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Q1: Spectrum (2 min)
- Asymptomatic stones → colic → cholecystitis → duct stones → cholangitis/pancreatitis/ileus/Mirizzi
Q2: Stone composition (2 min)
- Cholesterol (5 Fs, supersaturation); black pigment (haemolysis); brown pigment (infected ducts)
Q3: Charcot vs Reynolds (2 min)
- Charcot triad → suspect cholangitis → antibiotics + urgent ERCP
- Reynolds = + shock + confusion = severe
Q4: Imaging ladder (2 min)
- US first for GB stones; MRCP for intermediate CBD probability; ERCP therapeutic
Q5: Gallstone pancreatitis (3 min)
- Supportive care; severity stratification
- Index-admission chole for mild disease once settled; ERCP if cholangitis/obstruction
Q6: Gallstone ileus (3 min)
- Rigler triad; enterolithotomy; one- vs two-stage fistula debate
Q7: Courvoisier (2 min)
- Painless palpable GB + jaundice → malignancy more likely than stones
Q8: Asymptomatic stones (2 min)
- Usually observe; consider prophylaxis for porcelain GB, selected polyps, certain high-risk contexts
Q9: ERCP complications (2 min)
- Pancreatitis (commonest), bleeding, perforation, cholangitis, failed clearance
- Consent must name these before therapeutic ERCP
Q10: Mirizzi syndrome (2 min)
- Stone in cystic duct/Hartmann compresses CHD/CBD → jaundice mimicking malignancy
- Pre-op imaging (MRCP); careful surgery — high BDI risk; may need bilioenteric reconstruction in severe types
Q11: Post-cholecystectomy syndrome (2 min)
- Persistent pain: retained CBD stone, bile leak/biloma, sphincter of Oddi, peptic, IBS, wound
- Work-up with LFT, US/MRCP, not dismiss as "normal post-op"
Q12: India-specific (2 min)
- Pigment stones with haemolysis; GB carcinoma belt with longstanding stones; typhoid carrier association teaching point