Q1. Which of the following are not true for emphysematous cholecystitis?
✅ Answer: C. Air is seen in the lumen of gall bladder
🔍 Explanation:
Emphysematous cholecystitis is a severe form of acute cholecystitis often seen in elderly males (M:F = 3:1) and diabetics.
It is most often caused by gas-forming organisms like Clostridium perfringens and other clostridia.
It may be associated with acalculus cholecystitis, but not always.
The gas is characteristically found in the wall of the gallbladder, not in the lumen, which makes option C incorrect.
CT scan is the investigation of choice.
Treatment is usually emergency cholecystectomy.
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🔍 Explanation:
Emphysematous cholecystitis is a severe form of acute cholecystitis often seen in elderly males (M:F = 3:1) and diabetics.
It is most often caused by gas-forming organisms like Clostridium perfringens and other clostridia.
It may be associated with acalculus cholecystitis, but not always.
The gas is characteristically found in the wall of the gallbladder, not in the lumen, which makes option C incorrect.
CT scan is the investigation of choice.
Treatment is usually emergency cholecystectomy.
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Q2. Prophylactic cholecystectomy is not recommended for:
✅ Answer: B. Diabetes Mellitus
🔍 Explanation:
Diabetes mellitus was earlier thought to be associated with increased complications of cholelithiasis and cholecystitis. However, recent literature suggests that diabetes is not independently associated with increased complications.
Therefore, indications for surgery remain the same in diabetics as in the general population.
🧠 Key Notes:
- Heart transplant recipients have high prevalence and risk, hence prophylactic cholecystectomy is advised.
- Incidental gallstones during laparotomy may be managed surgically depending on context.
- Asymptomatic gallstones in elderly may require observation, but diabetes alone is not an indication.
🔍 Explanation:
Diabetes mellitus was earlier thought to be associated with increased complications of cholelithiasis and cholecystitis. However, recent literature suggests that diabetes is not independently associated with increased complications.
Therefore, indications for surgery remain the same in diabetics as in the general population.
🧠 Key Notes:
- Heart transplant recipients have high prevalence and risk, hence prophylactic cholecystectomy is advised.
- Incidental gallstones during laparotomy may be managed surgically depending on context.
- Asymptomatic gallstones in elderly may require observation, but diabetes alone is not an indication.
Q3. Which of the following is not an ultrasonic finding in acute cholecystitis?
✅ Answer: B. Gall bladder wall thickness more than 2 mm
🔍 Explanation:
- Ultrasound has a sensitivity of ~85% and specificity of ~95% for diagnosing acute cholecystitis.
- Wall thickness suggestive of inflammation is typically >4 mm, not 2 mm.
- Other findings include pericholecystic fluid, gallstones, and a positive sonographic Murphy's sign.
🧠 Key Point: Wall thickness >4 mm is considered diagnostic in the context of other clinical signs.
🔍 Explanation:
- Ultrasound has a sensitivity of ~85% and specificity of ~95% for diagnosing acute cholecystitis.
- Wall thickness suggestive of inflammation is typically >4 mm, not 2 mm.
- Other findings include pericholecystic fluid, gallstones, and a positive sonographic Murphy's sign.
🧠 Key Point: Wall thickness >4 mm is considered diagnostic in the context of other clinical signs.