General Surgery

20 learning units • 100 chapter sections • 200 explained questions. Assess surgical disease, recognise complications and connect intervention with safe recovery and follow-up.

Original RAHBAR study material for the Year 4 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 13 / 20

Gallbladder & Bile-Duct Emergencies

Distinguish biliary pain, gallbladder inflammation and infected obstruction to choose the correct urgency and pathway.

Choose an answer and check it immediately. Change your choice to try again. This is a self-study exercise; results are not saved.

Question 01. Persistent right-upper-quadrant pain with fever is more concerning for what than uncomplicated biliary colic? A. Acute cholecystitisB. Incidental asymptomatic stones onlyC. Functional dyspepsia in every caseD. Uncomplicated anal fissure

Question 02. Fever, jaundice and hypotension raise concern for what? A. Simple biliary colicB. Uncomplicated refluxC. A benign incidental cystD. Severe cholangitis

Question 03. Must every cholangitis patient have the complete classical triad? A. YesB. NoC. Only older patients mustD. Yes, before drainage is considered

Question 04. What is a common initial imaging test for gallstone disease? A. Routine brain MRIB. Colonoscopy as the first test in every caseC. Limb angiographyD. Ultrasound

Question 05. Why are gallstones on imaging not always the explanation for pain? A. They can be incidentalB. Every stone is acutely infectedC. Stones only occur in symptomatic peopleD. Imaging always establishes causation

Question 06. What may be essential in obstructed infected bile ducts? A. Biliary drainageB. Antipyretics alone indefinitelyC. A low-fat diet as sole emergency treatmentD. Waiting for spontaneous jaundice resolution

Question 07. Why is ERCP not routine for every gallbladder stone? A. It is a harmless screening testB. It removes the gallbladder in every caseC. It replaces all ultrasound assessmentD. It has risks and is mainly used for selected ductal therapeutic indications

Question 08. What must accompany insertion of a temporary biliary stent? A. Assumption that no follow-up is neededB. Permanent discharge from all careC. Advice to ignore recurrent feverD. A clear review and removal or exchange plan

Question 09. New pain and bile-stained drainage after cholecystectomy suggest what? A. Guaranteed normal healingB. A possible bile leak requiring reviewC. Complete duct clearance in every caseD. A reason to stop observations

Question 10. How are many truly asymptomatic incidental gallbladder stones managed? A. Emergency ERCP for everyoneB. Immediate antibiotics for lifeC. Observation with appropriate advice rather than automatic surgeryD. Mandatory urgent resection in every adult

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References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

NICE CG188 — Gallstone disease

Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.