Biliary Surgery Definitions Flashcards
Cholelithiasis
gallstones visualized in study
gallbladder sludge
thicker than bile, not as firm; falls apart unlike a stone (enough to cause symptoms)
porcelain gallbladder
calcium deposits in the wall–>seen on plain xray
gallbladder polyps
densities within the gallbladder that doesnt move when the patient moves; a stone will roll around but polyp will stay still
wall thickening
gall bladder wall itself, very subjective occasionally measured (accuracy is questionable)
should be no more than 2-3 mm thick normally
implies inflamed GB or possible malignancy (but rare)
Biliary Colic
RUQ pain but no stones in GB, when contracts not able to contract thoroughly and increase pressure causes pain
cholecystitis, acute or chronic
inflammation of the Gall bladder; 24 hours vs months
implies with stones unless you use Acalculous
note: can have acute episode with chronic pathology
acute acalculous cholecystitis
no GB stones in the inflammation
not often but can still call for gall bladder removal
acute emphysematous cholecystitis
gas or air within wall of the gall bladder–> BAD
can indicate a gas forming infection
show up on Xray
pneumobilia- air within the biliary tree
acute gangrenous cholecystitis
often preceded by acute emphysematous cholecystitis
loss of its blood supply and its dead
blackish bluish color
often leads to perforation (mortality around 50%)
Hydrops
enlargement of the gallbladder
blockage of the bile in or out
changes to not pigmented clear snotty fluid
can only make this diagnosis via ASPIRATION or during surgical removal
choledocholithiasis
stone has passed out of GB and into bile duct or biliary tree
cause similar symptoms to cholecystitis
can block ampulla to the doudenum
cholangitis
infection from the bile duct (Ascending)
- charcot’s triad
- reynold’s pentad
Mirizzi’s Syndrome
large stone in cystic duct before it gets into common duct, but it is so large it compresses/blocks the common bile duct
-not seen very often
gallstone pancreatitis
into common bile duct through ampullas or impacted in ampula, also blocks pancreatic duct
Gallstone ileus
“bullseye” in RLQ on Xray if calcified (5%)
in intestine creating a fistula ; ileocecal valve is smallest area where it usually gets stuck
-can present as a bowel obstruction and pain is generally not as severe
Choledochal cyst
cystic formation of biliary tree; multiple forms;congenital
- jaundice especially if child
- dont drain properly
- increased risk to form malignancy later in life
gall bladder carcinoma
not very common
- polyps can be indications
- stones for a long time increase risk
obstructive jaundice
blockage of bile duct (surgery needed) - bile can not get from Liver to GI tract or an increase bile production
nonobstructive jaundice
something is wrong with liver; not releasing bile (not-surgical)
murphy’s sign
doesnt have to be GB 100% of time - just keep that in mind
courvoisier’s sign
non tender palpable mass RUQ
BAD sign–> can indicate malignancy usually from bile duct obstruction
Cholecystectomy
=removal of the gallbladder
most are done laparoscopically
common procedure
cholecystotomy
make a hole in the gallbladder or place a drainage tube (invasive radiologist)
common bile duct exploration
can be done open or laparoscopically
intraoperative cholangiogram
X ray done during surgery
checks for stones in the biliary tree
Endoscopic retrograde cholangiopancreatography (ERCP)
scope, usually done by GI doc
different than standard GI scope
Radionuclide scope (HIDA)
Isotope filtered by liver then drained by bile
pictures of liver, bile ducts, and gall bladder, taken as isotope makes its way down
Triangle of Calot
edge of liver, cystic duct, common duct; lymph node within called node of calot
cystic artery within the triangle
spiral valves of heister
spiral-shaped anatomy explains why stones can get hung up in ducts
in cystic duct; folds in the submucosa
Hepatoduodenal ligament
lower part of the GB connected to the infundibulum.
contains portal triad
Common patient presentation of cholecystitis
RUQ/epigastic pain that radiates to Right SCAPULAR area
lasts a few hours
food related (especially fatty foods or spicy)
N/V
Diaphoresis, fever with obstruction maybe
anxious-pacing
Nothing helps time and potent analgesics
GERD
radiation directly into back
worse with recumbent position
EGD/UPGI
antacids
Pancreatitis patient presentation
radiates directly into back
helps to lean forward
amylase/lipase increased
CT SCAN
Appendicitis
shorter history requires RUQ appendix position (can start in umbilical region and then moves) no food relationship Rovsing CT scan
Myocardial infarction
Vascular Hx
EKG
Cardiac enzymes
Right lobe (lower) pneumonia
Fever, cough SOB smoking debilitation lung sounds CXR
pyelonephritis
fever, Lloyds sign, UA
Charcots Triad
RUQ pain, fever, Jaundice (Acute cholangitis relevance)
Reynolds Pentad
Charcots Triad (jaundice, RUQ pain, fever) plus hypotension and mental confusion
