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Q1: Murphy sign (2 min)
"Demonstrate and interpret Murphy sign."
- Palpate under right costal margin; ask patient to inspire deeply
- Positive = inspiratory arrest as inflamed GB touches fingers
- High specificity when combined with clinical/US context; compare left side
- Boas sign: hyperaesthesia right infrascapular region (classic teaching)
Q2: Tokyo diagnostic criteria & grading (3 min)
- Local signs (Murphy/RUQ mass/pain/tenderness) + systemic (fever, raised WBC/CRP) + imaging
- I mild: early lap chole
- II moderate: marked local inflammation — early surgery, experienced operator, bail-out ready
- III severe: organ dysfunction — ICU, source control often cholecystostomy, delayed chole
Q3: Critical view of safety (3 min)
- Clear hepatocystic triangle; free lower GB from cystic plate; only cystic duct + cystic artery enter GB
- Photo document; if impossible → subtotal / convert / drain — never clip uncertain structures
- Relate to Calot/hepatocystic triangle anatomy and cystic artery from right hepatic
Q4: Early vs delayed cholecystectomy (2 min)
- Early (within 72 h / index admission) reduces total stay and readmissions
- No consistent modern increase in BDI when CVS discipline maintained
Q5: Acalculous & emphysematous (3 min)
- Acalculous: critically ill (sepsis, burns, TPN, trauma); ischaemia/stasis; high mortality; often percutaneous drainage first
- Emphysematous: gas in wall, clostridial/gas-formers, diabetics; emergency surgery/source control; high mortality
Q6: Antibiotics (2 min)
- Co-amoxiclav 1.2 g IV TDS or cefuroxime + metronidazole; pip-tazo if severe
- Short course after source control for uncomplicated disease; longer if gangrene/empyema/cholangitis
Q7: Pregnancy (2 min)
- Second most common non-obstetric surgical emergency after appendicitis
- Lap chole feasible with obstetric input; avoid NSAIDs late pregnancy; do not endless-delay clear acute disease
Q8: Post-op bile leak (2 min)
- Cystic stump vs duct of Luschka; present with pain, fever, biloma
- Drain collections; ERCP ± stent for controlled fistula; HPB referral if major duct injury (Strasberg)