Q. Regarding percutaneous cholecystostomy A/E
a. Technical success in 90 – 98 % of cases
b. Indicated in Grade II cholecystitis with significant pericholecystic inflammation & GOO
c. Indicated in Gr III cholecystitis with significant comorbidity
d. In Grade III cholecystitis with biliary peritonitis, PCC results in significant improvement
Q. Patients with gallstones and choledocholithiasis in a centre with endoscopy, interventional radiology and tertiary care
a. Single setting lap chole + CBDE better than endoscopy followed by lap chole
b. In choledocholithiasis endoscopic clearance alone without lap chole can be done without any long term complication
c. For impacted ampullary stones with CBD dilatation that requires biliary enteric drainage is performed with a preferred open approach
Q) Which of the following is not a cause of acalculus cholecystitis? Questions on bile duct
a) Kinking of the neck of gall bladder
b) Acalculus cholecystitis Sphincter spasm
c) Thrombosis of cystic artery
d) Over eating
Ans d
Acalculus cholecystitis can be both acute and chronic in the absence of stones. Although it can present acutely, acalculous cholecystitis typically presents more insidiously.
Mostly the acute form is recognized and chronic form is called biliary dyskinesia.
The cause of acalculus cholecystitis are
Jaundice in acalculus cholecystitis is known to occur because of ischemia and inflammation cystic duct gets obstructed due to edema
Diagnosis
Chronic acalculus cholecystitis is a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK). After the . A calculated ejection fraction of 35% or less may be indicative of hypokinetic functioning of the gallbladder. An ultrasound of the gallbladder may also be useful. If this shows a thickened gallbladder wall of over 3.5 mm, this may be due to cholecystitis.
Acute acalculus cholecystitis - USG CT or HIDA
BEST BOOKSMCQ practise
MRCS Part A: Essential Revision Notes: Book 2
