GALL BLADDER

Question 1

for GB Contraction

Answer 1

Vagus;

CCK- Sphincter of oddi relaxation

Question 2

for GB relaxation

Answer 2

VIP

somatostatin

Question 3

gb stone usually due to hemolytic d/o and cirrhosis

small, spiculated

Answer 3

black pigment stones

Question 4

GB stones
soft and mushy
form either in gb or BD
usually sec to bacterial infection or bile stasis

Answer 4

brown pigment stones

Question 5

traditional indications for cholecystectomy for asymptomatic patients

Answer 5

elderly with DM
Isolation from medical care for extended periods
increased risk for GB cancer porcelaine GB

Question 6

ABSOLUTE contraindications to cholecystectomy

Answer 6

cannot tolerate gen anesthesia
refractory coagulopathy
diffuse peritonitis with hemodynamic compromise
cholangitis
potentially curable GB cancer

RID CP

Question 7

relative contraindication

Answer 7

Previous upper abdomen surgery with extensive adhesions
cirrhosis
portal HTN
severe CP disease
morbid obesity
pregnancy

Question 8

the most typical clinical sign of acute cholecystitis

Answer 8

abdominal pain

Question 9

hyperesthesia in RUQ or right infrascapular region

Answer 9

boas sign

Question 10

the patient points to the right scapular tip with fist and thumb pointing upwards

Answer 10

collins sign

Question 11

blush of increased pericholecystic radioactivity in cholecystitis in HIDA scan

Answer 11

rim sign

Question 12

what are elevated in choledocholithiasis

Answer 12

bilirupin
alk phosph
transaminase

Question 13

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct ot hartmann’s pouch of the gb

Answer 13

mirrizi syndrome

Question 14

gallstone ileus of the duodenum

Answer 14

bouveret syndrome

Question 15

gastric outlet obstruction caused by passage of stone from gb to pylorus or prox duodenum through cholecystoduodenal fistula

Answer 15

gallstone ileus

Question 16

riglers triad of gallstone ileus

Answer 16

SBO
Pneumobilia
ectopic gallstone

Question 17

congenital cystic dilatations of the biliary tree

Answer 17

choledochal cyst

Question 18

mc choledochal cyst

Answer 18

fusiform

Question 19

choledochal cyst triad

Answer 19

abdominal pain
jaundice
mass

Question 20

presence of inflammatory strictures involving both extra and intahepatic biliary tree
more common in MEN

Answer 20

Sclerosing cholangitis

Question 21

TX Sclerosing cholangitis

Answer 21

Liver transplant

Question 22

most gb polyps are what type

Answer 22

cholesterol type

Question 23

malignancy markers in gb polyps

Answer 23

solitary
>1cm
 >50 yo
rapid growth
sessile
adenomatous

Question 24

most important risk factor of gb carcinoma

Answer 24

gallstones

exposure to azotoluene, nitrosamines

Question 25

discontinuous mucosa, echogenic mucosa, submucosal echolucency in US

Answer 25

GB carcinoma

Question 26

tumor markers of GB carcinoma

Answer 26

CEA and CA 19-9

Question 27

RARE tmor mostly occuring in the hepatic duct bifurcation

Answer 27

bile duct carcinoma

Question 28

most common microorganism causing bile duct CA

Answer 28

Clonorchis

Question 29

mc type of bile duct CA

Answer 29

Nodular adenoCA

Question 30

Perihilar cholangiCA

Answer 30

Klatskin tumor

Question 31

painless jaundice

Answer 31

BD CA

Question 32

Elevated tumor markers in bile duct CA

Answer 32

CA 125, CEA CA 19-9

Question 33

Defines proximal extent in bile duct CA

Answer 33

PTC