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Gall Bladder Flashcards

1
Q

Shape of gallbladder

A

Pyriform

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2
Q

Gallbladder lacks which layer of GI

A

Submucosa

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3
Q

Which valve is present at GB Neck

A

Valve of heister

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4
Q

What are the function of GB

A

I. Reservoir for bile.
a. Secretes mucin.
3. The concentration of bile.

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5
Q

Boundaries of Cholecystohepatic triangle

A

1) The inferior edge of the liver.
2) Common hepatic duct.
3) Cystic duct.
contains a cystic artery.

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6
Q

Boundaries of calot’s triangle

A

Smaller triangle within bigger Cholecystohepatic triangle.
Bounded by: Cystic artery.
Cystic duct.
Common hepatic duct.

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7
Q

Which is the 1st LN to enlarged in GB cancer

A

Harbours cystic lymph lode of lund

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8
Q

What is Moynihan’s Hump

A

Right hepatic artery can have a tortuous course and can lie in the hepatocystic triangle.
The right hepatic artery can get injured and lead to hemorrhage during surgery.

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9
Q

What is Phrygian Cap (fundus folded inwards)

A

It is an anatomical variation of GB . Which is not an indication of sx

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10
Q

Most common Gall Stone in asia

A

Pigment Stones

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11
Q

Most common Gall Stone overall

A

Mixed stones

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12
Q

Composition of Brown Gall stones

A

Ca Palmitate ; Ca Stearate ;
Ca Bilirubinate

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13
Q

Composition of Black Gall stones

A

Ca Phosphate & Ca Bicarbonate

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14
Q

RF of gallstones

A

(1)Lithogenic Bile : Obese ; Increased cholesterol ; Post ileal resection
(2) Stasis : Pregnancy ; OCP’s ; TPN ; Rapid weight loss ; Post vagotomy
(3) Nucleation : Infections ; Clonorchis
; Cholangitis ; Ascariasis

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15
Q

How much percentage of gallstones are Radiolucent

A

90%

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16
Q

How much percentage of gallstones are Radioopaque

A

10%

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17
Q

How to differentiate on Ulrasound between gallbladder stone and polyp.

A

Gall bladder stone has shadow present .
Gall bladder polyp has no shadow present on ultrasound

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18
Q

Which sign is seen in radio opaque gall stones

A

Seagull sign (biradiate sign) ;;
Mercedes Benz sign (triradiate sign)

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19
Q

What is acute cholecystitis

A

Inflammation of gallbladder

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20
Q

Which sign is seen in acute cholecystitis

A

Murphy’s sign ;
boa’s sign

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21
Q

Describe Murphy’s sign

A

Patient catches his/her breath when pressed in the right hypochondrium

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22
Q

Describe boa’s sign

A

Hyperesthesia in the region of the 12th rib

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23
Q

WHAT IS HIDA Scan

A

Comes into gallbladder in 30 minutes (90% cases) . comes into bowel in 90 minutes. non-visualization of gallbladder in case of acute cholecystitis

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24
Q

Emergency cholecystectomy is done only if

A

Patient presents within 2-3 days

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25
HPE of Chronic cholecystitis
Rokitansky aschoff sinuses if it ruptures leads to Xanthogranulomatous cholecystitis.
26
Emphysematous cholecystitis is occurs due to which condition?
Clostridium.
27
Emphysematous pyelonephritis occurs due to which organism
E.Coli
28
What is mucocele
Aseptic dilatation of GB.
29
In mucocele stones get impacted at
Hartmann pouch
30
What is mirizzi syndrome
GB becomes adherent to CBD due to inflammation . The stones inside GB presses on CBD
31
IOC for mucocele
MRCP
32
What is gallstones ileus
Dynamic bowel obstruction. Secondary to a cholecysto-duodenal fistula. Due to inflammation GB becomes adherent to the duodenum.
33
MC site for gallstone ileus
Terminal 2 feet off the ileum
34
What is Bouveret syndrome
Stone leads to gastric outlet obstruction. Clinical features: Distension, obstipation, pain and vomiting. Initial investigation : X-ray abdomen
35
What is Rigler's triad
1) Pneumobilia 2) Features of small intestine obstruction 3) Radio-opaque shadow in right iliac fossa.
36
What is choledocholithiasis
Stones in the CBD which were formed in GB (90% of cases) ;; in 10% it is formed in CBD.
37
Charcot’s triad includes
Intermittent pain; Intermittent fever; Intermittent jaundice
38
Reynolds pentad includes
Charcot’s triad + Shock + AMS/altered mental status
39
IOC for CBD stones
MRCP
40
IOC for CBD microliths
Endoscopic ultrasound
41
What is burhenne technique
Insert a T-tube in CBD
42
ERCP
In ERCP a side viewing deodenoscope is introduced. (Is both Diagnostic and therapeutic). A cut is made in the spincter at 11'O' clock position. Complications: ERCP induced pancreatitis (mc). Duodenal perforation (2nd mc).
43
In Which position the patient of kept during lap.cholecystectomy
Reverse Trendelenburg position. (Head ends up, foot end down and right side up)
44
MC complication following lap. Chole
Right shoulder tip pain. (Retained CO2 under dome of the diaphragm)
45
What is Post cholecystectomy syndrome
Clinical features of cholecystitis even after laparoscopic cholecystectomy. Causes : Retained CBD stones. Biliary dyskinesia Sphincter of Oddi dysfunction.
46
Kocher incision is
Right Subcostal incision made in open cholecystectomy.
47
MRCP is only
Diagnostic ; not therapeutic.
48
Mgt if bile leak patient presents within 48 hours
Re-exploration and repair
49
Mgt if bile leak patient presents after 2 days ( inflammed tissue does not hold structure)
ERCP + Stent . ultrasound guided pigtail catheter is inserted to drain collection (Bilioma) till ERCP and stent placement.
50
Two classifications of bile duct injuries are
Bismuth and Strasberg.
51
GB cancer is an
Adenocarcinoma
52
Types of GB cancer
Infiltrating : worst prognosis Nodular Papillary : best prognosis
53
What is a late feature in GB cancer
Jaundice
54
Structure removed in radical cholecystectomy
{Done in T1B or T2 stage } GB + segment 4B and 5 of liver + lymph node along hepatoduodenal ligament + +- CBD
55
MIPMP prognostic factor in GB cancer
Depth of invasion (T satge)
56
Which serum marker should be monitored in GB cancer
Serum CA 19-9
57
What is cholesterosis
Deposition of cholesterol crystals in wall of gallbladder. AKA Strawberry gallbladder . Not an indication of GB cancer or cholecystectomy
58
What is extra hepatic biliary atresia
Inflammatory fibrosis of biliary tree
59
C/F of extra hepatic biliary atresia
Jaundice at birth. (Progressive jaundice), Pruritus , Pale stools, Liver failure
60
IOC AND GOLD STANDARD INVESTIGATION OF Extrahepatic biliary atresia
IOC : HIDA scan Gold standard : Intraoperative cholangiogram
61
Which sign is seen in intrahepatic atresia on USG
Triangular cord sign.
62
Management of biliary atresia
Surgery: • Type I : Roux-en-Y hepaticojejunostomy. Best result: Surgery is done < 8 weeks. • Type II & III : Portoenterostomy (Kasai procedure). irrespective of the surgery, 20 - 30% will show progressive fibrosis -> liver failure -> Transplant. (SHBA is the mCC of liver transplant in children).
63
What is the most common cause of liver transplant in children?
Extrahepatic biliary atresia EHBA
64
What is choledochal cyst
Cystic dilatation of biliary tree
65
Which classification is used for Choledochal cyst
Todani/modified Alonso - Lej classification
66
Todani/modified Alonso - Lej classification
Type I: Cystic dilatation of the cRD. Type II : Diverticulum of CBD. Type III: Dilatation of intraduodenal portion of CBD (Choledochocele). Type IV - A : Intrahepatic + extrahepatic biliary tree dilate. B : Only extrahepatic biliary tree dilated Type V : Dilatation of only intrahepatic biliary tree (Caroli's disease).
67
What is Caroli's disease
Dilatation of only intra hepatic biliary tree in Type V of Todani/modified Alonso - Lej classification
68
Management of choledochal cyst
• Туре 1 : Roux-en-Y hepaticojejunostomy. • Type II : Cut diverticulum + repair cBD. Roux-en-Y hepaticojejunostomy. • Type III: ERCP + sphincterotomy. • Type IVa § V : Liver transplant. • Type IVb : Kasai procedure (portoenterostomy).
69
What is thorotrast
"Thorotrast is a suspension containing particles of the radioactive compound thorium dioxide:
70
What is Cholangiocarcinoma
Carcinoma of biliary tree
71
Primary sclerosing cholangitis is associated with
IBD (ulcerative colitis) ; HLA B8 & DR3.
72
In Cholangiocarcinoma ; palpable GB (periampullary ca) is describe by which law
Courvoisier's law
73
Bismuth-Corlette classification of perihilar tumor
Type I : Tumor involves common Hepatic duct Type II : Tumor involves bifurcation of the common hepatic duct Type IIIa : Tumor involves the right hepatic duct Type IIIb : Tumor involves the left hepatic duct Type IV : Tumor involves both right and left hepatic duct
74
Klatskin tumor removed by which surgery
Portoenterostomy / Kasai
75
Supraduodenal CBD tumor which surgery is carried out
Hepaticojejunostomy
76
Distal CBD tumor which sx is carried out
Whipple sx
77
Which set a marker is used in Colangiocarcinoma for monitoring of progression of the disease
CA 19-9
78
What is haemobilia
Bleeding from the biliary tree. Arterial in nature
79
Quincke's triad in haemobilia includes
• Jaundice. • upper Gi hemorrhage (malena) - mc manifestation. • Pain.
80
What is bilhemia
Passage of bile into the bloodstream.. A fistula between vein and biliary tree

Surgery (30 decks)

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