11. Gallbladder

Question 1

Calot’s Triangle ?

Answer 1

the cystic duct, the common hepatic duct, and the cystic artery.

Question 2

Asymtomatic gallstone disease ?

Surgical treatment MAY be performed in:

Answer 2

• Patients with elevated risk of the cancer of gallbladder.
• Pts with chronic haemolitic anemia.
• Diabetic patients complicated by cardiac ischaemia or kidney disfunction.
• Candidates for a transplant: kidney, heart, lung.
• Young people with estimated life expectancy > 30 more years.
• Pts before long travels – on their own clear request.

Question 3

Mildly symptomatic cholelithiasis ?

Answer 3

• Belching, nausea, abdo heartburn, feeling of full epigastrium.
• Improvement in 80% of pts operated with these symptoms.

Question 4

Symptomatic cholelithiasis :

Answer 4

• Occurs in 3% of stone „owners”, with a rise of 1-2% yearly.
• <1/3 will get symptomatic within 20 years of observation.

Question 5

Biliary colic ?

Answer 5

• Moderate pain under right costal margin or right epigastrium lasting 0,5-6 h.
• Radiation of pain to the back or right scapula.
• Onset after a fatty meal.

Question 6

Forms of cholestitis ?

Answer 6

• Chronic Cholecystitis.
• Acute Cholecystitis.
• Acalculous Cholecystitis.

Question 7

Acute cholecystitis Causes ?

Answer 7

Obstruction of gallbladder’s neck or cystic duct by a stone leading to infection of bile or cystic wall

Question 8

Symptoms of Acute cholecystitis ?

Answer 8

• Strong pain in RUQ lasting usually more than 6 hrs.
• N and V.
• Fever.
• Murphy’s sign, Chełmonski sign, right shoulder pain (boas’ sign).
• Localized peritonitis sign may occur.
• sometimes palpable gallbladder.

Question 9

Acute cholecystitis

Imagining ?

Answer 9

• Abdominal USG (sensitivity 92-95%).

- Limited by: obesity, distention

Question 10

Acalculous Cholecystitis?

Answer 10

• May be acute or chronic.

- Complication in: burn, sepsis, trauma and collagen vascular disease.

Question 11

Complications of acute cholecystitis?

Answer 11

• Hydrops of gallbladder.
• Empyema of gallbladder.
• Perforation of gallbladder.
• Emphysematous cholecystitis.

Question 12

Complications of chronic cholecystits?

Answer 12

• Gallbladder cirrhosis.
• Biliary fistulas.
• Mirizzi Syndrome.

Question 13

Mirizzi syndrome ?

Answer 13

• is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder.
• Grade I and II.

Question 14

LAPAROSCOPIC CHOLECYSTECTOMY

Relative contraindications ?

Answer 14

• Liver cirrhosis
• Portal hypertension
• Pregnancy
• Previous abdominal surgery.

Question 15

LAPAROSCOPIC CHOLECYSTECTOMY

Absolute contraindications?

Answer 15

• Suspition of gallbladder cancer
• Peritonitis
• Coagulopathy
• Severe cardiopulmonary insufficiency