54 - Biliary system Flashcards
The gallbladder contains between ___ and ___ ml
30-60
The bile drains through the ___ lobe of the liver to the Rt and Lt ___ ducts, and from there to the ___
Caudate
hepatic
CHD
What are the ducts of Luska?
bile ducts that connects directly to the gallbladder through the liver’s wall
What should you do with ducts of Luska?
cauterize them in surgery
Define the borders of the Calot’s triangle
Cystic duct
Hepatic duct
Liver margin
What can be found the the Calot’s triangle?
Cystic artery
hepatic artery
Calot lymph node
What is the Hartmann pouch?
The lower part through which the cystic duct goes out from
What can be seen in the critical view?
CA
CD
What are the 2 roles of the bile?
toxins excretion
digestion of fatty food
Where does most of the bile get reabsorbed?
the terminal ileum
What happens to the bile when you resect the terminal ileum?
the bile continues to the colon and may cause bile diarrhea
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.
CCK
gallbladder
sphincter of Oddi
Symptoms are the result of a blockage leading to ___ and secondary ___ due to the first.
stasis
infection
What are the 3 categories of biliary obstruction?
extramural (pancreatic cancer)
intramural (cholangiocarcinoma)
intralaminar (choledocholithiasis)
What are the 3 common symptoms of the biliary patient (Charcot’s cholangitis triad)?
pain (cholic/acute)
fever
jaundice
Bilirubin above ___ will lead to jaundice in the sclera, above ___ in the skin
2.5
5
What does the Charcot’s triad lead to?
acute cholangitis (ascending cholangitis)
What does the Reynold pentad include? What does it lead to?
pain (cholic/acute) fever jaundice decrease in consciousness level hypotension severe cholangitis
What is the Courvoisier sign?
fullness/thickness in the gallbladder area w/o pain
What does Courvoisier sign + painless jaundice suggest? 3
pancreatic tumor or cholangiocarcinoma or duodenal tumor
Which lab markers should you pay attention to when approaching biliary patients? (3)
hepatocellular/transaminase (AST/ALT)
cholestatic (GGT/ALKP/bilirubin)
synthetic (albumin/INR/glucose)
AST/ALT/GGT/ALKP/bilirubin/albumin/INR/glucose
What should be the first imaging test for a biliary patient?
US
Biliary stasis is defined by extra hepatic duct > __ mm, or intra hepatic duct > __ mm
4
8
HIDA is a good test to rule out biliary stasis in the ___ of the gallbladder
origin
MRCP is the best imaging test for the biliary system since it is not ____ and allows the best view of the ___
invasive
anatomy
ERCP is an ___ test that may lead to pancreatitis, perforation, edema. But it can also ___ by removing stones or inserting stents
invasive
cure
The best test for the distal bile ducts is ___
EUS
The bile consists of ___, ___, and ___
cholesterol
bile acid
phospholipids (lecithin)
The ___ stone is the classic one, while ___ stone is less common (25%)
cholesterol
pigmented
Name 3 situations that increase the production of cholesterol stones:
- high saturation of cholesterol in the bile
- acceleration in nucleation process
- hypomotility of the gallbladder (pregnancy/fasting)
When will we see black pigmented stones? (4)
cirrhosis
chronic hemolysis
Gilbert
CF
When will we see brown pigmented stones? (4)
chronic infection of the biliary system
more in the CBD
Name 5 of the most common RF leading to cholelithiasis: remember 5 F’s
metabolic syndrome sharp loss of weight female sex hormones old age hypomotility of the gallbladder
