Hepatobiliary Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Hepatobiliary Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

A 55-year-old woman presents 36 hours after an uncomplicated laparoscopic cholecystectomy with persistent low-volume biliary drainage through a surgical drain. Her labs are stable, major bile ducts appear intact on imaging, and there's evidence of localized bile leakage. How should you interpret the clinical presentation and imaging findings to identify the most probable source of bile leakage in this postoperative scenario? Which anatomical considerations are essential for accurate diagnosis? VIDEO INFO Category: Hepatobiliary Anatomy, Human Anatomy, USMLE Step 1 Difficulty: Easy - Basic level - Suitable for medical students Question Type: Treatment Failure Case Type: Tricky Findings Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 55-year-old woman is 36 hours after an uncomplicated laparoscopic cholecystectomy for biliary colic. She has idiopathic pulmonary fibrosis treated with pirfenidone and uses acetaminophen for pain; she has no known drug allergies. She previously smoked 1 pack per day for 10 years and quit 5 years ago.... OPTIONS A. A small accessory subvesical bile duct in the gallbladder bed (also called a duct of Luschka) draining into right intrahepatic ducts; leakage from this duct causes confined, low-output bile in the drain with a HIDA focus at the fossa and normal duct imaging. B. A dehisced cystic duct stump at Calot s triangle; this typically produces a tract from the cystic stump and more diffuse peritoneal tracer or ductal outlining on imaging rather than a confined fossa focus with normal bilirubin. C. A partial common hepatic duct transection; this would more often lead to jaundice, rising bilirubin, and MRCP evidence of extra-luminal contrast or upstream ductal dilation instead of an isolated gallbladder fossa leak. D. Ischemic necrosis of the extrahepatic bile duct from injury to an aberrant right hepatic artery; arterial injury can impair healing but does not by itself explain a localized, low-volume leak confined to the gallbladder fossa with intact ducts. CORRECT ANSWER A. A small accessory subvesical bile duct in the gallbladder bed (also called a duct of Luschka) draining into right intrahepatic ducts; leakage from this duct causes confined, low-output bile in the drain with a HIDA focus at the fossa and normal duct imaging. EXPLANATION Low-volume, persistent bilious output with normal bilirubin and intact major ducts on MRCP points to a localized leak from a small accessory duct in the gallbladder bed rather than injury to the main ductal system. In this postoperative setting, hepatobiliary scintigraphy showing a focal tracer hot spot limited to the fossa while tracer also enters the common bile duct and bowel is classic for a subvesical (Luschka) duct leak. These subvesical ducts drain small portions of the right hepatic lobe into the gallbladder bed and are commonly unrecognized during cholecystectomy because they do not enter the cystic duct.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------