Appendix and GB Flashcards
Describe arterial supply of appendix
Aorta—>SMA—>ileocolic—> appendiceal
What causes appendicitis?
OBSTRUCTION of the appendiceal lumen (usually lymphoid hyperplasia or fecalith)
Most common cause of emergent abd surgery in US?
Acute appendicitis
What kind of appendicitis is a positive obturator sign suggestive of?
Pelvic
What kind of appendicitis is a positive psoas sign suggestive of?
Retrocecal
How can you differentiate gastroenteritis from appendicitis based on sx chronicity?
Gastroenteritis vomiting usually precedes abd pain
In appendicitis the pain usually precedes vomiting
What CT findings indicate acute appendicitis?
Periappendiceal fat stranding, appendiceal diameter >6mm, periappendiceal fluid, feaclith
Which bacteria is associated with mesenteric adenitis(which mimics appendicitis)?
Yersinia enterocolitica
Most common type of appendiceal tumor
Carcinoid
How do you treat appendiceal carcinoid?
<1.5cm appendectomy
>1.5cm right hemicolectomy
What type of appendiceal tumor can cause the dreaded pseudonymous peritonei if the appendix rupture?
Malignant mucous Adenocarcinoma
What are the small ducts that drain bile directly into the gallbladder from the liver?
Ducts of Luschka
Which artery is susceptible to injury in cholecystectomy?
Right hepatic artery
What stimulates the gallbladder emptying?
CCK and vagal input
What is the source of CCK?
Duodenal mucosal cells
At what level of serum bilirubin does one start to get jaundice?
2.5
Classically what is thought to be the anatomic location where one first finds evidence of jaundice?
Under the tongue (UV rays break down bili at other sites)
What causes itching in obstructive jaundice?
Bile salts in dermis (not bilirubin!)
Signs and sx of obstructive jaundice include:
Yellowing of skin Dark urine Clay colored stools Itching Loss of appetite Nausea
What is Klatskin’s tumor?
Cholangiocarcinoma of bile duct at junction of right and left hepatic
What is a biloma?
An intraperitoneal bile fluid collection
What lab results are associated with obstructive jaundice?
Elevated alk phos and bili. Without elevated LFTs
What is the incidence of cholelithiasis?
10% of the population will develops gallstones
What are the big 4 risk factors for cholelithiasis?
Female
Fluffy
Forty
Fertile
Most gallstones are this type
Cholesterol (75%)
What causes brown gallstones?
Billiary tract infection
What causes black gallstones?
Cirrhosis and hemolysis
What percentage of pts with gallstones are asymptotic?
80%
What are indications for cholecystectomy in the asymptotic pt?
Sickle cell dz
Calcifies gallbladder
Pt is a child
What is first line management for choledocholithiasis?
ERCP with papillotomy and retrieval of stone
What medications dissolve a cholesterol gall stone?
Chenodeoxycholic avid, ursodeoxycholic acid. (Takes >6m and if pt stops meds stones recur)
What is charcot’s triad and what does it indicate?
Fever/chills
RUQ pain
Jaundice
Cholangitis
What is reynold’s pentad and what does it indicate?
Fever/chills RUQ pain Jaundice AMS Shock
Cholangitis
What is suppurations cholangitis?
Severe infection with sepsis - “pus under pressure”
