General hepatobiliary diseases
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Choledochal cyst section
- 88 posts
17 topics in this forum
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[size=20px]A 12-year-old is referred to your clinic by their pediatrician for evaluation of crampy, post-prandial right upper quadrant pain of 8 months duration. A right upper quadrant ultrasound showed no gallstones or evidence of chronic cholecystitis. A HIDA scan was obtained and demonstrated an ejection fraction of 25%. The report notes that the patient had pain with CCK injection. What is the most appropriate next step in management? a Offer cholecystectomy or medical management based upon patient preference b Medical management c Cholecystectomy d Refer to a gastroenterologist for further evaluation[/size]
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A 4-yr old, previously healthy girl, born at term, has 3 days of generalized abdominal pain. Exam shows normal vital signs and a mildly tender abdomen without peritoneal signs. Abdominal ultrasound (shown) demonstrates a normal appendix, and a very thickened gallbladder wall (7 mm), without stones. The biliary tree is normal. L:ab tests show a mildly elevated CRP (28) and normal CBC & lipase. The AST, ALT, and direct bilirubin are mildly elevated. How will you treat this patient?
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A previously healthy 4-year old girl had an episode of pancreatitis which resolved after 72 hours. Ultrasound showed some gallbladder sludge, a mildly dilated common bile duct at 6.7 mm, and mildly dilated hepatic ducts. The GI specialist believes she passed a stone. What would you do next?
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[size=20px]A five-year old boy with a history of biliary atresia and liver failure after an initially successful Kasai procedure is transferred to the pediatric intensive care unit with hematemesis. He receives 20 mL/kg of lactated Ringers and one unit of pRBCs. The hemoglobin in 9 gm/dL. Flexible upper gastrointestinal endoscopy reveals bleeding from esophageal varices. Octreotide is administered. The next best step in management in this child with bleeding esophageal varices is A transjugular intrahepatic portosystemic shunt (TIPS). B placement of a Sengstaken Blakemore tube (balloon tamponade). C emergency mesocaval shunt procedure. D variceal banding. …
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Cotton Mather;1724 The Angel of Bethesda
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