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 [/s2If]

Risk for gall bladder perforation

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Q) High risk for gall bladder perforation and stone spillage are all except? AIIMS 2020 a. Trainee surgeon b. Brown stones c. More than 10 stones d. Cholecystitis  

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

Carcinoma GB epidemiology

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Q) Not true about GB malignancy A. 80 percent of porcelain gall bladder predispose to malignancy B. Untreated advanced  CA GB  median survival is 2-5 months C. Stippled calcification of mucosa has higher risk of malignancy than diffuse intramural calcification D. More than 75 percent of CA gall bladder has history of cholelithiasis   Ans a  69% to 86% of patients with gallbladder cancer have a personal history of gallstone disease. The presence of an abnormal pancreaticobiliary duct junction, thought to promote chronic biliary inflammation, has been associated with both choledochal cyst disease and gallbladder cancer. In porcelain gallbladder, risk of ca gb due to chronic inflammation and calcification of the gallbladder wall, was once estimated to be as high as 61%; however, more contemporary analyses suggest that the correct figure is more likely between 7% and 25% Ref Shackelford 8th page 1323

Intra op cholangio

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Q) All of the following are indications for performing intra op cholangiography except: A. Pain around the day of surgery B. Anomalous biliary anatomy C. Suspicious findings on ERCP D. Abnormal hepatic function panel Ans visible for premium members

Risk factors for Ca gall bladder

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Q) Risk factor for CA GB are all except A. Multiple polyp B large gall stone >3 cm C PSC D pigment stone same risk as cholesterol stone Ans visible for premium members

Radical Cholecystectomy

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 Q) Radical cholecystectomy includes all except a) Segment IVb and Va b) 2cm wedge resection c) Rt Extended Hepatectomy d) Paraaortic lymphnodes Answer and Explanation here History of Radical Cholecystectomy Early 20th century removal of gall bladder and wedge of liver ( No lymphadenectomy)  In 1954, Glenn et al – radical resection procedure with intended regional lymphadenectomy (portal lymph node dissection), designated as “radical cholecystectomy” (Glenn operation)  Fahim et al in 1962 advocated radical resection consisting of hepatectomy and portal lymph node dissection Read on for full answer – Premium members only

NOTES

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Q) Regarding minimal access cholecystectomy all are true except? a) NOTES can be done transvaginally and transgastrically b) Transgastric route is preferred c) SILS is done through single port with multiple instruments avoiding multiple ports d) SILS has difficulty with triangulation and retraction Answer : Save time!! Be a premium member and get access to all questions and answers Answer is B Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy.  The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application.  This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue. Shackelford

Post cholecystectomy injury

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Q) Post cholecystectomy injury  which is true a) Bile duct leak occurs in 1% b) After open cholecystectomy bile duct injury occurs in 0.5 to 1 % c) Most common cause of bile duct injury is cystic stump blow out and duct of luschka injury d) Type E injury is clipping of CBD by mistake Premium  members answer