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
Features of adenomatous polyps?
- • Adenomatous polyp has malignant potentialQ.
- • Main differentiating feature is a lack of transmural invasion on USGQ
Risk factors of adenomatous polyp for malignant transformation?
- −−Age > 60 yearsQ
- −−Coexistence of gallstonesQ
- −−Documented increase in sizeQ
- −−Size > 10 mmQ
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.
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
Incidence of cholelithiasis in carcinoma gall bladder?
The incidence of CA GB in a population of patients with gallstones?
Risk Factors for Carcinoma Gallbladder?
- • Gallstones >3 cmQ
- • Porcelain gallbladderQ
- • Anomalous pancreatobiliary junctionQ
- • Choledochal cystsQ
- • Adenomatous polypsQ
- • Primary sclerosing cholangitisQ
- • ObesityQ
- • Salmonella typhi infectionQ
Transmission of Clonorchis sinensis?
Ingestion of raw or inadequately cooked freshwater fishesQ.
What is Nevin classification?
It is used for CA GB staging
MC histologic subtype of CA GB?
MC gene mutation in CA GB?
MC Site of carcinoma gall bladder?
Fundus (60%)Q >Body (30%) >Neck (10%)
Histological types of carcinoma gall bladder?
- - Diffuse Infiltrative: MC typeQ
- −−Nodular or mass forming
- −−Papillary: best prognosisQ.
Best tumor marker for CA GB?
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
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
Management of T1b, T2, T3 tumor with no evidence of metastasis?
Re-resection, extended cholecystectomy
Managemnt of T4? \
Extended cholecystectomy with extended right hepatectomyQ
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
Palliation therapy for carcinoma gall bladder?
Gemcitabine plus cisplatin
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.
Modes of Metastasis in Carcinoma Gallbladder?
- Direct hepatic invasion in 59%Q
- LN metastasis in 45%
- Perineural invasion in 42% cases
Layers that are note present in GB?
Muscularis mucosa and submucosaQ
Capacity of gall bladder?
Mucosa of the cystic duct?
Spiral folds known as valves of HeisterQ surrounded by a sphincteric structure called sphincter of LutkansQ
What is Hartmann’s pouch?
Acquired diverticulumQ of the infundibulum or neck of the gallbladder
Characteristic feature of GB mucosa?
Greatest absorptive capacityQ per unit of any structure in the body, concentration of bile 5-10 timesQ
What is Sump Syndrome?
Particulate matter accumulate and stagnate in the distal, “blind” end of the common ductQ after choledochoduodenostomyQ
Components of sphincters of Oddi?
- 1. Superior sphincter choledochusQ
- 2. Inferior sphincter choledochusQ
- 3. Sphincter pancreaticusQ
- 4. Sphincter of the ampullaQ
What is Limey Bile?
Calcium salts in the lumen of the GB - calcium carbonate and calcium phosphate usually, the consistency of toothpasteQ
What is Courvoisier’s sign?
- A palpable, non-tender gallbladderQ
- Results from a distal common duct obstruction secondary to a peripancreatic malignancyQ
What is Phrygian cap?
- Most common anomaly of the gallbladderQ
- Created by an infolding of a septum between the body and the fundusQ
What is Moynihan’s Hump (Caterpillar’s Turn)?
- • Most dangerous anomaly (for cholecystectomy)
- • Right hepatic artery takes a tortuous turn