Gall bladder

Gall bladder stone with obstruction

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A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.What is the most likely diagnosis?

Gall stone and intesinal obstruction

A. Acute cholecystitis
B. Gallstone ileus
C. Small bowel volvulus
D. Duodenal perforation

Answer: B. Gallstone ileus

Explanation:
Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.

A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).

The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.

The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.

Gall bladder cancer

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Q) True about the presentation of Gall Bladder cancer is ?

a) 50% of the cancers originate in the fundus and body.

b) Nodal disease is present in 1/3 at presentation.

c) Distant metastasis is present is <1/3 of patients at presentation.

d) Acute cholecystitis due to neck mass has worse prognosis.

AIIMS 2017 Questions

Gall bladder MCQS  

Aclaculus choelcystitis

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Q)  True about acalculous cholecystitis is:

a) Mortality more than that of calculus cholecystitis

b) GB rupture chances are more

c) Immediate cholecystectomy is the treatment of choice

d) Only A & B are correct

 A12) d

The disease  process  is  generally  more  fulminant  than  that  of  calculous cholecystitis  and  may  progress  to  gangrene  and  perforation  of  the gallbladder.

Treatment  of  acalculous  cholecystitis  is  similar  to  that  of  calculous  cholecystitis,  with  cholecystectomy  being  therapeutic. Given  the  substantial  inflammation  and  high  risk  of  gallbladder gangrene,  an  open  procedure  is  generally  preferred.

However, many  of  these  patients  are  critically  ill  and  would  not  tolerate  the physiologic  insult  of  a  laparotomy,  explaining  why  the  mortality rate  of  cholecystectomy  for  acalculous  cholecystitis  is  up  to  40%. Accordingly,  percutaneous  drainage  of  the  distended  and  inflamed gallbladder  is  carried  out  in  patients  unable  to  tolerate  a  laparotomy.

Approximately  90% of  patients  will  improve  with  percutaneous  drainage,  and  the  tube  can  eventually  be  removed.  If  follow-up  imaging  continues to  demonstrate  no  stones,  interval  cholecystectomy  is  generally unnecessary.

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Perforation during Lap cholecytectomy

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Q.     Regarding Lap Cholecystectomy false  is  (AIIMS) 

a.       GB perforation occurs in 40%

b.      Perforation occurs at time of dissection from GB bed

c.       10 – 30 % incidence of missed stones in peritoneal cavity

d.      Missed stones seldom cause any problem in the future

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