Gallstone polyps, choledochal cysts, GB cancer, cholangiocarcinoma

Question 1

Symptomatic gallstone polyp = ___

Answer 1

LAP cholecystectomy

Question 2

If the gallstone polyp is with one of the following GB cancer RF, open cholecystectomy should be performed: 3

Answer 2

polyp > 1 cm
stone in the bladder
age > 60

Question 3

Biliary cyst = ___

Answer 3

choledochal cyst

Question 4

Choledochal cysts are more common in ___ (X3-8). Usually diagnosed during ___

Answer 4

female

infancy

Question 5

Choledochal clinical manifestation triad includes: (3). Usually not all 3.

Answer 5

obstructive jaundice
RUQ pain
palpable mass

Question 6

What is the most common malignancy of the biliary system?

Answer 6

GB cancer

Question 7

Most of GB cancer is ___ (90%). It is X2-3 more common in ___

Answer 7

adenocarcinoma

women

Question 8

GB cancer has very bad ___ with __% survival rate.

Answer 8

prognosis

15

Question 9

_____ increase the risk for GB cancer by __, especially if they are >3 cm.

Answer 9

gallstone

7

Question 10

GB cancer RF: (6)

Answer 10

gallstone
old age
female
gallbladder polyps > 1
porcelain bladder 
PSC

Question 11

Most GB cancer patients are ___ until very progressive stage

Answer 11

asymptomatic

Question 12

We use 3 imaging test for GB cancer diagnosis:

Answer 12

RUQ US
abdominal CT
AXr

Question 13

There are 4 groups when deciding the appropriate treatment for GB cancer:

Answer 13

innocent polyp
finding GB carcinoma post cholecystectomy
Pre cholecystectomy GB carcinoma suspicion
Progressive and advanced disease

Question 14

Treatment after finding GB carcinoma post cholecystectomy:

Answer 14

T1a- cholecystectomy was sufficient
T1b- if the borders are clean- sufficient, if not- extended cholecystectomy
T2- extended cholecystectomy

Question 15

What does extended cholecystectomy include? (5)

Answer 15

extended resection of lymph nodes
2 cm of liver (the bladder bed)
cystic duct resection
CBD resection and Roux en Y choledochojejunostomy

Question 16

Treatment of patients with pre cholecystectomy GB carcinoma suspicion includes:

Answer 16

Radical resection (laparotomy)

It is an all/nothing surgery, if R0 cannot be achieved than we should not preform the surgery

Question 17

GB cancer patients with an extensive disease should be treated with

Answer 17

palliation

Question 18

Gallbladder cancer staging:

Answer 18

T1- tumor in mucosa borders (a-lamina propria, b-muscularis propria)
T2-beyond mucosa-perimuscular (no liver or beyond the serosa)
T3- beyond serosa or to the liver/other visceral organs
T4- porta/hepatic artery, or >=2 extra hepatic organs

Question 19

Cholangiocarcinoma is missing- complete if necessary

Answer 19

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