Gallbladder Disease

Question 1

What is the dx method of gallbladder and biliary tract dis? (most sensitive examination to show gallstones)

Answer 1

U/s

Question 2

Gold standard for dx of acute cholycystitis ?

Answer 2

Hida Scintigraphy Tc99

Question 3

What are the cotraindications of ERCP ?

Answer 3

Patients with gastric resection bcz rod cant enter duodenum

Question 4

What are the complications of ERCP ?

Answer 4

Pancreatitis
Cholangitis
Bleeding
Perforation

Question 5

What is the clinical sign for cholylithiasis?

Answer 5

Murphy’s sign

Question 6

Pain is from which nerve in murphy’s sign?

Answer 6

Phrenic nerve

Question 7

What are symptoms of gallbladder dis?

Answer 7

Murphys sign

Itching

Jaundice

Vomiting nausea

Right upper quad pain

Question 8

Risk factors of gallstones/

Answer 8

Females

*Obesity

Crohn’s

TPN

OC or Estrogen use

*morbid obesity surgeries

*Pregnancy

Vagotomy(removal of vagus)

Question 9

indication for surgery in Asymptomatic cholelithiasis?

Answer 9

[the porcelain NOn-functioning gallbladder in diabetic and pediatric patients causes multiple millimetric stones and stones >2.5cm]

Diabetic pts

Non-functioning gallbladder

Multiple millimetric stones

Porcelain gallbladder

Pediatric patients (congenital hemolytic anemia, sickle cell anemia)

Patients with stones larger than 2.5cm

Question 10

What is most common symptom of cholelithiasis?

Answer 10

Biliary colic; pain in murphy’s area due to biliary duct block

Question 11

Clinical findings of gallstones?

Answer 11

Biliary colic(pain in murphy’s sign due to biliary duct blockage)

Gallbladder hydrops

Dyspepsia(indigestions)

Question 12

Lab findings of acute cholecystitis?

Answer 12

Bilirubin ALP AST ALT are NORMAL

Murphy+

Leukocytosis >20,000

Question 13

Tx in acute cholecystitis

Answer 13

Cholecystectomy

Interval cholecystectomy

Percutaneous or surgical
cholecystostomy: Especially in cholecystitis without stones

Question 14

Which type of cholecystitis is in diabetic pts?

Answer 14

Emphysematous Cholecystitis

Question 15

Which type of cholecystitis has no stones?

Answer 15

Acalculous cholecystitis

Question 16

recurrent attacks of obstruction in biliary duct is known as?

Answer 16

Chronic cholecystitis

Question 17

Which type of disease is caused by residual stone in common bile duct after forgeting to remove it in surgery?

Answer 17

Postcholecystectomy syndrome

Question 18

Most common gallbladder cancer/biliary system?

Answer 18

Adenocarcinoma 90%

Question 19

The first examination performed in a patient with jaundice is ……..***

Answer 19

USG

Question 20

In the patient with jaundice, if nothing is palpable with an hydropicly gall bladder , the stone should be considered, and if something is palpable (pancreatic head) …… should be considered.***

Answer 20

tumor

Question 21

The most effective and reliable method of showing gallstones is …..***

Answer 21

USG

Question 22

The most common symptom of gallstones is ,,,,,, and the most common
complication is ………

Answer 22

biliary colic,

acute cholecystitis.

Question 23

The most common cause of acute cholecystitis is …….. **

Answer 23

obstruction of the ductus cysticus

Question 24

While the most specific, most sensitive method for the diagnosis of acute cholecystitis is …….., the most preferred method is …….***

Answer 24

HIDA scintigraphy

USG

Question 25

What is charcot triad?

Answer 25

Detects cholangitis;
Right upper quadrant pain, Fever
Jaundice

Question 26

What is the findings of most severe cholangitis?

Answer 26

Reynolds Pentate:
CHOLANGITIS
– Charcot triad + septic shock and neurological findings

Question 27

The most common type of sclerosing cholangitis is the primary type of sclerosing cholangitis and is ………***

Answer 27

idiopathic

Question 28

Cholangitis vs cholecystitis ?

Answer 28

Cholangitis is the inflammation of the bile duct system

Cholecystitis:is the inflammation of wall of gall bladder

Question 29

Cholangitis is always accompanied with …..?

Answer 29

obstruction

Question 30

Where is cholangiocarcinoma mostly found?

Answer 30

It can present anywhere in the biliary tract. 2/3 is in hepatic duct bifurcation (**Klatskin’s tumor) most common)

Question 31

Symptoms of cholangiocarcinoma?

Answer 31

**painless jaundice

CA 19-09 is high**

Loss of appetite

Question 32

Cholecystectomy is the tx choice for all gallbladder diseases except for …..

Answer 32

Cholangiocarcinoma stage 4; tx is transplantation

Question 33

Dx in cholangiocarcinoma?

Answer 33

USG, CT
*PTC (in proximal lesions), *ERCP (in distal lesions)

Question 34

What causes cholangiocarcinoma ?

Answer 34

Pimary sclerosing cholangitis

Question 35

What is the difference between biliary colic and cholecystitis?

Question 36

What to do in pt with cholecystitis?

Answer 36

Antibiotics and surgery and for dx senUSG or HIDI scintigraphy

Question 37

Manifests as fever and signs of infection with stones visualized:

Answer 37

Cholecytitis

Question 38

Which gall bladder disease manifests as AFEBRILE and will commonly have no abnormal vitals in contrast to acute cholecystitis or cholangitis

Answer 38

Biliary colic

Question 39

The most sensitive examination. First choice in treatment used in Choledocolithiasis

Answer 39

ERCP

Question 40

What is the most common type of sclerosing cholangitis ?

Answer 40

Primary type of sclerosing cholangitis &is idopathic