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COMAT: Surgery > Biliary Tract > Flashcards

Biliary Tract Flashcards

1
Q

what are the boundaries of the triangle of Calot?

A

Three C’s
cystic duct
common hepatic duct
cystic artery

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2
Q

what is the source of alkaline phosphatase?

A

bile duct epithelium

- expect alkaline phosphatase to be elevated in bile duct obstruction

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3
Q

what is in bile

A

cholesterol, lecithin, bile acids, and bilirubin

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4
Q

what does bile do

A

emulsify fats

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5
Q

what is the enterohepatic circulation

A

circulation of bile acids from liver to gut and back to the liver

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6
Q

where are most of the bile acids absorbed

A

terminal ileum

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7
Q

what stimulates gallbladder emptying

A

cholecystokinin and vagal input

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8
Q

what is the source of CCK?

A

duodenal mucosal cells

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9
Q

at what level of serum total bilirubin does one start to get jaundiced

A

2.5

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10
Q

what are the signs and symptoms of obstructive jaundice

A 
jaundice
dark urine
clay-colored stools (echoic stools)
pruritus
loss of appetite
nausea
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11
Q

what causes the itching in obstructive jaundice

A

bile salts in the dermis

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12
Q

what is cholelithiasis

A

gallstones in gallbladder

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13
Q

what is choledocholithiasis

A

gallstone in the common bile duct

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14
Q

what is cholecystitis

A

inflammation of the gallbladder

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15
Q

what is cholangitis

A

infection of biliary tract

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16
Q

what is cholangiocarcinoma

A

adenocarcinoma of bile ducts

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17
Q

what is Klatskin’s tumor

A

cholangiocarcinoma of bile duct at the junction of the right and left hepatic ducts

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18
Q

what is biliary colic

A

pain from gallstones, usually from a stone in cystic duct

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19
Q

what is biloma

A

intraperitoneal bile fluid collection

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20
Q

what is the initial diagnostic study of choice for evaluation of the biliary tract/gallbladder/cholelithiasis

A

ultrasound

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21
Q

what is ERCP

A

endoscopic retrograde cholangiopancreatography

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22
Q

what is PTC

A

percutaneous trans-hepatic cholangiogram

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23
Q

what is HIDA scan

A

radioisotope study

  • isotope concentrated in liver and secreted into bile
  • will demonstrate cholecystitis, bile leak, or CBD obstruction
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24
Q

how does HIDA scan reveal cholecystitis

A

nonopacification of the gallbladder from obstruction of the cystic duct

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25
Q

what lab results are associated with obstructive jaundice

A

elevated alk phos, elevated bilirubin w/ or w/o elevated LFTs

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26
Q

what is cholelthiassi

A

formation of gallstones

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27
Q

what are the Big 4 risk factors for cholelithiasis

A

Female
Fat
Forty
Fertile

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28
Q

what are the five major complications of gallstones

A
  • acute cholecystitis
  • choledocholithiasis
  • gallstone pancreatitis
  • gallstone ileus
  • cholangitis
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29
Q

how is cholelithiasis diagnosed

A

ultrasound

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30
Q

what are indications for cholecystectomy in asymptomatic patient

A

sickle-cell
calcified gallbladder
patient is child

31
Q

what is the major feared complication of ERCP

A

pancreatitis

32
Q

what is the pathogenesis of acute cholecystitis

A

obstruction of the bile duct leads to inflammation of the gallbladder

33
Q

what are the risk factors foracute cholecystitis

A

gallstones

34
Q

what are the signs and symptoms of acute cholecystitis

A
  • unrelenting RUQ pain or tenderness
  • fever
  • nausea/vomiting
  • painful palpable gallbladder
  • positive Murphy’s sign
  • right sub scapular pain
  • epigastric discomfort
35
Q

what are the complications of acute cholecystitis

A

abscess
perforation
choledocholithiasis
cholecystenteric fistula formation

36
Q

what lab results are associated with acute cholecystitis

A

increased WBC
may have:
- slight elevation of alk phos, LFTs
- slight elevation in amylase, total bilirubin

37
Q

what is the treatment of acute cholecystitis

A

IVFs, abx, and early cholecystectomy

38
Q

what is acute acalculous cholecystitis

A

acute cholecystitis without evidence of stones

39
Q

what is the pathogenesis of acute acalculous cholecystitis

A

sludge and gallbladder disuse and biliary stasis

40
Q

what are the findings of acute acalculous cholecystitis on HIDA

A

non filling of the gallbladder

41
Q

what is the management of acute acalculous cholecystitis

A

cholecystectomy

42
Q

what is cholangitis

A

bacterial infection of the biliary tract from obstruction

43
Q

what are the common causes of cholangitis

A

choledocholithiasis

44
Q

what are the signs and symptoms of cholangitis

A

Charcot’s triad

  • fever/chills
  • RUQ pain
  • jaundice
45
Q

what is Reynold’s pentad

A

Charcot’s triad (fever/chills, RUQ pain, jaundice) +

  • mental status changes
  • shock
46
Q

which organisms are most commonly isolated with cholangitis

A

gram negative organisms

- E. coli, Klebsiella, Psuedomonas, Enterobacter, Proteus, Serratia

47
Q

what is suppurative cholangitis

A

severe infection with sepsis

- ‘pus under pressure’

48
Q

what is the management of cholangitis

A

nonsuppurative:
- IVF and abx, definitive tx later
suppurative:
- IVF, abx, decompression

49
Q

what is sclerosing cholangitis

A

multiple inflammatory fibrous thickenings of bile duct walls resulting in biliary strictures

50
Q

what is the natural history of sclerosing cholangitis

A

progressive obstruction possibly leading to cirrhosis and liver failure

51
Q

what is the major risk factor of sclerosing cholangitis

A

IBD

52
Q

what type of IBD is the most common risk factor

A

ulcerative colitis

53
Q

what are the signs and symptoms of sclerosing cholangitis

A

same as for obstructive jaundice:

  • jaundice
  • dark urine
  • itching
  • clay-colored stools
  • loss of energy
  • weight loss
54
Q

how is sclerosing cholangitis diagnosed

A

elevated alk phos

PTC or ERCP revealing ‘beads on a string’

55
Q

what are the management options for sclerosing cholangitis

A

hepatoenteric anastomosis and resection of extra hepatic bile ducts because of risk of cholangiocarcinoma

56
Q

what is gallstone ileus

A

SBO from a large gallstone that has eroded through the gallbladder and into the duodenum/small bowel

57
Q

what is the classic site of obstruction in gallstone ileus

A

ileocecal valve

58
Q

what are the classic findings of gallstone ileus

A

air int he hepatic bile ducts
SBO with air fluid levels
gallstone in ileocecal valve

59
Q

what are the signs/symptoms of gallstone ileus

A

symptoms of SBO:

  • distention
  • vomiting
  • hypovolemia
  • RUQ pain
60
Q

what are the diagnostic test of choice

A

abdominal xray - air in biliary tract

abdominal CT scan

61
Q

what is the management of gallstone ileus

A

surgery

62
Q

what is carcinoma of the gallbladder

A

malignant neoplasm arising in the gallbladder

- majority are adenocarcinoma

63
Q

what are the risk factors for carcinoma of the gallbladder

A

gallstones, porcelain gallbladder, cholecystenteric fistula

64
Q

what is a porcelain gallbladder

A

calcified gallbladder

65
Q

what are the symptoms of carcinoma of the gallbladder

A

biliary colic, weight loss, anorexia

  • many are asymptomatic until late
  • may present as acute cholecystitis
66
Q

what are the signs of carcinoma of the gallbladder

A 
jaundice (from invasion of the CBD or compression by involved pericholedochal lymph nodes)
RUQ mass
palpable gallbladder (advanced disease)
67
Q

what is the route of spread in carcinoma of the gallbladder

A

contiguous spread to the liver

68
Q

what is cholangiocarcinoma

A

malignancy of the extra hepatic or intrahepatic ducts

- primary bile duct cancer

69
Q

what is the histology of cholangiocarcinoma

A

almost all are adenocarcinomas

70
Q

what are the signs/symptoms of cholangiocarcinoma

A

those of biliary obstruction:

- jaundice, pruritus, dark urine, clay-colored stools, cholangitis

71
Q

what is the most common location of cholangiocarcinoma

A

proximal bile duct

72
Q

what is an MRCP

A

MRI with visualization of pancreatic and bile ducts

73
Q

what is the management of a proximal bile duct cholangiocarcinoma

A

resection with Roux-en-Y

74
Q

what is the management of distal common bile duct cholangiocarcinoma

A

Whipple procedure

COMAT: Surgery (17 decks)

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