BILIARY Flashcards
During a laparoscopic cholecystectomy an injury to the common bile duct occurs and is
recognized. This situation requires
conversion to a laparotomy and cholangiography.
If the injured segment of bile duct is short (
Drainage and pre-op temporizing for patent with CBD injury after lap chole
PTC with catheter drainage to determine level of injury and
leave catheter tip*
at injury site to assist with intra-operative identification
Postcholecystectomy syndrome
Can present with right upper quadrant pain post cholecystectomy
Need a good history including alcohol abuse
Get upper endoscopy and ERCP
If you suspect sphincter of OD dysfunction duodenal pressure can be measured to diagnose sphincter oh any spasm or stenosis
May require sphincterotomy
Choledochal cyst
Types and surgeries for them
Pancreatic ascites
Emily’s is very high and me be from leaking pseudocyst or pancreatic duct
Initial treatment is conservative:
NPO TPN
Octreotide 150 mg sub queue queue eight hours or drip
Repeat abdominal taps
May need ERCP with center out of me and possible stent
Treatment pink relativism
Non-fusion of the Long dorsal duct main dark in the short ventral dart
Also the main duct usually drains via the minor papilla instead of the normal anatomy and the minor papilla can be overwhelmed
Diagnosed with ultrasound and give secretin injection to see if dorsal duct dilation response with the patient’s pain
Give ERCP and have them stand the dorsal duct
May require dorsal duct plasty
24-year-old female with the gallstone polyp that is 7 mm ultrasound sound performed in six months later this his 9 mm
What is the management
Laparoscopic cholecystectomy
Consider open cholecystectomy and frozen section
Laparoscopic cholecystectomy is performed and there is muscular invasion
What is the management
Radical cholecystectomy
Liver segments 4b and 5
Portal notes
Cystic duct margin
Port site excision
