Nir Hus Q 31 32 iv

Q: 31 - 32

Q31: Greatest risk factor gastric Adeno CA.

In most of the western world gastric CA is relatively uncommon.

The overall incidence of this condition has decreased in the past few decades, but gastric carcinoma remains the second leading cause of cancer death worldwide.

The reported reductions in gastric cancer mortality may be linked to better refrigeration and a concomitant decrease in the intake of salted, pickled, smoked, and chemically preserved foods; however, this link remains controversial. An inverse association with the consumption of fresh fruits and

vegetables has also been noted.


Associations have also been reported between cancer of the gastric cardia and infection with: Helicobacter pylori Epstein-Barr virus


Gastric CA occurs 1.5 to 2.5 times more frequently in males than in females.

It is rarely diagnosed before the age of 40 Its incidence peaks in the seventh decade of life. African Americans, Hispanic Americans, and Native

Americans are two times more likely to have gastric cancer than white Americans are

The decline in incidence has not translated into an improvement in the 5-year survival rate. Across all races, the 5-year relative survival was 23% for the period extending from 1992 to 1999


5-year survival rates after resection with curative intent are directly related to stage at presentation. Stage I: 43% Stage II: 37% Stage III: 18% Stage IV: 20%

Q32: Indication Cholecystectomy

The most common indication for cholecystectomy is biliary colic caused by chronic cholecystitis and cholelithiasis.

Acute cholecystitis, secondary to obstruction of the cystic duct by a gallstone, is the second most common reason.

Pancreatitis and cholangitis caused by obstruction of the pancreatic duct and/or distal CBD by a stone are generally the third most common indication.

Despite the high incidence of gallstone disease in many countries, approximately 75% of patients with gallstones are asymptomatic.


Ejection fraction of GB < 33% in otherwise normal studies.

Cholelithiasis in a pt. with DM and uncontrolled BG.

Acute cholecystitis requires urgent but not an emergency cholecystectomy.

Ascending Cholangitis is an emergency.Don’t forget Acalculous cholecystitis in ICU

settings of chronic pt.


Severe jaundice is suggestive of common bile duct stones or obstruction of the bile ducts by severe pericholecystic inflammation secondary to impaction of a stone in the infundibulum of the gallbladder that mechanically obstructs the bile duct (Mirizzi's syndrome).

Ascending Cholangitis Presentation: fever, epigastric or right upper quadrant

pain, and jaundice -- classic symptoms known as Charcot's triad.

With delay…Reynolds pentad -- fever, jaundice, right upper quadrant pain, septic shock, and mental status changes.

Nir Hus Q 31 32 iv

Health & Medicine

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