GB cancer

Question 1

Stem: A 74- year- old patient with DM, HTN underwent cholecystectomy for cholecystitis and at operation the gallbladder was found to be thickened and fixed to the liver.

Q1: What’s the most probable diagnosis for a thickened, fixed gallbladder in an elderly female?

Answer 1

GB Cancer ( adenocarcinoma )

Question 2

Q2: What’s the main risk factor of this tumor in the UK?

Answer 2

Gall stones

Question 3

What are other risk factors?

Answer 3

Smoking / Family Hx / Elderly / Female/ Obesity / Gall polyps / porcelain GB

Question 4

Q3: Where does gallbladder cancer spread to first?

Answer 4

Liver – Local nodes

Question 5

Q4: What’s the most common pathological type of gallbladder cancer?

Answer 5

Adeno

Question 6

Q5: If the wound breaks down with yellowish and smelly discharge, what’s your diagnosis?

Answer 6

Local infection (Bacterial)

Question 7

Q6: What’s the most common organism causing surgical site infection?

Answer 7

S. Aureus

Question 8

Q7: If you have minimal inflammation without local cellulitis, what will you do?

Answer 8

I&D – Sample for C&S – Clean wound and keep the wound open

Question 9

Few days later, the patient’s condition deteriorates with high fever, tachycardia, the wound, and the surrounding local tissues become very congested with purple discoloration and tissue necrosis

Q8: What’s the most probable diagnosis now?

Answer 9

Nec. Fascitis

Question 10

Q9: What are the most common organisms causing necrotizing fasciitis?

Answer 10

Strept. Pyogens (Grp a stertococci) / Others S. Aureus / Cl.Perfringens / vibrio / Bacteroids

Question 11

Q10: How can you suspect the diagnosis of necrotizing fasciitis?

Answer 11

Prodromal signs Fever unwell, Local signs Cellulitis with crepitation
Lab; LRINEC ≥ 6 ( NEC.F is highly considered)

Question 12

Q11: What are the pathological changes in necrotizing fasciitis?

Answer 12

Extensive necrosis and thrombosis of Blood vessels

Question 13

Q12: How would you treat such patient? Who would you involve in the care of this patient?
Nec. Fasc

Answer 13

According CCrisp protocol – ABX for C&S
Defintive ttt early ext debridement of all necrotic tissue until healthy tissue are reached and we might need a relook after 24hr and redebridment
– Surgeon / ITU specialist / Anesthetist / Microbiologist and plastic surgeon

Question 14

Few days after receiving treatment including broad-spectrum antibiotics, the patient developed bloody diarrhea.

Q13: What’s the differential diagnosis of post-operative bloody diarrhea?

Answer 14

Pseudomembrance colitis / Ischemic colitis / hosp. acquired GE (noro virus)/ IBD

Question 15

Colonoscopy was done,

what can you see?

Answer 15

Multiple yellowish eruption with inflamed ulcerated mucosa in btw

Question 16

Q14: What’s the treatment of this condition?

Answer 16

Non sever  TLC < 15 – > Oral Vancomycin 10-14 dys / Erythromycin / Metronidazole
Severe  TLC > 15 / High fever / AKI – > Vanco + Metro
Nor responding like in Toxic megacolon – > Colectomy

Question 17

Q13: What’s the pathological process responsible for this picture?
Psaudomemb colitis

Answer 17

Bact. Exotoxins cause damage of the mucosa these will lead to exudation of ptns and inflame cells forming pseudo membrane.

Question 18

Q13: How you clinically suspect pseudomembranous colitis? And how to confirm the diagnosis?

Answer 18

Hx of Broad spectrum Abx / Clinical signs fever Pain diarrhea
- Confirmed by ELIZA for toxins / PCR for toxins / x-ray to role out Toxic megacolon.