MPMSU MBBS Surgery 2022 Paper 2 questions with their answers

• Caused by Echinococcus granulosus.
• Dogs = definitive host; humans = intermediate host.
• Ingested ova → penetrate gastric mucosa → portal vein → liver → cyst formation.

1. Adventitia (Pseudocyst): Host-derived fibrous tissue (pericyst). Non-separable, forms reaction layer.
2. Ectocyst: Laminated white, elastic membrane. Gets peeled off during surgery.
3. Endocyst: Germinal epithelium → secretes fluid & produces scolices inside brood capsules.

• Often asymptomatic; incidental finding.
• Dragging pain in RUQ due to hepatomegaly.
• Smooth, nontender liver enlargement.
• Rare: Hydatid thrill on percussion.
• May present with anaphylaxis or acute abdomen after trauma.

• USG: Modality of choice, classification (WHO-IWGE):
• Group 1: Active (>2 cm, fertile).
• Group 2: Transitional (degenerating).
• Group 3: Inactive (calcified).
• X-ray Abdomen: Speckled calcification.
• CT Scan: For superficial or complicated cysts.
• ERCP: If obstructive jaundice present.
• Serology: ELISA, Immunoelectrophoresis.
• Casoni’s test: Obsolete (low sensitivity/specificity).

I. Conservative:

• Leave calcified or asymptomatic small cysts.

II. Medical Treatment:

• Albendazole 8 mg/kg or 400 mg BD x 21 days + 2-week break. Max: 3 cycles.
• Monitor for neutropenia.

Indications:

• Disseminated disease, inoperable cysts, recurrent cases, surgical contamination.

III. Surgical Treatment:

• Indications:
• Symptomatic
• > 5 cm, non-calcified
• Infected cyst
• Principles:
• Isolate cyst with hypochlorite-soaked packs.
• Aspirate + inject scolicidal agents (e.g. hypertonic saline).
• Incise & remove laminated membrane.
• Leave adventitia (bleeds if removed).
• Ensure hemostasis + suture any bile leaks (ERCP stenting if required).
• Scolicidal Agents & Side Effects:
• Hypertonic saline – Hypernatremia
• Chlorhexidine – Acidosis
• Alcohol (80%) – Cholangitis
• Sodium hypochlorite – Hypernatremia
• Precautions:
• Pre-op Albendazole.
• Prevent spillage (to avoid peritoneal seeding).
• IV Hydrocortisone 100 mg to prevent anaphylaxis.

IV. PAIR (Percutaneous Aspiration, Injection, Reaspiration):

• CT/US-guided.
• Indications: Unilocular, uncomplicated cysts. Poor surgical candidate, post-surgery relapse.
• Contraindications: Multiseptated, biliary communication, dead/inactive cysts.

• Rupture: → Peritoneal hydatidosis, anaphylaxis, empyema, obstructive jaundice.
• Jaundice: Due to bile duct compression or intrabiliary rupture.
• Suppuration: Rare due to thick adventitia.
• Calcification: In chronic cases.

• Ileocaecal region due to:
• Rich lymphatics (Peyer's patches)
• Alkaline pH favors bacilli growth
• Stasis at ileocaecal valve
• Terminal ileum = max absorption

1. Ulcerative
2. Hyperplastic
3. Mixed

• Abdominal pain (most common): Dull, vague or colicky; Post-prandial or relieved by vomiting
• Diarrhoea: Watery, foul-smelling, may alternate with constipation
• Flatulence, borborygmi
• Abdominal distension: Due to ascites or subacute obstruction
• Constitutional symptoms: Weight loss, anorexia, pallor, tiredness

• Malnourished, pale appearance
• Visible peristalsis
• Palpable distended loops
• Doughy abdomen (peritoneal involvement)
• Right iliac fossa mass, rolled-up omentum, loculated ascites

1. No obstruction: Anti-Tubercular Therapy (ATT)
2. With Obstruction:
   • Solitary stricture: Stricturoplasty (longitudinal incision, transverse suture)
   • Multiple strictures at intervals: Multiple stricturoplasties
   • Multiple strictures in short segment: Segmental resection
3. Hyperplastic Tuberculosis:
   • Limited resection: Terminal 8–10 cm ileum, caecum, appendix, part of ascending colon
   • Followed by ileocolic anastomosis

All cases require:

• ATT for 9–12 months
• Nutritional support: Albumin, Hb correction, +/- transfusions

• Intestinal obstruction: Often ileal/jejunal
• Perforation: 6–8% mortality with peritonitis
• Malnutrition: Due to diarrhea, blind loop syndrome
• Faecal fistula: Post-op complication from resection/anastomosis (due to anastomotic dehiscence)
• Disseminated TB: Rare; occurs in untreated/immunocompromised patients, often with fulminant pulmonary TB

• Chronic duodenal/juxtapyloric ulcer causing cicatrisation + narrowing
• More common in South Indian patients
• Other causes: Gastric cancer, GAVE, corrosives

• Hunger pain of DU disappears, replaced by:
• Dull aching (gastric distension)
• Colicky pain (gastric hyperperistalsis)
• Vomiting: Profuse, projectile, persistent, foul-smelling, non-bilious
• Upper abdominal distension, epigastric fullness

1. Visible Gastric Peristalsis (VGP):
   • L hypochondrium → across umbilicus → R hypochondrium
   • Seen, felt, and heard
   • Made prominent by drinking 500–1000 ml water or flicking abdomen
2. Succussion Splash: On fasting stomach, splashing sound = residual gastric fluid
3. Auscultopercussion/Auscultoscraping Test: To outline greater curvature of stomach

• Infuse 700 ml NS via NG tube
• Clamp for 3.5 mins, aspirate: >350 ml residual = obstruction

• Hypochloraemic, hypokalaemic, hyponatraemic metabolic alkalosis
• Paradoxical aciduria

1. Barium meal X-ray: Dilated stomach, low position, no duodenal transit, mosaic appearance
2. Gastroscopy: Foul-smelling residue, scope may not pass into duodenum, rule out carcinoma
3. Serum Electrolytes: Confirm characteristic imbalances

• A: Aspiration: NG tube wash with NS, 3–5 days pre-op
• B: Blood: Arrange pre-op, correct anemia
• C: Charts: Monitor urine output, IV fluid support
• D: Drugs: Start antibiotics pre-op
• E: Exploratory laparotomy: Vagotomy + Gastrojejunostomy (GJ); Pyloroplasty avoided
• F: Fluids: Correct electrolytes with Ringer lactate

• Middle-aged women, antrum involved
• Red parallel stripes on endoscopy
• Associated with portal HTN, liver disease, autoimmune diseases, H. pylori
• If bleeding persists → Antrectomy

• Perforation usually involves anterior wall of duodenum; posterior ulcers bleed.
• Full-thickness defect → gastric/duodenal contents enter peritoneal cavity → chemical peritonitis.

Stages of Perforation:

1. Stage of Chemical Peritonitis (0–4 hrs):
   • Leakage of acid & enzymes → sharp pain, peritonitis signs
   • Absent liver dullness due to pneumoperitoneum
2. Stage of Reaction (4–6 hrs):
   • Peritoneal fluid dilutes acid → transient pain relief
   • Hypovolemia, paralytic ileus, worsening signs
3. Stage of Bacterial Peritonitis (>6 hrs):
   • Contamination with gut flora → sepsis
   • Toxic features: fever, shock, distension, rigidity, peritonitis

• A. Aspiration: Ryle’s tube decompression to reduce further spillage
• B. Blood: Grouping, cross-matching, transfuse if needed
• C. Charts: Monitor TPR, BP, urine output; Foley catheterisation
• D. Drugs: Triple antibiotic cover:
  • Ampicillin (G+ve), Gentamicin (G–ve), Metronidazole (anaerobes)
  • Cephalosporins if needed
• E. Exploratory Laparotomy:
  • Midline incision
  • Closure with omental patch (Graham's patch)
  • Peritoneal washout + drain placement
  • Large gastric ulcers → Gastrectomy if stable
  • Vagotomy & GJ deferred if poor condition
• F. Fluids: Correct dehydration, electrolytes; continue post-op till bowel function returns

• Erect X-ray chest/abdomen: Gas under diaphragm (pneumoperitoneum)
• CT abdomen with contrast: When X-ray inconclusive
• Blood tests: CBC, electrolytes, renal function

• IV fluids, NPO till ileus resolves
• Anti-ulcer therapy
• Endoscopy after 6–8 weeks
• If ulcer persists: H. pylori eradication
• Elective vagotomy + GJ if symptoms continue

• Achalasia = Failure of relaxation of the lower oesophageal sphincter (LOS)
• Primary motility disorder of the oesophagus
• Also called cardiospasm (spasm at gastroesophageal junction)

• Primary (Idiopathic): Degeneration of Auerbach’s plexus → loss of inhibitory neurons
• Secondary: Chagas disease (Trypanosoma cruzi – South America)
• Others: Stress, vitamin deficiencies, pseudoachalasia (malignancy)

• Type I: Classic achalasia – complete aperistalsis, no pressurization
• Type II: Panesophageal pressurization
• Type III: Spastic achalasia – premature contractions

• Dysphagia: Initially for liquids > solids
• Regurgitation of undigested food → foul smell
• Weight loss, malnutrition
• Retrosternal pain, heartburn
• Recurrent respiratory infections from aspiration
• Triad: Dysphagia + Regurgitation + Weight loss

Suspect clinically → Support with Barium Swallow → Confirm by Manometry → Exclude malignancy via Endoscopy

• Barium Swallow: Dilated oesophagus with tapering at GE junction (“Bird-beak” appearance)
• Manometry (Gold standard): Incomplete LOS relaxation, aperistalsis, elevated LES pressure
• Endoscopy: Rule out malignancy; assess oesophagitis or strictures
• X-ray Chest/Abdomen: Dilated mediastinum, air-fluid level, absent fundic gas
• CT/USG: If malignancy suspected

• Oesophagitis
• Aspiration pneumonia
• Anaemia
• Carcinoma oesophagus (8% risk over 20 years – squamous type)

Goal: Relieve LOS obstruction and improve emptying

Surgical (Definitive)

• Modified Heller’s Cardiomyotomy:
  • Laparoscopic myotomy of distal oesophagus + proximal stomach (7–10 cm)
  • Often with anti-reflux procedure (e.g., Dor fundoplication)
  • Success ~90%, reflux ~5%
• POEM (Peroral Endoscopic Myotomy):
  • Endoscopic submucosal tunneling + myotomy
  • Minimally invasive; effective in Type III achalasia

Non-surgical

• Pneumatic Balloon Dilatation:
  • Inflated to 300 mmHg under fluoroscopy
  • ~70% success, risk of recurrence, reflux, perforation
• Botulinum Toxin Injection:
  • Endoscopic injection into LOS
  • Temporary relief, requires repeat injections
• Drugs (Short-term only):
  • Nifedipine, isosorbide dinitrate – reduce LES pressure
  • Not preferred long-term due to side effects

Mesh repair is the most preferred surgical technique for incisional hernias, especially in obese, multiparous females with large fascial defects and poor abdominal wall tone. It provides a tension-free, non-absorbable suture-based repair using synthetic mesh.

• Large incisional hernias
• Obese patients
• Multiparous women
• Poor muscle tone
• Recurrent hernias

• 1. Onlay Mesh Repair:
  • Mesh placed over anterior rectus sheath in subcutaneous plane
  • Technically simple but requires wide flap dissection
• 2. Sublay (Retromuscular) Mesh Repair:
  • Mesh placed between posterior rectus sheath and rectus muscle
  • Preferred due to lower seroma and recurrence rates
  • Not feasible below arcuate line (no posterior sheath)

• 1. Incision and Exposure: Previous incision reopened; scar excised; flaps raised to expose muscles
• 2. Identification of Sac: Hernial sac dissected and opened; contents reduced; redundant omentum excised
• 3. Sac Management: Sac excised; peritoneum closed to avoid mesh contact
• 4. Mesh Placement:
  • Mesh (Prolene/Marlex) placed tension-free with 5 cm overlap in all directions
  • Secured using non-absorbable sutures
  • Onlay: Mesh in subcutaneous plane over anterior sheath
  • Sublay: Mesh between posterior sheath and rectus muscle

• Mesh: Prolene / Marlex (non-absorbable)
• Sutures: Non-absorbable (e.g., Prolene)

• Seroma formation (most common)
• Wound infection
• Mesh infection
• Recurrence (due to inadequate overlap or persistent tension)

• Tension-free closure
• Low recurrence rate
• Suitable for large defects
• Durable and strong repair

Portal venous pressure >15 mmHg or >20 cm saline.

• Bleeding varices: Occurs in ~33% of cirrhotic patients
• Variceal hemorrhage: 25–35% of cirrhotics
• Varices cause 10–30% of UGIB
• 30% of initial bleeds are fatal
• 70% of survivors have recurrent bleeding

• Formation: Splenic vein + SMV → Portal vein (behind pancreas neck)
• Length: Extrahepatic portal vein = 6–8 cm
• Branches: Divides at porta hepatis into R & L branches
• Blood supply: Portal vein supplies 75% of liver's blood
• Left gastric vein: Usually enters portal vein; 25% enter splenic vein

I. Extrahepatic (Prehepatic):

• Splenic vein thrombosis
• Portal vein thrombosis:
  • Neonates: Omphalitis
  • Adults: Pancreatic Ca, cavernoma formation
• Portal vein agenesis – Common in female children, LFTs normal

II. Intrahepatic (80% cases):

• Cirrhosis – Regenerating nodules compress portal radicles
• Schistosomiasis – Egg-induced fibrosis (S. mansoni, S. japonicum)

III. Posthepatic:

• Tricuspid regurgitation
• Constrictive pericarditis
• Budd-Chiari syndrome

Obstruction → Opening of portosystemic collaterals
Sites of anastomoses → Oesophageal varices → Haematemesis
Treatment aims at controlling oesophageal varices

Bleeding varices: Major cause of death in cirrhosis

Risk Factors for Variceal Bleed:

• Variceal wall tension
• Ongoing alcohol intake
• Poor liver function
• HVPG >12 mmHg (Normal = 5 mmHg)

• CBC: Anemia, pancytopenia (hypersplenism)
• LFTs: ↓ Albumin, reversed A:G, ↑ SGOT/SGPT, bilirubin, PT/BT/CT
• OGD Scopy: Varices, cherry red spots, grading
• SPV (obsolete): Splenic pulp pressure
• USG: Liver texture, portal vein, cavernoma, splenic vein diameter

• Eruptive theory: ↑ Intravariceal pressure
• Erosive theory: Mucosal erosion

Presentation: Haematemesis or malaena, haemodynamic instability

I. Primary Prophylaxis (Pre-Bleed):

• Pharmacologic: Non-selective β-blockers ± Isosorbide MN
• Endotherapy: Band ligation > Sclerotherapy

II. Secondary Prophylaxis (Post-Bleed):

Prevent rebleed post acute variceal bleed
Use Modified Child’s criteria: Albumin, bilirubin, ascites, encephalopathy, PT

III. Acute Variceal Bleed:

• General: ICU care, IV access, resuscitation, transfusion
• Prevent Encephalopathy: RT wash, bowel wash, neomycin, lactulose
• Drugs: Vasopressin, somatostatin, octreotide, terlipressin, metoclopramide

• Banding (Gold Standard): Effective, 10% rebleed
• Sclerotherapy: 2% ethanolamine oleate; not for gastric varices
• Balloon Tamponade: Rescue; Sengstaken/Minnesota tubes; max 12–24 hrs
• TIPSS: Refractory bleed; hepatic ↔ portal vein stent; risk: encephalopathy

A. Devascularisation:

• Oesophageal transection (Milnes-Walker)
• Gastric transection (Tanner)
• Sugiura–Futagawa: Most effective; includes splenectomy + EEA staplers

B. Shunt Procedures:

• Indications: Refractory bleed, Child A/B
• CI: Jaundice, ascites, hypoalbuminemia

Types:

• End-to-side portocaval – 90–95% success; 30% encephalopathy
• Side-to-side portocaval – Less encephalopathy (10%)
• Proximal splenorenal – Preferred in children
• Distal splenorenal (DSRS/Warren’s) – Extrahepatic PHT; minimal encephalopathy
• Mesentericocaval – SMV ↔ IVC; safe in children; used if portal/splenic vein thrombosed

Congenital defect due to imperfect fusion of post-allantoic gut with proctodaeum.

1 in 4,500 live births.

1. Wingspread Classification: Based on level of rectal pouch in relation to pelvic floor (puborectalis):

Type	Features
Low	Below puborectalis; e.g. covered anus, anal stenosis, anal membrane
Intermediate	At puborectalis level
High	Above puborectalis; may involve fistula to urethra, vagina, bladder

2. Present Classification:

A. Nonsyndromic ARM:

With fistula:

• Males: Rectoperineal, rectobulbar, rectoprostatic, rectobladder neck
• Females: Rectovestibular, rectovaginal, cloaca

Without fistula: Imperforate anus

Complex fistula:

• Cloaca with common channel <3cm or >3cm
• H-shaped rectovaginal fistula
• Rectal duplication

B. Syndromic ARM: Associated with syndromes (e.g. VATER/VACTERL)

• Males: Rectobulbar fistula
• Females: Rectovestibular fistula

• Failure to pass meconium
• Abdominal distension
• Anal dimple absent/malformed
• Meconuria (meconium per urethra) in males
• Associated anomalies: Cardiac, renal, spinal, tracheoesophageal (VACTERL)

• Wangensteen’s Invertogram (6–12 hrs after birth): Marker at anal dimple, lateral X-ray
  • High ARM: Rectal pouch >2.5 cm above marker
  • Low ARM: Pouch below Stephen's line
  • Intermediate: Pouch at ischial spine (Kelly’s point)
• Murugasu’s Technique: Needle aspiration → Contrast → Lateral X-ray
• Others: US abdomen (renal), Echocardiography (cardiac), MRI spine

Low ARM: Single-stage surgery under GA:

• Anoplasty
• Anovestibuloplasty
• Anal dilatation
• Incision of anal membrane

High ARM: Stage-wise surgery:

• 1. Initial colostomy
• 2. Definitive repair (e.g. posterior sagittal anorectoplasty)
• 3. Colostomy closure

Note: Outcome depends on rectal pouch level and sacral development.

• Infection
• Faecal fistula
• Anal stenosis
• Colitis
• Malnutrition
• Faecal incontinence

IVP (Intravenous Pyelography) is a radiological procedure used to visualize the kidneys, ureters, and urinary bladder using contrast dye injected intravenously.

• To assess renal function and detect structural abnormalities
• To diagnose conditions like:
  • Hydronephrosis
  • Renal, ureteric, or bladder stones
  • Congenital anomalies (e.g. polycystic kidney)
  • Urinary tract tumors

• Subcutaneous
• Submucosal
• Low anal fistula
• High anal fistula
• Pelvirectal fistula

Based on relation to anal sphincters:

• Intersphincteric (70%) – Commonest type; tract lies between internal and external sphincters.
• Transphincteric (25%) – Tract crosses both sphincters.
• Suprasphincteric / Supralevator (4%) – Tract arches above the puborectalis.
• Extrasphincteric (1%) – Tract extends from rectum to skin without involving sphincters.

• Low-level fistulas – Open below the internal anal sphincter (anal ring).
• High-level fistulas – Open at or above the internal anal sphincter.

A clinical rule to predict the course of an anal fistula tract based on the external opening:

• Direct (Anterior) Type: External opening anterior to an imaginary transverse line through the anus. Tract is straight and radial. Applies if opening is <3.75 cm from anal verge.
• Indirect (Posterior) Type: External opening posterior to the line. Tract curves to the posterior midline, may be horseshoe-shaped.

Note: Exceptions may occur in complex or multiple fistulae.

Definition: Hypospadias is a congenital condition in which the external urethral meatus opens on the underside (ventral surface) of the penis instead of at the tip, often associated with chordee (ventral curvature) and hooded prepuce.

• Glandular – Opening within the glans.
• Coronal – Opening at the junction of glans and shaft.
• Penile – Opening on the shaft of the penis.
• Penoscrotal/Perineal – Opening near the scrotum or perineum; may be associated with ambiguous genitalia.

• One-stage urethroplasty: Correct chordee and create neourethra in a single surgery.
• Two-stage urethroplasty:
  • Stage 1 (6–12 months): Chordee correction (orthoplasty).
  • Stage 2 (5–6 years): Urethral reconstruction using local skin (urethroplasty).
• Note: Circumcision should be avoided before surgery.

Definition: In a jaundiced patient, if the gall bladder is palpably enlarged, it is not due to stones.

Reason: In case of stones, previous inflammation causes fibrosis of gall bladder, hence non-palpable.

Implication: Palpable gall bladder + jaundice = Malignancy more likely (e.g., periampullary carcinoma, carcinoma head of pancreas).

Clinical Note:

• 90% of obstructive jaundice cases are due to:
• Stones
• Periampullary carcinoma
• Carcinoma of head of pancreas

1. History:

• Onset, duration, and progression:
  • When was the mass first noticed?
  • Has it increased in size? If so, over what period?
• Associated symptoms:
  • Pain: Is it painful or painless? (Painless is more typical of malignancy.)
  • Heaviness or dragging sensation in the scrotum
  • History of trauma to the area
  • Constitutional symptoms: Weight loss, night sweats, fever, fatigue
• Urological and reproductive history:
  • Undescended testis (cryptorchidism)
  • Infertility or subfertility
  • Previous testicular conditions (e.g., torsion, epididymitis)
• Family history:
  • Testicular cancer or other genitourinary malignancies

2. Physical Examination:

• Inspection:
  • Asymmetry, swelling, skin changes
  • Visible veins (e.g., varicocele)
• Palpation:
  • Each testis assessed separately
  • Size, consistency (hard, firm, rubbery), tenderness, mobility
  • Intra-testicular mass: usually malignant
  • Extra-testicular mass: usually benign (e.g., epididymal cyst)
• Transillumination:
  • Solid tumors do not transilluminate
• Other examinations:
  • Abdomen: Retroperitoneal lymphadenopathy
  • Supraclavicular lymph nodes
  • Breasts: Gynecomastia (e.g., choriocarcinoma)

1. Emergency Splenectomy

• Indication: Haemodynamic instability (BP < 90 mmHg, HR > 130/min)
• Steps:
  • Ligate splenic artery (upper border of pancreas)
  • Ligate splenic vein
  • Mobilise spleen via lienorenal ligament
  • Clamp splenic hilum → remove spleen
• Life-saving and quick

2. Partial Splenectomy

• Indication: Stable patient, especially children
• Rationale: Splenic artery has upper and lower polar branches
• Procedure: Ligate one branch → stop bleeding → remove part of spleen
• Optional: Implant splenic fragments in omentum → neovascularisation

3. Splenorrhaphy

• Indication: Small tear, stable condition
• Procedure:
  • Suturing with chromic catgut
  • Wrap with greater omentum
• Aim: Preserve splenic function

4. Nonoperative (Conservative) Management

• Indication: Stable adults/children with isolated splenic injury
• Criteria for caution:
  • Age > 50 years
  • Grade 3/4 injury
  • Blood > 500 ml on CT
  • Associated solid organ injury (e.g., liver)
  • Systemic vascular lesions (e.g., pseudoaneurysm, AV fistula)
• Monitoring:
  • ICU care
  • Serial Hb, WBC count, BP, abdominal girth
  • Risk of delayed rupture

Definition:
Sustained intra-abdominal pressure (IAP) >20 mmHg with or without abdominal perfusion pressure (APP) <60 mmHg, associated with new organ dysfunction/failure.

Normal IAP: 0–5 mmHg

Grades (Burch Classification):

• Grade I: 12–15 mmHg
• Grade II: 16–20 mmHg
• Grade III: 21–25 mmHg
• Grade IV: >25 mmHg

Systems Affected:

• Pulmonary: Hypoxia, ARDS
• Cardiovascular: Arrest
• Renal: Oliguria, ARF
• CNS: Cerebral edema

Risk Factors:
Tight closure, obesity, ascites, ileus, pneumoperitoneum, burns

Management:

• Medical: Treat cause, hemodynamic support
• Surgical:
  • Temporary closure (Bogotá bag, VAC)
  • Definitive closure (mesh, primary closure)

Definition:
A type of central neuraxial blockade where local anaesthetic is injected into the epidural space, blocking spinal nerves as they exit the intervertebral foramen.

Position:
Sitting or lateral decubitus.

Technique:

• Needle: 16–18G Tuohy needle
• Approach: Midline or paramedian
• Entry confirmed by: Loss of resistance to air/saline after piercing ligamentum flavum
• Catheter: Inserted 3–4 cm into epidural space
• Test dose: 3 ml of 2% lignocaine + 15 μg adrenaline to rule out intrathecal/intravascular injection

Advantages:

• Can be used at lumbar, thoracic, cervical, sacral levels
• Segmental block possible
• Prolonged anaesthesia via catheter
• Lower incidence of hypotension and PDPH

Definition:
MRCP is a non-invasive imaging technique using MRI to visualize biliary and pancreatic ducts, including gallbladder, bile ducts, pancreatic duct, liver, and pancreas.

Purpose:

• Detect gallstones or bile duct stones
• Bile duct obstruction or strictures
• Pancreatitis or pancreatic duct abnormalities
• Tumors of bile ducts, gallbladder, pancreas
• Congenital biliary abnormalities

How It Works:
Uses strong magnetic fields and radio waves; fluid in bile and pancreatic ducts appears bright. Usually no contrast needed.

Advantages:

• Non-invasive
• No radiation exposure
• High soft tissue detail
• Safe for most patients

Preparation:

• Fasting for 4–6 hours
• Screen for metal implants, pacemakers, MRI contraindications