MCQ Gall Bladder Malignant diseases

  1. Features of cholesterol polyp?
    • • Cholesterol polyps are the most commonQ
    • • Usually <10 mm in sizeQ
    • • Have a characteristic echogenic pedunculatedQ appearance on USG
    • • Multiple (30% of cases)Q
  2. Features of adenomatous polyps?
    • • Adenomatous polyp has malignant potentialQ.
    • • Main differentiating feature is a lack of transmural invasion on USGQ
  3. Risk factors of adenomatous polyp for malignant transformation?
    • −−Age > 60 yearsQ
    • −−Coexistence of gallstonesQ
    • −−Documented increase in sizeQ
    • −−Size > 10 mmQ
  4. What is Adenomyomatosis of Gallbladder?
    Benign condition characterized by hyperplastic changesQ of unknown etiology involving the GB wall - overgrowth of mucosa, thickening of muscular wall, and formation of intramural diverticula or sinus tracts termed as Aschoff-Rokitansky sinusesQ - sinuses may contain cholesterol crystalsQ. - no malignant potentialQ.
  5. USG finding in adenomyomatosis?
    Cholesterol crystals in these sinuses can result in “diamond ring sign”Q, “V-shaped”Q, or “comet-tail” artifactsQ on USG
  6. Incidence of cholelithiasis in carcinoma gall bladder?
    75–98%
  7. The incidence of CA GB in a population of patients with gallstones?
    0.3–3%Q.
  8. Risk Factors for Carcinoma Gallbladder?
    • • Gallstones >3 cmQ
    • • Porcelain gallbladderQ
    • • Anomalous pancreatobiliary junctionQ
    • • Choledochal cystsQ
    • • Adenomatous polypsQ
    • • Primary sclerosing cholangitisQ
    • • ObesityQ
    • • Salmonella typhi infectionQ
  9. Transmission of Clonorchis sinensis?
    Ingestion of raw or inadequately cooked freshwater fishesQ.
  10. What is Nevin classification?
    It is used for CA GB staging
  11. MC histologic subtype of CA GB?
    AdenocarcinomaQ
  12. MC gene mutation in CA GB?
    p53> K-ras>BRAFQ
  13. MC Site of carcinoma gall bladder?
    Fundus (60%)Q >Body (30%) >Neck (10%)
  14. Histological types of carcinoma gall bladder?
    • - Diffuse Infiltrative: MC typeQ
    • −−Nodular or mass forming
    • −−Papillary: best prognosisQ.
  15. Best tumor marker for CA GB?
    CA19-9Q
  16. TNM staging of carcinoma gall bladder?
    • T1a - Lamina propria invasionQ
    • T1b - Muscular invasionQ
    • T2 - Invade the perimuscular connective tissueQ
    • T3 - Serosal perforation and/or direct invasion of the liver (regardless of extent) and/or invasion of any other single extrahepatic organQ
    • T4 - Tumor invades the main portal vein, hepatic artery or two or more extrahepatic organQ
  17. Management of T1a carcinoma gall bladder?
    • Negative cystic duct margin: No further therapyQ
    • T1a with positive cystic duct margin: Re-resection of cystic duct or CBD to negative marginQ
  18. Management of T1b, T2, T3 tumor with no evidence of metastasis?
    Re-resection, extended cholecystectomy
  19. Managemnt of T4? \
    Extended cholecystectomy with extended right hepatectomyQ
  20. Indications for repeat operative intervention in CA GB diagnosed incidentally after laparoscopic cholecystectomy?
    • • Pathologic analysis identifies T2 or greater degree invasionQ
    • • Cystic duct margins are positiveQ
    • • Presence of intra-operative bile spillage
  21. Palliation therapy for carcinoma gall bladder?
    Gemcitabine plus cisplatin
  22. Significance of port site excision in carcinoma gall bladder?
    • • Port site excision is done for staging purposes to identify M1 diseaseQ
    • • Port site excision is not having any potential therapeutic benefitQ.
  23. Modes of Metastasis in Carcinoma Gallbladder?
    • Direct hepatic invasion in 59%Q
    • LN metastasis in 45%
    • Perineural invasion in 42% cases
  24. Layers that are note present in GB?
    Muscularis mucosa and submucosaQ
  25. Capacity of gall bladder?
    30–50 mLQ.
  26. Mucosa of the cystic duct?
    Spiral folds known as valves of HeisterQ surrounded by a sphincteric structure called sphincter of LutkansQ
  27. What is Hartmann’s pouch?
    Acquired diverticulumQ of the infundibulum or neck of the gallbladder
  28. Characteristic feature of GB mucosa?
    Greatest absorptive capacityQ per unit of any structure in the body, concentration of bile 5-10 timesQ
  29. What is Sump Syndrome?
    Particulate matter accumulate and stagnate in the distal, “blind” end of the common ductQ after choledochoduodenostomyQ
  30. Components of sphincters of Oddi?
    • 1. Superior sphincter choledochusQ
    • 2. Inferior sphincter choledochusQ
    • 3. Sphincter pancreaticusQ
    • 4. Sphincter of the ampullaQ
  31. What is Limey Bile?
    Calcium salts in the lumen of the GB - calcium carbonate and calcium phosphate usually, the consistency of toothpasteQ
  32. What is Courvoisier’s sign?
    • A palpable, non-tender gallbladderQ
    • Results from a distal common duct obstruction secondary to a peripancreatic malignancyQ
  33. What is Phrygian cap?
    • Most common anomaly of the gallbladderQ
    • Created by an infolding of a septum between the body and the fundusQ
  34. What is Moynihan’s Hump (Caterpillar’s Turn)?
    • • Most dangerous anomaly (for cholecystectomy)
    • • Right hepatic artery takes a tortuous turn
Author
surgerymaster
ID
334106
Card Set
MCQ Gall Bladder Malignant diseases
Description
Malignant conditions of gall bladder
Updated