Q1. Which of the following are not true for emphysematous cholecystitis?
a) Usually it is associated with acalculus cholecystitis.
b) Most common with diabetes mellitus
c) Air is seen in the lumen of gall bladder
d) Clostridium perfringes and other clostridia are the comomn causative organisms.
Q2. Prophylactic cholecystectomy is not recommended for
a) Heart transplant receipients
b) Diabetes Mellitus
c) Incidental gallstones on laparotomy
d)
Q3. Which of the following is not an ultrasonic finding in acute cholecystitis
a) Absence of gallstomes
b) Gallbladder wall thickness more than 6 mm
c) Pericholecystic fluid
d) Sonographic Murphy's sign
Q4. Which of the following is not a premalignant condition of gallbladder?
a) Porcelain gallbladder
b) Adenomyomatosis of gallbladder
c) Salmonella infection
d) Phrygian cap
Answers
1. c
Emphysematous cholecytitis is seen in elderly patients with male to female ratio of 3:1.
It is mostly caused by clostridia species and commonly seen in diabetics.
It is usually but not always associated with aclaculus cholecystitis.
CT scan is the investigation of choice and air is not seen in the lumen of gallbladder but in the wall of gallbladder.
Treatment is emergency cholecystectomy.
2. b
Diabetes mellitus was earlier thought to be associated with increased compications of cholelithiais and cholecystitis but recent literature suggests that Diabetes is not associated wuth increasesd complications. The indication of surgery for cholelithiasis remain the same in diabetis mellitus.
Cardiac transplant patients have a high prevalence of biliary tract disease, Studies reported in the surgical literature seem to favor prophylactic cholecystectomy for patients identified with cholelithiasis preoperatively. Patients with asymptomatic cholelithiasis before transplantation commonly develop symptoms and often complications after transplantation
(Gallbladder Disease in Cardiac Transplant Patients
A Survey Study
Michael J. Englesbe, MD; Derek A. Dubay, MD; Audrey H. Wu, MD, MPH; Shawn J. Pelletier, MD; Jeffery D. Punch, MD; Michael G. Franz, MD
Arch Surg. 2005;140:399-403.) Link
3. b
Ultrasound has a sensitivity of 85% and specificity of 95% in diagnosing acute cholecystitis. If the wall thickness is more than 4 mm, it is suggestive of Acute Cholecystitis.
4. d
