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Surgery final (Sabiston) > 54 - Biliary system > Flashcards

54 - Biliary system Flashcards

1
Q

The gallbladder contains between ___ and ___ ml

A

30-60

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2
Q

The bile drains through the ___ lobe of the liver to the Rt and Lt ___ ducts, and from there to the ___

A

Caudate
hepatic
CHD

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3
Q

What are the ducts of Luska?

A

bile ducts that connects directly to the gallbladder through the liver’s wall

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4
Q

What should you do with ducts of Luska?

A

cauterize them in surgery

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5
Q

Define the borders of the Calot’s triangle

A

Cystic duct
Hepatic duct
Liver margin

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6
Q

What can be found the the Calot’s triangle?

A

Cystic artery
hepatic artery
Calot lymph node

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7
Q

What is the Hartmann pouch?

A

The lower part through which the cystic duct goes out from

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8
Q

What can be seen in the critical view?

A

CA

CD

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9
Q

What are the 2 roles of the bile?

A

toxins excretion

digestion of fatty food

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10
Q

Where does most of the bile get reabsorbed?

A

the terminal ileum

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11
Q

What happens to the bile when you resect the terminal ileum?

A

the bile continues to the colon and may cause bile diarrhea

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12
Q

When eating there is a secretion of ___ leading the the contraction of the ___ and the relaxation of the ___ resulting in an easy flow of the bile.

A

CCK
gallbladder
sphincter of Oddi

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13
Q

Symptoms are the result of a blockage leading to ___ and secondary ___ due to the first.

A

stasis

infection

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14
Q

What are the 3 categories of biliary obstruction?

A

extramural (pancreatic cancer)
intramural (cholangiocarcinoma)
intralaminar (choledocholithiasis)

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15
Q

What are the 3 common symptoms of the biliary patient (Charcot’s cholangitis triad)?

A

pain (cholic/acute)
fever
jaundice

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16
Q

Bilirubin above ___ will lead to jaundice in the sclera, above ___ in the skin

A

2.5

5

17
Q

What does the Charcot’s triad lead to?

A

acute cholangitis (ascending cholangitis)

18
Q

What does the Reynold pentad include? What does it lead to?

A 
pain (cholic/acute)
fever
jaundice 
decrease in consciousness level
hypotension
severe cholangitis
19
Q

What is the Courvoisier sign?

A

fullness/thickness in the gallbladder area w/o pain

20
Q

What does Courvoisier sign + painless jaundice suggest? 3

A 
pancreatic tumor
or
cholangiocarcinoma
or
duodenal tumor
21
Q

Which lab markers should you pay attention to when approaching biliary patients? (3)

A

hepatocellular/transaminase (AST/ALT)
cholestatic (GGT/ALKP/bilirubin)
synthetic (albumin/INR/glucose)
AST/ALT/GGT/ALKP/bilirubin/albumin/INR/glucose

22
Q

What should be the first imaging test for a biliary patient?

A

US

23
Q

Biliary stasis is defined by extra hepatic duct > __ mm, or intra hepatic duct > __ mm

A

4

8

24
Q

HIDA is a good test to rule out biliary stasis in the ___ of the gallbladder

A

origin

25
Q

MRCP is the best imaging test for the biliary system since it is not ____ and allows the best view of the ___

A

invasive

anatomy

26
Q

ERCP is an ___ test that may lead to pancreatitis, perforation, edema. But it can also ___ by removing stones or inserting stents

A

invasive

cure

27
Q

The best test for the distal bile ducts is ___

A

EUS

28
Q

The bile consists of ___, ___, and ___

A

cholesterol
bile acid
phospholipids (lecithin)

29
Q

The ___ stone is the classic one, while ___ stone is less common (25%)

A

cholesterol

pigmented

30
Q

Name 3 situations that increase the production of cholesterol stones:

A
  • high saturation of cholesterol in the bile
  • acceleration in nucleation process
  • hypomotility of the gallbladder (pregnancy/fasting)
31
Q

When will we see black pigmented stones? (4)

A

cirrhosis
chronic hemolysis
Gilbert
CF

32
Q

When will we see brown pigmented stones? (4)

A

chronic infection of the biliary system

more in the CBD

33
Q

Name 5 of the most common RF leading to cholelithiasis: remember 5 F’s

A 
metabolic syndrome
sharp loss of weight
female sex hormones 
old age
hypomotility of the gallbladder

Surgery final (Sabiston) (54 decks)

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