctAnswerText12":"","question13":"","answers13":"","correctAnswer13":"","correctAnswerText13":"","question14":"","answers14":"","correctAnswer14":"","correctAnswerText14":"","question15":"","answers15":"","correctAnswer15":"","correctAnswerText15":"","icon":"chest","parentId":"","recapId":"","_links":{"self":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/630"}],"collection":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=630"}],"version-history":[{"count":5,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/630\/revisions"}],"predecessor-version":[{"id":738,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=\/wp\/v2\/posts\/630\/revisions\/738"}],"wp:attachment":[{"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vapp.rguc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}