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Chapter 32: The Gallbladder and Extrahepatic Biliary System

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The arterial supply of the common bile duct is derived from

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A. The left hepatic artery

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B. The right hepatic artery

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C. The gastroduodenal artery

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D. The right hepatic and gastroduodenal arteries

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E. The left hepatic and gastroduodenal arteries

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Answer: D

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The majority of the blood flow to the human common bile duct originates from the right hepatic artery and gastroduodenal arteries, with major trunks running along the medial and lateral aspects of the common duct (often referred to as the 3 o’clock and 9 o’clock positions). (See Schwartz 10th ed., p. 1311.)

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Anomalies of the hepatic artery and cystic artery are present in what percent of individuals

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A. 15%

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B. 25%

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C. 35%

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D. 50%

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E. 75%

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Answer: D

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Variations in the anatomy of the cystic and hepatic arteries are exceedingly common, the “classical” anatomy only appearing in 50 to 60% of the population. The cystic artery is a branch of the right hepatic artery in 90% of individuals. The most common arterial anomaly of the portal arterial system is a replaced right hepatic artery originating from the superior mesenteric artery; this happens in 20% of persons. (See Schwartz 10th ed., p. 1312.)

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The treatment of choice for a type I choledochal cyst is

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A. Observation.

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B. Cyst resection and primary re-anastomosis of the common bile duct.

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C. Resection of the common bile duct, cholecystectomy, and hepatico-jejunostomy.

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D. Resection of the cyst and choledocho-duodenostomy.

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Answer: C

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Choledochal cysts are rare congenital cystic dilations of the extrahepatic and/or intrahepatic biliary tree. Females are affected three to eight times more commonly than men. Though they are commonly diagnosed in childhood, as many as one half of patients are not diagnosed until adulthood. The most common presentations in adulthood are jaundice and cholangitis, and less than one-half of patients present with the classic clinical triad of abdominal pain, jaundice, and a mass. Ultrasonography (US) or computed tomographic (CT) scanning will confirm the diagnosis, but a more definitive imaging technique such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography, or magnetic resonance cholangiopancreatography (MRCP) is required to ...

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