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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
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Features of adenomatous polyps?
- • Adenomatous polyp has malignant potentialQ.
- • Main differentiating feature is a lack of transmural invasion on USGQ
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Risk factors of adenomatous polyp for malignant transformation?
- −−Age > 60 yearsQ
- −−Coexistence of gallstonesQ
- −−Documented increase in sizeQ
- −−Size > 10 mmQ
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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.
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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
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Incidence of cholelithiasis in carcinoma gall bladder?
75–98%
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The incidence of CA GB in a population of patients with gallstones?
0.3–3%Q.
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Risk Factors for Carcinoma Gallbladder?
- • Gallstones >3 cmQ
- • Porcelain gallbladderQ
- • Anomalous pancreatobiliary junctionQ
- • Choledochal cystsQ
- • Adenomatous polypsQ
- • Primary sclerosing cholangitisQ
- • ObesityQ
- • Salmonella typhi infectionQ
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Transmission of Clonorchis sinensis?
Ingestion of raw or inadequately cooked freshwater fishesQ.
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What is Nevin classification?
It is used for CA GB staging
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MC histologic subtype of CA GB?
AdenocarcinomaQ
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MC gene mutation in CA GB?
p53> K-ras>BRAFQ
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MC Site of carcinoma gall bladder?
Fundus (60%)Q >Body (30%) >Neck (10%)
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Histological types of carcinoma gall bladder?
- - Diffuse Infiltrative: MC typeQ
- −−Nodular or mass forming
- −−Papillary: best prognosisQ.
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Best tumor marker for CA GB?
CA19-9Q
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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
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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
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Management of T1b, T2, T3 tumor with no evidence of metastasis?
Re-resection, extended cholecystectomy
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Managemnt of T4? \
Extended cholecystectomy with extended right hepatectomyQ
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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
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Palliation therapy for carcinoma gall bladder?
Gemcitabine plus cisplatin
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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.
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Modes of Metastasis in Carcinoma Gallbladder?
- Direct hepatic invasion in 59%Q
- LN metastasis in 45%
- Perineural invasion in 42% cases
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Layers that are note present in GB?
Muscularis mucosa and submucosaQ
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Capacity of gall bladder?
30–50 mLQ.
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Mucosa of the cystic duct?
Spiral folds known as valves of HeisterQ surrounded by a sphincteric structure called sphincter of LutkansQ
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What is Hartmann’s pouch?
Acquired diverticulumQ of the infundibulum or neck of the gallbladder
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Characteristic feature of GB mucosa?
Greatest absorptive capacityQ per unit of any structure in the body, concentration of bile 5-10 timesQ
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What is Sump Syndrome?
Particulate matter accumulate and stagnate in the distal, “blind” end of the common ductQ after choledochoduodenostomyQ
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Components of sphincters of Oddi?
- 1. Superior sphincter choledochusQ
- 2. Inferior sphincter choledochusQ
- 3. Sphincter pancreaticusQ
- 4. Sphincter of the ampullaQ
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What is Limey Bile?
Calcium salts in the lumen of the GB - calcium carbonate and calcium phosphate usually, the consistency of toothpasteQ
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What is Courvoisier’s sign?
- A palpable, non-tender gallbladderQ
- Results from a distal common duct obstruction secondary to a peripancreatic malignancyQ
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What is Phrygian cap?
- Most common anomaly of the gallbladderQ
- Created by an infolding of a septum between the body and the fundusQ
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What is Moynihan’s Hump (Caterpillar’s Turn)?
- • Most dangerous anomaly (for cholecystectomy)
- • Right hepatic artery takes a tortuous turn
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