Question 1

Findings in Gallbladder Stone

Accepted Answer

Gallstones may not present any symptoms, and they often present with pain that starts in the upper right region of the abdomen and spreads to the back. The pain may be in the form of cramps, or in inflammatory conditions, it is continuous and does not decrease in severity, and fever may be detected. There may be nausea, vomiting, loss of appetite and indigestion. Jaundice occurs if the stones fall into the bile duct and cause obstruction in the biliary tract. There are 5 main tables that gallstones can lead to. Acute cholecystitis (inflammation of the gallbladder), Choledocholithiasis (main bile duct stone), Pancreatitis (inflammation of the pancreas due to gallstones), Gallstone ileus (intestinal obstruction), Cholangitis (inflammation of the bile ducts).

Question 2

Investigations in Gallbladder Diseases

Accepted Answer

Ultrasonography is the basic imaging tool after anamnesis and examination in gallstones. MRCP may be preferred when detailed evaluation of the bile ducts is required. Computed Tomography is guiding in the presence of inflammatory disease or when cancer is suspected. ERCP, which is a non-surgical method, can be performed when the operation for the stone in the bile duct is required.

Question 3

Gallbladder Inflammation

Accepted Answer

It usually occurs as a result of the stone in the gallbladder blocking the duct and preventing the bladder from emptying. The gallbladder swells, edema on its wall, circulatory disorder occurs. Deterioration is likely to progress and result in perforation. Pain is continuous in inflammatory conditions and does not decrease in severity, fever can be detected. Nausea, vomiting, loss of appetite may accompany indigestion. If the diagnosis is made, it is detected in the early period and if there is no obstacle to the operation, early surgery is recommended. In case of accompanying medical problems or delayed admission, antibiotic treatment and a gallbladder draining tube (cholecystostomy) may be recommended. Surgery is recommended for these patients before the second attack develops after the inflammatory event subsides.

Question 4

Gallbladder Polyp

Accepted Answer

They are millimetric soft tissue masses in the shape of a mushroom, stemmed and clustered, originating from the inner layer of the gallbladder wall. Surgery is recommended for patients over 60 years of age, polyps associated with gallstones, polyps that rapidly increase in size during follow-up, and polyps larger than 10 mm in size because of the risk of cancer development.

Question 5

Gallbladder Stone Treatment

Accepted Answer

Surgery is not recommended for gallstones detected incidentally in a patient with no complaints and for elderly patients who do not have any complaints. Surgery is recommended for patients with millimetric stones such as sand and mud. Because such stones are more prone to blockage by passing into the bile ducts. As a result of the obstruction, more serious secondary problems such as jaundice, pancreatitis may develop. Surgery is recommended for stones larger than 2 cm, as it is known that it can damage the bile ducts with the effect of compression and increase the risk of developing gallbladder cancer in the long run.

Question 6

Laparoscopic Cholecystectomy

Accepted Answer

These are surgeries performed with special devices of 0.5-1 cm in size placed through the abdominal wall, accompanied by a camera. The basis of the operation is the removal of the entire gallbladder. for this, after the canal and vein of the gallbladder are closed with titanium and plastic staples, the sac is separated from the liver bed. The procedure is performed with general anesthesia.

Question 7

Open Cholecystectomy

Accepted Answer

The first choice for gallbladder removal is laparoscopic surgery. Although very rarely, there may be patients who need direct open surgery or who need to return to the open technique during a laparoscopic surgery. In case of difficulties in grasping and holding the tissues due to inflammation of the gallbladder, in the presence of peripheral adhesions in the tissues due to ongoing inflammation or due to previous surgeries, Bile In case of structural abnormalities of the ducts or additional problems of the biliary tract, there should be no hesitation to return to open surgery if a safe image cannot be obtained with the laparoscopic method.

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