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Surgery > Gall Bladder > Flashcards

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
Q

HPE of Chronic cholecystitis

A

Rokitansky aschoff sinuses if it ruptures leads to Xanthogranulomatous cholecystitis.

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26
Q

Emphysematous cholecystitis is occurs due to which condition?

A

Clostridium.

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27
Q

Emphysematous pyelonephritis occurs due to which organism

A

E.Coli

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28
Q

What is mucocele

A

Aseptic dilatation of GB.

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29
Q

In mucocele stones get impacted at

A

Hartmann pouch

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30
Q

What is mirizzi syndrome

A

GB becomes adherent to CBD due to inflammation . The stones inside GB presses on CBD

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31
Q

IOC for mucocele

A

MRCP

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32
Q

What is gallstones ileus

A

Dynamic bowel obstruction.
Secondary to a cholecysto-duodenal fistula. Due to inflammation GB becomes adherent to the duodenum.

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33
Q

MC site for gallstone ileus

A

Terminal 2 feet off the ileum

34
Q

What is Bouveret syndrome

A

Stone leads to gastric outlet obstruction.
Clinical features: Distension, obstipation, pain and vomiting.
Initial investigation : X-ray abdomen

35
Q

What is Rigler’s triad

A

1) Pneumobilia
2) Features of small intestine obstruction
3) Radio-opaque shadow in right iliac fossa.

36
Q

What is choledocholithiasis

A

Stones in the CBD which were formed in GB (90% of cases) ;; in 10% it is formed in CBD.

37
Q

Charcot’s triad includes

A

Intermittent pain; Intermittent fever; Intermittent jaundice

38
Q

Reynolds pentad includes

A

Charcot’s triad + Shock + AMS/altered mental status

39
Q

IOC for CBD stones

A

MRCP

40
Q

IOC for CBD microliths

A

Endoscopic ultrasound

41
Q

What is burhenne technique

A

Insert a T-tube in CBD

42
Q

ERCP

A

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
Q

In Which position the patient of kept during lap.cholecystectomy

A

Reverse Trendelenburg position.
(Head ends up, foot end down and right side up)

44
Q

MC complication following lap. Chole

A

Right shoulder tip pain. (Retained CO2 under dome of the diaphragm)

45
Q

What is Post cholecystectomy syndrome

A

Clinical features of cholecystitis even after laparoscopic cholecystectomy.
Causes : Retained CBD stones.
Biliary dyskinesia
Sphincter of Oddi dysfunction.

46
Q

Kocher incision is

A

Right Subcostal incision made in open cholecystectomy.

47
Q

MRCP is only

A

Diagnostic ; not therapeutic.

48
Q

Mgt if bile leak patient presents within 48 hours

A

Re-exploration and repair

49
Q

Mgt if bile leak patient presents after 2 days ( inflammed tissue does not hold structure)

A

ERCP + Stent . ultrasound guided pigtail catheter is inserted to drain collection (Bilioma) till ERCP and stent placement.

50
Q

Two classifications of bile duct injuries are

A

Bismuth and Strasberg.

51
Q

GB cancer is an

A

Adenocarcinoma

52
Q

Types of GB cancer

A

Infiltrating : worst prognosis
Nodular
Papillary : best prognosis

53
Q

What is a late feature in GB cancer

A

Jaundice

54
Q

Structure removed in radical cholecystectomy

A

{Done in T1B or T2 stage } GB + segment 4B and 5 of liver + lymph node along hepatoduodenal ligament + +- CBD

55
Q

MIPMP prognostic factor in GB cancer

A

Depth of invasion (T satge)

56
Q

Which serum marker should be monitored in GB cancer

A

Serum CA 19-9

57
Q

What is cholesterosis

A

Deposition of cholesterol crystals in wall of gallbladder.
AKA Strawberry gallbladder .
Not an indication of GB cancer or cholecystectomy

58
Q

What is extra hepatic biliary atresia

A

Inflammatory fibrosis of biliary tree

59
Q

C/F of extra hepatic biliary atresia

A

Jaundice at birth. (Progressive jaundice), Pruritus , Pale stools, Liver failure

60
Q

IOC AND GOLD STANDARD INVESTIGATION OF Extrahepatic biliary atresia

A

IOC : HIDA scan
Gold standard : Intraoperative cholangiogram

61
Q

Which sign is seen in intrahepatic atresia on USG

A

Triangular cord sign.

62
Q

Management of biliary atresia

A

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
Q

What is the most common cause of liver transplant in children?

A

Extrahepatic biliary atresia EHBA

64
Q

What is choledochal cyst

A

Cystic dilatation of biliary tree

65
Q

Which classification is used for Choledochal cyst

A

Todani/modified Alonso - Lej classification

66
Q

Todani/modified Alonso - Lej classification

A

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
Q

What is Caroli’s disease

A

Dilatation of only intra hepatic biliary tree in Type V of Todani/modified Alonso - Lej classification

68
Q

Management of choledochal cyst

A

• 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
Q

What is thorotrast

A

“Thorotrast is a suspension containing particles of the radioactive compound thorium dioxide:

70
Q

What is Cholangiocarcinoma

A

Carcinoma of biliary tree

71
Q

Primary sclerosing cholangitis is associated with

A

IBD (ulcerative colitis) ; HLA B8 & DR3.

72
Q

In Cholangiocarcinoma ; palpable GB (periampullary ca) is describe by which law

A

Courvoisier’s law

73
Q

Bismuth-Corlette classification of perihilar tumor

A

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
Q

Klatskin tumor removed by which surgery

A

Portoenterostomy / Kasai

75
Q

Supraduodenal CBD tumor which surgery is carried out

A

Hepaticojejunostomy

76
Q

Distal CBD tumor which sx is carried out

A

Whipple sx

77
Q

Which set a marker is used in Colangiocarcinoma for monitoring of progression of the disease

A

CA 19-9

78
Q

What is haemobilia

A

Bleeding from the biliary tree.
Arterial in nature

79
Q

Quincke’s triad in haemobilia includes

A

• Jaundice.
• upper Gi hemorrhage (malena) - mc manifestation.
• Pain.

80
Q

What is bilhemia

A

Passage of bile into the bloodstream..
A fistula between vein and biliary tree

Surgery (30 decks)

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