Surgery > Gall Bladder > Flashcards

Gall Bladder Flashcards

(64 cards)

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1
Q

sentinel LN in GB Cancer

A

Cystic lymph node of LUND

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2
Q

what is MOYNIHAN‘ S hump

A

r cystic artery having a torturous course lying in Calot triangle

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3
Q

anatomical variation of gallbladder shape

A

phyrigian cap

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4
Q

MC Gallstones

A

mixed variety

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5
Q

Most common gallstones in Asia

A

Pigmented

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6
Q

composition of brown pigment, stones

A

Calcium Palmitate
Calcium stearate
Calcium BilliRubinate

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7
Q

Composition of black pigment, stone

A

insoluble BiliRubin plus calcium phosphate, and bicarbonate

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8
Q

IOC gallstones

A

USG

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9
Q

Infections leading to gallstone

A

clonorchis
cholangitis
ascariasis

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10
Q

how do you differentiate gallbladder stone from polyp

A

Post acoustic shadow is present only in gallstone

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11
Q

Indications for surgery in asymptomatic gallstone

A
  1. salmonella typic carrier.
  2. Porcelain GB.
  3. GB Polyp > 1 cm with stones
  4. Undergoing bariatric surgery.
  5. DM.
  6. Endemic zone of GB CA
  7. Stone > 2 cm.
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12
Q

various presentations of gallstone

A

asymptomatic
Acute cholecystitis
Acute calculus cholecystitis
Chronic cholecystitid

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13
Q

signs in acute cholecystitis and explain

A

Murphy sign
Patient catches his or her breath when pressed in right hypochondrium

boa sign
Hyperaesthesia in the region of 12th rib

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14
Q

USD findings in acute cholecystitis

A

Wall thickness >3 mm
Pericholecystitic fluid
Probe tenderness

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15
Q

Findings on HIDA scan in cholecystitis

A

Non-visualisation of GB

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16
Q

Cystic plate

A

Fibrous sheet continues with liver capsule of segments 4&5

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17
Q

Rouviere sulcus

A

Sulcus on under surface of right lobe of liver running to right of hepatic hilum

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18
Q

importance of R4U line

A

Cystic duct and artery lie above it, and CBD lies below

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19
Q

management of acute cholecystitis is based on what guidelines?

A

Tokyo consensus guidelines

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20
Q

moderate acute cholecystitis features

A

WBC > 18,000
Duration of symptoms > 72 hours
Palpable tender mass in RUQ
Marked local inflammation

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21
Q

management of grade 2 acute cholecystitis unfit for surgery

A

tube cholecystostomy

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22
Q

classical USG finding in chronic cholecystitis

A

Wall eco shadow sign

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23
Q

HPE of chronic cholecystitis

A

Rokitansky Aschoff sinus

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24
Q

structure formed when RA sinuses rupture

A

Xantho granulomatous cholecystitis

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25
gas within gallbladder and its wall diagnosis
emphysematous cholecystitis
26
Aseptic dilatation of GB is called as
Mucocele
27
Mirizzi syndrome
GB becomes adherent to CBD due to inflammation causing obstruction and jaundice
28
ioc of Mirizzi syndrome
MRCP
29
gallstone ileus is
dynamic bowel #
30
MC site of gallstones ileus
terminal 2 feet of ileum
31
Gallstone leading to GOO
Bouveret syndrome
32
x-ray abdomen finding in gallstone ileus
Ringlers triad
33
riglers triad
pneumobilia features of small bowel # Radio pic shadow in RIF
34
ioc gallstone Ileus
CECT
35
Mx of gallstone ileus w no h/o peritonitis
milk stone beyond the ileo caecal junction crush the stone, remove stone 4-6 w later —> cholecystectomy and repair of fistula
36
Mx gallstone ileus w h/o peritonitis
resection and anastomosis
37
C/F cholangitis
Charcots triad Intermittent pain Intermittent fever Intermittent jaundice
38
Reynolds pentax
Charcot triad + shock + alter mental status
39
IOC CBD stone
MRCP
40
Mx CBD AND GB stone detected before surgery
ERCP + Sphincterot-omy Followed by Laparoscopic cholecystectomy after few days
41
Mx CBD stone detected during surgery
confirmed by MRCP . Laparoscopic Cholecystectomy + Laparoscopic Exploration of CBD.
42
Burhene technique
Insert a T-tube in CBD Inject dye after 7-10 days T-tube cholangiogram no residual stone - remove T tube stones present: retain for 3-4 w and then remove stones through tract
43
Mx recurrent stone
ERCP + sphincterotomy
44
MC cx after ERCP
ERCP induced pancreatitis > duodenal perforation
45
position in lap chole
Surgeon stands on the left side of the operating table. Assistant stands on the left side of the operating table. Position of patient: Reverse Trendelenburg position. Head end up, foot end down and right side up.
46
B SAFE method
•Bile duct • sulcus of Rouviere • Hepatic A •umbilical fissure • enteric/duodenum to correctly place a cognitive map dwing dissection
47
MC CX of lap chole and reason
right, shoulder tip, pain because of retained CO2 under the right dome of diaphragm
48
Mx partial injury in bile duct identified during surgery
Repair injury
49
Mx complete transaction without loss of segment bile duct identified during surgery
Anastomose over T tube
50
Mx complete transaction and loss of segment bile duct injury identified during surgery
choledochojejunostomy
51
symptomatic bile leak identified after surgery next step
confirm by MRCP
52
management symptomatic bile leak within 48 hours
Re-explore and repair
53
definitive management symptomatic bile leak after 48 hours
ERCP + stent
54
first intervention in symptomatic bile leak after 48 hours
Ultrasound guided pigtail catheter insertion
55
classification of bile duct injury
Bismuth and Strasberg
56
IOC GB ca for dx
CECT
57
T1 stage of GB CA
T1 : invades lamina propria and muscularis T1 a : above muscle layer T1b: into “”
58
Mx T1a GB CA
simple cholecystectomy
59
Mx T1b GB CA
radical cholecystectomy
60
Mx T2 GB CA
radical cholecystectomy
61
Mx T3/4 GB CA
Gemcitabine based chemo
62
most important prognostic factor in GB CA
Depth of invasion
63
monitoring of GB CA done by
serum CA 19-9
64
strawberry GB is
cholesterolosis
Surgery
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