Biliary Surgery Definitions

Question 1

Cholelithiasis

Answer 1

gallstones visualized in study

Question 2

gallbladder sludge

Answer 2

thicker than bile, not as firm; falls apart unlike a stone (enough to cause symptoms)

Question 3

porcelain gallbladder

Answer 3

calcium deposits in the wall–>seen on plain xray

Question 4

gallbladder polyps

Answer 4

densities within the gallbladder that doesnt move when the patient moves; a stone will roll around but polyp will stay still

Question 5

wall thickening

Answer 5

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)

Question 6

Biliary Colic

Answer 6

RUQ pain but no stones in GB, when contracts not able to contract thoroughly and increase pressure causes pain

Question 7

cholecystitis, acute or chronic

Answer 7

inflammation of the Gall bladder; 24 hours vs months
implies with stones unless you use Acalculous
note: can have acute episode with chronic pathology

Question 8

acute acalculous cholecystitis

Answer 8

no GB stones in the inflammation

not often but can still call for gall bladder removal

Question 9

acute emphysematous cholecystitis

Answer 9

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

Question 10

acute gangrenous cholecystitis

Answer 10

often preceded by acute emphysematous cholecystitis
loss of its blood supply and its dead
blackish bluish color
often leads to perforation (mortality around 50%)

Question 11

Hydrops

Answer 11

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

Question 12

choledocholithiasis

Answer 12

stone has passed out of GB and into bile duct or biliary tree
cause similar symptoms to cholecystitis
can block ampulla to the doudenum

Question 13

cholangitis

Answer 13

infection from the bile duct (Ascending)

• charcot’s triad
• reynold’s pentad

Question 14

Mirizzi’s Syndrome

Answer 14

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

Question 15

gallstone pancreatitis

Answer 15

into common bile duct through ampullas or impacted in ampula, also blocks pancreatic duct

Question 16

Gallstone ileus

Answer 16

“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

Question 17

Choledochal cyst

Answer 17

cystic formation of biliary tree; multiple forms;congenital

• jaundice especially if child
• dont drain properly
• increased risk to form malignancy later in life

Question 18

gall bladder carcinoma

Answer 18

not very common

• polyps can be indications
• stones for a long time increase risk

Question 19

obstructive jaundice

Answer 19

blockage of bile duct (surgery needed) - bile can not get from Liver to GI tract or an increase bile production

Question 20

nonobstructive jaundice

Answer 20

something is wrong with liver; not releasing bile (not-surgical)

Question 21

murphy’s sign

Answer 21

doesnt have to be GB 100% of time - just keep that in mind

Question 22

courvoisier’s sign

Answer 22

non tender palpable mass RUQ

BAD sign–> can indicate malignancy usually from bile duct obstruction

Question 23

Cholecystectomy

Answer 23

=removal of the gallbladder
most are done laparoscopically
common procedure

Question 24

cholecystotomy

Answer 24

make a hole in the gallbladder or place a drainage tube (invasive radiologist)

Question 25

common bile duct exploration

Answer 25

can be done open or laparoscopically

Question 26

intraoperative cholangiogram

Answer 26

X ray done during surgery

checks for stones in the biliary tree

Question 27

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer 27

scope, usually done by GI doc

different than standard GI scope

Question 28

Radionuclide scope (HIDA)

Answer 28

Isotope filtered by liver then drained by bile

pictures of liver, bile ducts, and gall bladder, taken as isotope makes its way down

Question 29

Triangle of Calot

Answer 29

edge of liver, cystic duct, common duct; lymph node within called node of calot
cystic artery within the triangle

Question 30

spiral valves of heister

Answer 30

spiral-shaped anatomy explains why stones can get hung up in ducts
in cystic duct; folds in the submucosa

Question 31

Hepatoduodenal ligament

Answer 31

lower part of the GB connected to the infundibulum.

contains portal triad

Question 32

Common patient presentation of cholecystitis

Answer 32

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

Question 33

GERD

Answer 33

radiation directly into back
worse with recumbent position
EGD/UPGI
antacids

Question 34

Pancreatitis patient presentation

Answer 34

radiates directly into back
helps to lean forward
amylase/lipase increased
CT SCAN

Question 35

Appendicitis

Answer 35

shorter history 
requires RUQ appendix position (can start in umbilical region and then moves)
no food relationship
Rovsing
CT scan

Question 36

Myocardial infarction

Answer 36

Vascular Hx
EKG
Cardiac enzymes

Question 37

Right lobe (lower) pneumonia

Answer 37

Fever, cough SOB
smoking
debilitation
lung sounds
CXR

Question 38

pyelonephritis

Answer 38

fever, Lloyds sign, UA

Question 39

Charcots Triad

Answer 39

RUQ pain, fever, Jaundice (Acute cholangitis relevance)

Question 40

Reynolds Pentad

Answer 40

Charcots Triad (jaundice, RUQ pain, fever) plus hypotension and mental confusion