Gallbladder Cancer and Anatomy Quiz

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Questions and Answers

What is the least common location for Cholangiocarcinoma?

  • The distal duct (correct)
  • The proximal duct
  • The intrahepatic biliary radicles
  • The confluence of the hepatic duct

Which of the following is NOT a characteristic of First order branches?

  • They are always associated with gallstones (correct)
  • They are involved in either type 3 or both type 4 of the hepatic ducts
  • Ultrasound demonstrates dilatation of intrahepatic biliary radicles without any evidence of extrahepatic dilatation
  • Tumors may be small and difficult to visualize on sonography

What is the most common histological type of gallbladder cancer?

  • Squamous cell carcinoma
  • Sarcoma
  • Adenocarcinoma (correct)
  • Lymphoma

Which of these is NOT a common symptom of gallbladder cancer?

<p>Constipation (A)</p> Signup and view all the answers

What is the most common factor associated with gallbladder cancer?

<p>Gallstones (B)</p> Signup and view all the answers

What is the primary treatment for resectable gallbladder cancer?

<p>Cholecystectomy (D)</p> Signup and view all the answers

Which geographical regions have the highest incidence of gallbladder cancer?

<p>South America and North America (A)</p> Signup and view all the answers

What proportion of patients with gallbladder cancer have gallstones?

<p>70-90% (A)</p> Signup and view all the answers

What is the primary function of the superior pancreaticoduodenal artery?

<p>Supply the second part of the duodenum and head of the pancreas (B)</p> Signup and view all the answers

Which artery anastomoses with the left gastroepiploic artery?

<p>Right gastroepiploic artery (A)</p> Signup and view all the answers

Which of the following describes the splenic artery's course?

<p>It passes to the left along the upper border of the pancreas, behind the peritoneum and stomach (C)</p> Signup and view all the answers

What is the procedure for closing the cystic duct after a cholangiogram?

<p>A pretied loop ligature or a standard suture is tied laparoscopically for secure closure. (A), Two clips are placed distally on the cystic duct, and then the duct is divided. (B)</p> Signup and view all the answers

When is a closed-suction drain placed during gallbladder removal?

<p>Only if there is concern about bile accumulation or leak. (C)</p> Signup and view all the answers

What is the difference between a magistral splenic and a distributing splenic?

<p>Magistral splenic is located closer to the hilum, distributing is further away (C)</p> Signup and view all the answers

Which arteries provide blood supply to the gastric fornix?

<p>Short gastric arteries (D)</p> Signup and view all the answers

What is the purpose of dissecting the gallbladder out of the liver bed?

<p>To facilitate the removal of the gallbladder. (A)</p> Signup and view all the answers

What is the direction of the left gastroepiploic vein?

<p>To the left along the greater curvature (B)</p> Signup and view all the answers

What is the procedure for removing the gallbladder after it has been dissected?

<p>Through the umbilical port. (B)</p> Signup and view all the answers

Which vein receives blood from the first 2 cm of the duodenum?

<p>Prepyloric vein (A)</p> Signup and view all the answers

What is the triangular area where the cystic duct and cystic artery enter the gallbladder known as?

<p>The triangle of Calot. (D)</p> Signup and view all the answers

What is the normal range for serum bilirubin in a healthy individual?

<p>Less than 40 mol/L (B)</p> Signup and view all the answers

Which of the following veins ultimately joins with the superior mesenteric vein to form the portal vein?

<p>Splenic vein (D)</p> Signup and view all the answers

What is the name of the pigment that causes yellowing of the skin and sclera in jaundice?

<p>Bilirubin (B)</p> Signup and view all the answers

Which of the following is NOT a possible cause of jaundice?

<p>Hypertension (D)</p> Signup and view all the answers

When is a total pancreatectomy indicated?

<p>When the pancreas is so friable that it is unsuitable for anastomosis. (A), When frozen section reveals the presence of tumor at the resection line. (B), When diffuse involvement of the entire pancreas is present. (C)</p> Signup and view all the answers

Which of the following is NOT a criterion for resectability of pancreatic cancer?

<p>The tumor is fixed to surrounding organs. (B)</p> Signup and view all the answers

What is the 5-year actuarial survival rate after pancreaticoduodenectomy?

<p>12% (D)</p> Signup and view all the answers

Which surgical procedure is associated with a higher mortality rate and brittle diabetes than the Whipple procedure?

<p>Total pancreatectomy (B)</p> Signup and view all the answers

What is the main advantage of pylorus-preserving pancreaticoduodenectomy over the classic Whipple procedure?

<p>It is associated with better nutritional status. (B)</p> Signup and view all the answers

What is one of the main reasons why radiation and chemotherapy are not considered effective treatment options for pancreatic cancer?

<p>They are not effective in providing palliation. (B)</p> Signup and view all the answers

What is a major concern associated with pylorus-preserving pancreaticoduodenectomy?

<p>The procedure may not adequately remove all of the tumor. (C)</p> Signup and view all the answers

Which of the following is a true statement about surgical palliation for pancreatic cancer?

<p>Surgical palliation can involve both gastric bypass and biliary bypass. (B)</p> Signup and view all the answers

Which of these are diagnostic findings on an ultrasound for echinococcosis?

<p>Well-circumscribed cyst with budding signs on the cyst membrane (A), A cystic mass with a rosette appearance (B), Calcifications in the wall of the cyst (C)</p> Signup and view all the answers

What is considered a risk factor for anaphylactic reaction during surgery for hydatid cyst removal?

<p>Spillage of cyst fluid (A)</p> Signup and view all the answers

Which of the following is NOT recommended for the treatment of hydatid cysts?

<p>Removal of the cyst by aspiration followed by injection of a scolecocidal agent (A)</p> Signup and view all the answers

What is the primary method for treating symptomatic, large hydatid cysts?

<p>Surgery (B)</p> Signup and view all the answers

What is the significance of a positive Casoni skin test in a patient with hydatid cysts?

<p>It indicates exposure to hydatid cysts, but not necessarily an active infection. (A)</p> Signup and view all the answers

What is the primary reason for isolating the hydatid cyst from the peritoneal cavity during surgery?

<p>To prevent the spread of infection (D)</p> Signup and view all the answers

Which of the following imaging techniques can be used to assess extrahepatic disease related to hydatid cysts?

<p>Both B and C (B)</p> Signup and view all the answers

What is the purpose of instilling a scolecocidal agent into the cyst cavity during surgery?

<p>To kill the parasitic scolices (D)</p> Signup and view all the answers

What is the primary reason for packing off the abdomen during hydatid cyst surgery?

<p>To prevent anaphylaxis and spillage of parasitic material (A)</p> Signup and view all the answers

Which of the following techniques is NOT a possible surgical intervention for removing or treating a hydatid cyst?

<p>Percutaneous aspiration (C)</p> Signup and view all the answers

What is a common scolicidal agent used to treat hydatid cysts?

<p>Hypertonic saline (A)</p> Signup and view all the answers

Which of the following surgical approaches for hydatid cyst treatment has shown similar effectiveness to radical resection but has not been conclusively proven through prospective comparison?

<p>Drainage and evacuation (A)</p> Signup and view all the answers

What is the primary reason for the growing acceptance of percutaneous aspiration and injection of scolicidal agents (PAIR) for hydatid cyst treatment?

<p>It is a minimally invasive procedure (B)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the role of chemotherapy in hydatid cyst disease?

<p>Chemotherapy is only considered for patients with extensive disease or high surgical risk. (C)</p> Signup and view all the answers

What is the primary concern regarding the use of percutaneous aspiration (PAIR) technique for hydatid cyst treatment?

<p>Risk of cyst rupture and spillage of parasitic material (A)</p> Signup and view all the answers

Which of the following procedures involves the joining of the omentum to the cyst wall, aiming to seal off the cyst and prevent further growth?

<p>Omentoplasty (B)</p> Signup and view all the answers

Flashcards

Cholangiogram

An imaging test to visualize the bile ducts.

Cystic duct

The duct connecting the gallbladder to the common bile duct.

Hemostasis

The process of stopping bleeding during surgery.

Laparoscopic suture

A method to close tissue using minimally invasive techniques.

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Gallbladder fossa

The depression on the liver where the gallbladder sits.

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Mechanical jaundice

Jaundice caused by obstructed bile flow, leading to high bilirubin levels.

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Cystic artery

The artery supplying blood to the gallbladder.

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Closed-suction drain

A device used to remove excess fluids from surgical sites.

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Superior pancreaticoduodenal artery

Artery supplying the second part of the duodenum and pancreas head.

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Right gastroepiploic artery

Artery running along the greater curvature of the stomach, branching to gastric walls.

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Left gastroepiploic artery

Supplies blood to the stomach and anastomoses with the right gastroepiploic artery.

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Splenic artery

Artery supplying the spleen while giving branches to the pancreas.

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Left gastric vein

Vein running along the lesser curvature, draining into the portal vein.

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Right gastric vein

Vein running toward the pylorus and joining the portal vein.

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Left gastroepiploic vein

Vein draining along the greater curvature into the splenic vein.

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Right gastroepiploic vein

Vein running to the right toward the head of the pancreas.

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First order branches

Branches of hepatic ducts involving type 3 or 4 conditions.

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Cholangiocarcinoma location

Least common location for cholangiocarcinoma is the distal duct.

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Gallbladder cancer incidence

Fifth most common malignancy in the gastrointestinal tract.

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Gallstones and GB cancer

70% to 90% of patients with gallbladder cancer have gallstones.

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Histology of gallbladder cancer

Most cases are adenocarcinoma, often scirrhous; 15% are papillary.

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Clinical picture of GB cancer

Often found incidentally during cholecystectomy for gallstones.

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Symptoms of GB cancer

Weight loss, anorexia, and jaundice may occur in the absence of gallstones.

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Treatment for resectable GB cancer

Cholecystectomy is the treatment of choice, sometimes with lymph node dissection.

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Gastric bypass

A surgical procedure to reduce stomach size and aid digestion.

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Resectable tumor

A tumor that can be surgically removed without evidence of spread.

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Pancreaticoduodenectomy

A surgical procedure that removes the pancreas and part of the duodenum.

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Pylorus-preserving pancreaticoduodenectomy

A type of Whipple surgery that spares the pylorus.

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Total pancreatectomy

Removal of the entire pancreas, used in specific cases.

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Postoperative delayed gastric emptying

A common effect after pancreatic surgery where the stomach empties slowly.

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Mortality rate after pancreaticoduodenectomy

The percentage of patients who die following the Whipple surgery.

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5-year survival rate after pancreaticoduodenectomy

The proportion of patients alive five years post-surgery, approximately 12%.

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Complement fixation test

A less sensitive test for diagnosing infections.

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Casoni skin test

A skin test positive in 90% of hydatid cyst cases.

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Ultrasound for echinococcosis

Commonly used imaging test for diagnosing echinococcosis.

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Hydatid cyst ultrasound findings

Simple cyst well circumscribed with possible hyperechogenic sand.

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CT and MRI in hydatid disease

Cross-sectional imaging that evaluates cysts and surrounding tissue.

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Surgery for hydatid cysts

Primary treatment involves laparoscopic or open surgical isolation and excision.

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Scolecocidal agents

Substances like hypertonic saline used during cyst treatment.

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Conservative management of cysts

Appropriate for elderly patients with small, asymptomatic cysts.

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Anaphylaxis risk

Rupture of an abdominal cyst can lead to severe allergic reactions and diffuse seeding.

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Scolicidal agent

Substance used to kill cysts, such as hypertonic saline, during aspiration.

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Pericystectomy

Surgical excision of the cyst along with the surrounding tissue.

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Marsupialization

Surgical procedure where the cyst is opened and left in communication with the abdominal cavity.

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PAIR technique

Puncture, aspiration, injection, and reaspiration method for treating cysts.

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Albendazole use

Chemotherapy drug used for shrinking hydatid cysts in echinococcosis patients.

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Biliary repair

Surgical techniques to fix bile duct leaks or damage during cyst management.

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Laparoscopic techniques

Minimally invasive approaches for drainage and unroofing of cysts.

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Study Notes

Gastrointestinal Anatomy and Physiology

  • The stomach is the most dilated part of the digestive tube, holding 1000-1500 mL in adults.
  • It is located in the epigastric, umbilical, and left hypochondrial regions of the abdomen.
  • It connects the esophagus and duodenum.
  • The stomach has two openings (cardiac and pyloric), two surfaces, two curvatures, and two omenta.
  • The gastroesophageal junction is located at the level of T10.
  • The pylorus, forming the gastric outlet, connects to the duodenum at the level of the upper border of L1.

Gastric and Duodenal Ulcer

  • The stomach is the most dilated part of the digestive tube.
  • The intra-abdominal oesophagus is short and conical.
  • The pylorus forms the gastric outlet, communicating with the duodenum.
  • The lesser curvature forms the right border of the stomach.
  • The greater curvature, four to five times longer, arches backwards, upwards, to the left, and descends downwards.
  • The surfaces of the stomach, anterosuperior (covered by peritoneum), and posteroinferior (partially covered by peritoneum).
  • Omenta, hepatogastric (lesser omentum) and gastrosplenic (gastrocolic ligaments) are attached to the curvatures.
  • Blood supply to the stomach, provided by branches of the celiac artery (left gastric, hepatic, splenic arteries), which arises from the front of the aorta.
  • The left gastric artery runs along the lesser curvature, providing supply to the upper part of the stomach.
  • The hepatic artery gives off gastroduodenal artery and right gastric branches which anastomoses.
  • The venous drainage of the stomach is similar to the arteries' course (left and right gastric veins, left and right gastroepiploic veins).

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