Gallbladder

Question 0

Investigation for stones in ducts

Answer 0

MRCP (magnetic resonance cholangiopancreatography)

Question 1

Investigations for stones in gallbladder

Answer 1

Ultrasound

Question 2

Complications of laparoscopic Cholecystectomy

Answer 2

Conversion rate to open cholecystectomy 3%
Bile leak 1% (damage to the very fine accessory duct of Luschka)
Damage to common bile duct 0.5%
Bowel perforation 0.2%

Question 3

Calots triangle

Answer 3

Components: Cystic artery, common hepatic duct, cystic duct
Contents: lymph node of Mascagni, accessory duct of Luschka

Question 4

Types of gallstones

Answer 4

Mixed stones: faceted (calcium salts, pigment, and cholesterol)
Cholesterol stones: large often solitary; caused by female, age, obesity (Admirands triangle: increased risk of stone if decreased lectin, bile salts and increased cholesterol)
Pigment stones (<10%) small, friable, irregular (causes haemolysis)

Question 5

Complications of gallstones

Answer 5

In the gallbladder & cystic duct:
Biliary colic, acute and chronic cholecystitis, mucocoele, empyema, carcinoma, mirizzis syndrome

In the bile ducts:
Obstructive jaundice, cholangitis, pancreatitis

In the gut:
Gallstone ileus

Question 6

Clinically differentiate between biliary colic, cholecystitis, cholangitis

Answer 6

Biliary colic: RUQ pain, no fever/raised WCC or jaundice
Acute cholecystitis: RUQ pain & fever/raised WCC no jaundice
Cholangitis: RUQ pain & fever/raised WCC & jaundice