Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ABSITE > 32 Biliary > Flashcards

32 Biliary Flashcards

1
Q

Cystic artery

A

Branch off right hepatic artery

Found in triangle of calot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Triangle of Calot

A

Cystic duct (lateral)
Common bile duct (medial)
Edge of liver (superior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Blood supply to hepatic and common bile duct

A

Right hepatic (lateral)
Retroduodenal branches of the gastroduodenal artery (medial)
Longitudinal blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cystic veins drain:

A

Into right branch of the portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lymphatics in relation to common bile duct?

A

Right side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Parasympathetic nervous supply to biliary tree

A

Left (anterior) trunk of vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sympathetic nervous supply to biliary tree

A

T7-10 (splanchnic and celiac ganglion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does the gallbladder normally fill?

A

Contraction of sphincter of Oddi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristics of the gallbladder and biliary tree

A

No submucosa
Mucosa is columnar epithelium
Ducts do NOT have periastalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Effect on sphincter of Oddi: Morphine

A

Contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effect on sphincter of Oddi: Glucagon

A

Relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal sizes:

  • Common bile duct
  • Gallbladder wall
  • Pancreatic duct
A

<8mm (<10 s/p chole)
<4mm
<4mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Highest concentration of CCK and secretin cells are in:

A

The duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epithelial invaginations in the gallbladder wall

A

Rokitansky-Aschoff sinuses

FOrmed from increased gallbladder pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biliary ducts that can leak after a cholecystectomy

A

Ducts of Luschka

Lie in the gallbladder fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes increased bile excretion?

A

CCK, secretin, vagal input

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What causes decreased bile excretion?

A

Somatostatin, sympathetic stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What causes gallbladder contraction?

A

CCK causes constant, steady, tonic contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Essential functions of bile?

A

Fat-soluble vitamin absorption
Essential fat absorption
Bilirubin and cholesterol excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does the gallbladder form concentrated bile?

A

Active resoprtion of NaCl and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Concentration of hepatic bile?

Concentration of gallbladder bile?

A

Na 140-170 (225-350)
Cl 50-120 (1-10)
BIle salts 1-50 (250-350)
Cholesterol 50-150 (300-700)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Active resorption of conjugated bile salts?

A

Terminal ileum (50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Passive resorption of nonconjugated bile salts?

A 
Small intestine (45%)
Colon (5%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Postprandial gallbladder maximal emptying is at:

A

2hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Bile is secreted by:
Hepatocytes (80%) | Bile canalicular cells (20%)
26
Cholesterol and bile synthesis
HMG CoA > HMG CoA reductase > cholesterol > 7-a-hydroxylase > bile salts
27
Rate-limiting step in cholesterol synthesis?
HMG CoA reductase
28
Cholesterol stones
Nonpigmented stones Causes: stasis, calcium nucleation, increased water reabsorption, decreased lecithin/bile salts Found exclusively in the gallbladder
29
Black stones
Pigmented Causes: hemolytic disorders, cirrhosis, ileal resection (loss of bile salts), chronic TPN Due to increased bilirubin load, decreased hepatic function and bile stasis Form in gallbladder
30
Brown stones
Pigmented Cause: infection (deconjugates bilirubin) Check for: ampullary stenosis, duodenal diverticula, abnormal sphincter of Oddi Primary common bile duct stones Tx: sphincteroplasty
31
Most common organisms in cholecystitis?
E. coli Klebsiella Enterococcus
32
Risk factors for gallstones
``` >40yo Female Obesity Pregnancy Rapid weight loss Vagotomy TPN (pigmented stones) Ileal resection (pigmented stones) ```
33
Best initial test for jaundice or RUQ pain?
Ultraound
34
Ultrasound findings - Hyperechoic focus, posterior shawdoing, movement of focus with changes in position
Cholelithysis
35
Ultrasound findings - Gallstones, gallbladder wall thickening, pericholecystic fluid
Acute cholecystitis
36
Ultrasound findings - dilated CBD
CBD stone and obstruction
37
HIDA scan
Technetium taken up by liver and excreted in the biliary tract
38
Findings on cholecystokinin cholecintigraphy that indicate need for cholecystectomy?
Gallbladder not seen (cystic duct likely has a stone) Takes >60 minutes to empty (chronic cholecystitis) Ejection fraction < 40% (biliary dyskinesia)
39
Most sensitive test for cholecystitis?
Cholecystokinin cholescintigraphy
40
Indications for immediate ERCP?
Signs that a common bile duct stone is present | Jaundice, cholangitis, US show stone in CBD
41
Indications for pre-op ERCP?
Persistently high for >24hrs: - AST/ALT >200 - Bilirubin >4 - Amylase/lipase >1000
42
Best treatment for late common bile duct stone?
ERCP | Sphincerotomy allows for removal of stone
43
Risks of ERCP?
Bleeding, pancreatitis, perforation
44
MCC of air in the biliary tree?
Previous ERCP and sphincteretomy Cholangitis Erosion of the biliary system into the duodenum Previous whipple
45
Risk factors for acalculous cholecystitis?
``` Severe burns Prolonged TPN Trauma Major surgery Bile stasis (nacotics, fasting) ```
46
Emphysematous gallbladder disease
Gas in GBW Increased risk in diabetics Risk for perforation
47
Gallstone ileus
Fistula between gallbladder and duodenum Pneumobilia Terminal ileum - site of obstruction Tx: Cholecystectomy, fistula resection (if stable)
48
Management of an intra-op CBD injury?
If <50% of circumference - primary repair | >50% - hepaticojejunostomy or choledochjejunostomy
49
Post-op lap chole - persistent nausea, vomiting or jaundice?
Assess with ultrasound | Looking for a fluid collection
50
Post-op lap chole - persistent nausea, vomiting or jaundice? Ultrasound shows fluid collection
Percutaneous drainage If bilious > ERCP - Cystic duct remnant leak, small injuries to hepatic or common bile duct, leak from duct of luschka - Sphincterotomy and stent - Large lesion - hepaticojejunostomy or choledochojejunostomy
51
Post-op lap chole - persistent nausea, vomiting or jaundice? Ultrasound shows no fluid collection with dilated hepatic ducts
Completely transected CBD | PTC tube then hepaticojejunostomy or choledochojejunostomy
52
Timing of surgical intervention after CBD injury?
``` Early symptoms (<7 days) - immediate Late symptoms (>7 days) - wait 6-8 weeks ```
53
Sepsis following lap chole?
Fluid resuscitation and stabilization | May be due to complete transection of CBD and cholangitis - get US
54
Treatment of anastomotic leak following transplantation or hepaticojejunstomy?
Percutaneous drainage of fluid followed by ERCP with temporary stent (leak will heal)
55
Most common cause of late post-op biliary stricture?
``` Ischemia following Lap Chole Other causes: - Chronic pancreatitis - Gallbladder CA - Bile duct CA Bile duct strictures w/o hx of pancreatitis or biliary surgery is CA until proven otherwise ```
56
Treatment of bile duct stricture?
MRCP (defines anatomy - look for mass) ERCP - brush biopsy If due to ischemia or chronic pancreatitis - choledochojejunostomy
57
MCC hemobilia
Fistula between bile duct and hepatic arterial system Occurs with trauma or percutaneous instrumentation to liver
58
Workup and treatment of hemobilia?
DX: angiogram Tx: angioembolism, if that fails - OR
59
Most common cancer of biliary tree?
GB adenocarcinoma
60
Most common site of GBCa metastasis?
Liver (segments IV and V)
61
Risk of GBCa with porcelain gallbladder?
15% | Do cholecystectomy
62
Symptoms of GBCa?
``` Jaundice first (due to bile duct invasion with obstruction) Then RUQ pain ```
63
Treatment of Gallbladder Cancer?
If muscle is not involved - open chole sufficient Invades muscularis - Chole + wedge resection of segments IVb and V Beyond muscle, but resectable - Formal resection of segments IVb and V NO lap chole - tumor implants in trocar sites
64
Risk factors for cholangiocarcinoma
``` C. sinesis infection Ulcerative colitis Choledochal cysts Primary sclerosing cholangitis Chronic bile duct infection ```
65
Symptoms/Signs of cholangiocarcinoma?
Painless jaundice (early) Weight loss, pruritis (late) Increased bilirubin and alkphos
66
Diagnosis of cholangiocarinoma?
MRCP (defines anatomy, look for mass)
67
Discovery of focal bile duct stenosis in patient w/o history of biliary surgery or pancreatitis?
Bile duct CA until proven otherwise
68
Treatment of cholangiocarcinoma?
Surgery - if no distant mets or tumor is resectable Upper 1/3 (Klatskin tumors) - lobectomy and stenting of contralateral bile duct (if localized on one duct) Middle 1/3 - Hepaticojejunostomy Lower 1/3 - Whipple
69
Treatment of intrahepatic cholangiocarinoma?
Klatskin tumor - upper 1/3 | Lobectomy and stenting of contralateral bile duct (if localized to one duct)
70
Treatment of perihilar cholangiocarcinoma?
Middle 1/3 | Hepaticojejunostomy
71
Treatment of distal extrahepatic cholangiocarcinoma?
Lower 1/3 | Whipple
72
Cholangiocarcinoma risk with choledochal cysts?
15%
73
Treatment of type I choledochal cysts?
Cyst excision with hepaticojejunostomy and cholecystectomy
74
Treatment of Type IV and V choledochal cysts?
Partial liver resection or liver TXP
75
Type I Choledochal cyst
Fulsiform/saccular
76
Type II choledochal cyst
Choledochal diverticulum (periduodenal)
77
Type III choledochal cyst
Intraduodenal diverticulus - choledochocele
78
Type IVa choledochal cyst
Multiple intra and extra hepatic cysts
79
Type IVb choledochal cyst
Multiple extrahepatic cysts
80
Type V choledochal cysts
Totally intrahepatic cysts
81
Primary sclerosing cholangitis
Men, 40-50s Assoc: ulcerative colitis, pancreatitis, diabetes Sx: jaundice, fatigue, pruritus, weight loss, RUQ pain Multiple strictures through out hepatic ducts Complications: portal HTN and hepatic failure, cirrhosis, cholangiocarinoma
82
Multiple strictures through out hepatic ducts - diagnosis?
Primary sclerosing cholangitis | Progressive fibrosis of both intra and extra hepatic ducts
83
Treatment of primary sclerosing cholangitis?
Liver TXP PTC tube drainage, choledochojejunostomy or balloon dilation - symptom relief Cholestyramine - pruritis Ursodeoxycholic acid - improve liver enzymes, pruritis
84
Primary biliary cirrhosis
``` Women Medium-sized hepatic ducts Cholestasis > cirrhosis > portal HTN Sx: jaundice, fatigue, pruritus, xanthomas Antimitochondrial antibodies Tx: Liver TXP ```
85
Cirrhosis with antimitochondrial antibodies?
Primary biliary cirrhosis
86
Charcot's triad
RUQ pain Fever Jaundice (Cholangitis)
87
Reynold's pentad
``` RUQ pain Fever Jaundice + Mental status changes Shock (Septic cholangitis) ```
88
Most common organisms in cholangitis?
E. coli* | Klebsiella
89
Why do you get systemic bacteremia with cholangitis?
When pressure in the biliary system gets greater than 200mmHg, you get colovenous reflux
90
How do you diagnose cholangitis?
Increased AST/ALT, bilirubin, alkaline phosphatase, WBCs | US - dilated CBD (>8mm)
91
Most serious complication of cholangitis?
Renal failure, secondary to sepsis Others - structure, hepatic abscess
92
MCC of cholangitis? Others?
Gallstones Biliary stricture Neoplasm Chleodochal cyst Duodenal diverticula
93
Treatment of cholangitis?
Fluid resuscitation and antibiotics Emergent ERCP with sphincterotomy and stone extraction If ERCP fails - PTC to decompress biliary system If due to infected PTC tube - change the tube
94
Early cause of shock following lap chole?
First 24hrs - hemorrhagic shock from clip that fell off cystic artery
95
Late cause of shock following lap chole?
After 24hrs - septic shock from accidental clip on CBD with subsequent cholangitis
96
Adenomyomatosis
Thickened nodule of mucosa and muscle associated with Rokitansky-Aschoff sinus NOT premalignant Can cause RUQ pain Tx: cholecystectomy
97
Granular cell myoblastoma
Benign neuroectoderm tumor of gallbladder Can occur in biliary tract with signs of cholecystitis Tx: Cholecystectomy
98
Cholesterolosis
Speckled cholesterol deposits on the gallbladder wall
99
Gallbladder polyps
>1cm, concern of malignancy Polyps in patients >60yo, more likely to be malignant Tx: Cholecystectomy
100
Delta bilirubin
Bound to albumin covalently Half-life of 18 days May take a while to clear after long-standing jaundice
101
Mirizzi syndrome
Compression of common hepatic duct from: a) stone in gallbladder infundibulum b) inflammation from gallbladder or cystic duct extending to contiguous hepatic duct (causes hepatic duct stricture) Tx: Cholecystectomy (poss hepaticojejunostomy for hepatic duct stricture)
102
Complications of ceftriaxone in reference to biliary system?
Can cause gallbladder sludging and cholestatic jaundice
103
Indications for asymptomatic cholecystectomy?
Liver transplant | Gastric bypass proceedure (if stones are present)

ABSITE (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions