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A 38 y.o. white female presents with a 6 month history of recurrent right upper quadrant/epigastric pain that radiates through to her back and has associated nausea. The episodes last for up to one hour, then resolve and are usually associated with eating food. Her past medical history is unremarkable. Pre-operative blood work, to include a CBC and liver panel, are all within normal limits. An abdominal ultrasound demonstrates several small stones in the gallbladder with no evidence of gallbladder wall thickening and a normal size common bile duct. The patient is scheduled for a cholecystectomy, and at surgery the follow view of the liver is seen:

a) Granulomatous hepatitis
b) Actinomycosis
c) Crytococcosis
d) Sarcoidosis
e) None of the above
f) Don't Know

2. What would be an appropriate approach to this patient's operative care?

a) Proceed on with the cholecystectomy and ignore the findings in the liver.
b) Perform the cholecystectomy along with a liver biopsy.
c) Convert to an open laparotomy and do a full exploration of the abdomen along with a cholecystectomy and liver biopsy.
d) Explore the abdomen laparoscopically, biopsy the liver, and terminate the procedure without performing the cholecystectomy.
e) None of the above.
f) Don't Know

3. What is the most likely pathological diagnosis of the liver findings?

a) Sarcoidosis
b) Actinomycosis
c) Crytococcosis
d) TB
e) All of the above
f) Don't Know

This 48 year old male presented with a history of recent onset of sever sub-acute pain in the right lower quadrant. Physical exam was unremarkable except for tenderness to palpation in the right lower quadrant without peritoneal signs. He was afebrile, and had normal laboratory studies. Work-up to include barium enema and CT scan of the abdomen were unremarkable. He underwent a diagnostic laparoscopy with the following findings:

a) Incarcerated inguinal hernia
b) Incarcerated obturator hernia.
c) Incarcerated femoral hernia.
d) Incarcerated spigelian hernia.
e) Don't Know