Gallbladder & Pancreas

Question 1

Charcots triad of ascending cholangitis

Answer 1

Intermittent- pain, fever, jaundice

Question 2

Reynold’s Pentad of acute obstructive cholangitis

Answer 2

Charcot+ shock + altered mental status

Question 3

Investigation for choledocholithiasis

Answer 3

CT & helical CT cholangiography
USG- stone, CBD>8mm
MRCP
EUS
ERCP

Question 4

Rx of choledocholithiasis

Answer 4

1. Remove stone by ERCP
   2.Lap Chole + on table cholangiogram to see CBD block
2. Choledochotomy done if stones in CBD
3. Use Bakes CBD dilator to confirm CBD patency
4. Place T tube for 14 days
5. Do T tube cholangiogram— if stone persists- extract with Dormia basket or Fogarty catheter

Question 5

__% gallstones are radiolucent

Answer 5

90

Question 6

Multiple Stones are faceted due to

Answer 6

Exertion of equal pressure in a compact gallbladder

Question 7

Plain X ray finding of gallstone

Answer 7

Seagull sign / merc Benz sign (central radiolucent)
Gallstone in lateral view- in front of vert
Kidney stone- overlaps vert

Question 8

Best investigation for gallbladder function assessment

Answer 8

Radioisotope HIDA/ PIPIDA Scan

Question 9

Limey gallbladder

Answer 9

Gallbladder filled with toothpaste like mixture of CaCO3 & Ca3PO4
X ray—> opaque gallbladder

Question 10

Porcelain gallbladder

Answer 10

Calcified wall of GB In chronic cholecystitis
- potentially Mx

Question 11

Moynihans aphorism

Answer 11

“Gallstone is a tombstone erected in memory of the organism within it”

Question 12

Saints triad

Answer 12

Gallstone
Colon diverticulitis
Hiatus hernia

Question 13

Xanthogranulomatous cholecystitis

Answer 13

Due to ulcer or rupture of Rokitansky Aschoff sinuses—> bile extravasated into GB wall—> accumulation of lipid laden yellowish xanthoma cells & inflammatory cells in the wall—> mimics Carcinoma in CT

Question 14

2nd mc non obstetric indication for Sx during preg

Answer 14

Acute chole

Question 15

Courvoisier’s law

Answer 15

In a patient with jaundice, if there is palpable gallbladder, it is not due to stones

Question 16

Exceptions to Courvoisiers law

Answer 16

1. Double impacted stone
2. Large stone in Hartmann’s pouch
3. Empyema GB with CBD stone

Question 17

Sump syndrome

Answer 17

After choledochoduodenostomy, CBD distal to it acts as a reservoir with stasis of food particles, bile, sludge and stones.
It causes cholangitis & narrowing of the choledochoduodenostomy stoma

Question 18

Causes of obstructive jaundice

Answer 18

1. Congenital: Biliary atresia, choledochal cyst.
2. Inflammatory: Ascending cholangitis, sclerosing cholangitis.
3. Obstructive: CBD stones, biliary stricture, parasitic infestation
4. Neoplastic: Carcinoma of head or periampullary region o pancreas, cholangiocarcinomas, Klatskin tumour.
5. Extrinsic compression of CBD by lymph nodes or tumours.

Question 19

Tumor marker for ca pancreas

Answer 19

CA 19/9

Question 20

Urine tests for obstructive jaundice

Answer 20

Fouchets
Hays
Ehrlichs

Question 21

Klatskin tumor

Answer 21

Cholangiocarcinoma at the confluence of hepatic ducts and common hepatic duct above the level of cystic duct

• causes obst jaundice with hydrohepatosis without enlargement of GB

• 4 types

Question 22

Parasites causing cholangiocarcinoma

Answer 22

Clonorchis sinensis, opisthorchis viverrini

Question 23

Hemobilia

Answer 23

Bleeding from the liver Or GB into the biliary tract.
Abn commu.cn b/w biliary tract and bv

Question 24

C/F of hemobilia

Answer 24

Colic- pain
Obs Jaundice
Hemetemesis, malena
GI bleed
= SANDBLOM’S/ QUINCKES TRIAD IN HEMOBILIA

Question 25

White bile

Answer 25

Mucous secreted by lining of biliary tree Signifies severe CBD obstruction due to stone or ca head of pancreas or periampullary carcinoma

Question 26

Mucinous ca of pancreas

Answer 26

Body & tail of panc Ovary Like stroma ER, PR+ High CEA. H/o pancreatitis

Question 27

CT finding in mucinous ca pancreas

Answer 27

Egg shell calcification with enlarged size

Question 28

IPMN

Answer 28

Intraductal papillary mucous neoplasm

Question 29

Triad in IPMN

Answer 29

Ohashi’s triad:

Question 30

Solid pseudopapillary tumour/ Gruber Frantz tumour/ Hamoudi tumour

Answer 30

Slow progressing malignant panc lesion Beta catenin/ vimentin mutation More in females

Question 31

Gene in hereditary pancreatitis

Answer 31

PRSS

Question 32

Tropical calcific pancreatitis gene

Answer 32

SPINK 1 gene

Question 33

Syndromes associated with panc carcinoma

Answer 33

Peutz Jeghers syndrome Familial atypical mole and multiple melanoma syndrome FAP Lynch synd BRCA2

Question 34

Whipples surgery

Answer 34

Pancreaticoduodenectomy For Ca head of pancreas Incision: CHEVRON/ ROOFTOP incision

Question 35

Modified whipples procedure

Answer 35

Pylorus preserving whipple Aka LONGMIRE & TRAVERSO PROCEDURE Adv- less dumping.

Question 36

Tunnel of love

Answer 36

Tunnel created between portal vein and pancreas in Whipples procedure

Question 37

Chemotherapy drugs for panc ca

Answer 37

Gemcitabine + capecitabine FOLFIRINOX (also for colorectal ca)

Question 38

Patients with jaundice has bradycardia because

Answer 38

Deposition of bile salts in pacemakers