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Surgery rotation #1 > Billiary tract > Flashcards

Billiary tract Flashcards

surgical recall book

1
Q

Name strucutre #1

A

intrahepatic ducts

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2
Q

Name strucutre #2

A

Left hepatic duct

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3
Q

Name strucutre #3

A

Right hepatic duct

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4
Q

Name strucutre #4

A

Common hepatic duct

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5
Q

Name strucutre #5

A

Gallbladder

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6
Q

Name strucutre #6

A

Cystic duct

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7
Q

Name strucutre #7

A

Common bile duct

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8
Q

Name strucutre #8

A

Ampulla of Vator

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9
Q

What is the name of the node in Calot’s triangle?

A

Calot’s node

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10
Q

What are the small ducts that drain bile directly into the gallbladder from the liver?

A

Ducts of Luschka

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11
Q

Which artery is susceptible to injury during cholecystectomy?

A

Right hepatic artery, because of its proximity to the cystic artery and Calot’s triangle

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12
Q

Where is the infundibulum of the gallbladder?

A

Near the cystic duct

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13
Q

Where is the funduc of the gallbladder?

A

At the end of the gallbladder

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14
Q

What are the boundaries of the triangle of Calot?

A

“the 3 C’s”
1. Cystic duct
2. Common hepatic duct
3. Cystic artery

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15
Q

What is the source of alkaline phosphatase?

A

bile duct epithelium; expect alk phose to be elevated in a bile duct obstruction

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16
Q

What is bile?

A

Cholesterol, lecithin (phospholipid), bile acids, and bilirubin

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17
Q

What does bile do?

A

Emulsifies fats

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18
Q

What is the enterohepatic circulation?

A

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

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19
Q

Where are most of the bile acids absorbed?

A

terminal ileum

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20
Q

What stimulates gallbladder emptying?

A

Cholecystokinin and vagal input

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21
Q

What is the source of Cholecystokinin (CCK)?

A

Duodenal mucosal cells

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22
Q

What are the actions of CCK?

A

gallbladder emptying
opening of ampulla of Vater
slowing of gastric emptying
pancreas acinar cell growth and release of exocrine products

23
Q

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

A

2.5

24
Q

Classically, what is thought to be the anatomic location where one first finds evidence of jaundice?

A

under the tongue (bc UV light breaks down bilirubin at other sites)

25
Q

What are the signs and symptoms of obstructive jaundice?

A

jaundice
dark urine
clay-colored stool (acholic stools)
pruritis (itching)
loss of appetitie
nausea

26
Q

What causes the itching in obstructive jaundice?

A

Bile salts in the dermis (not bilirubin!!)

27
Q

Define: cholelithiasis

A

gallstones in gallbladder

28
Q

Define: choledocholithiasis

A

gallstones in the common bile duct

29
Q

Define: cholecystitis

A

inflammation of gallbladder

30
Q

Define: cholangitis

A

infection of biliary tract

31
Q

Define: cholangiocarcinoma

A

adenocarcinoma of bile ducts

32
Q

Define: Klatskin’s tumor

A

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

33
Q

Define: Biliary colic

A

pain from gallstones, usually from a stone at cystic duct
- pain is located in the RUQ, epigastrium, or right subscapular region of the back
- usually lasts minutes to hours, but eventually goes away; often postprandial, especially after fatty foods

34
Q

Define: Biloma

A

intraperitoneal bile fluid collection

35
Q

Define: choledochojejunostomy

A

anastomosis between common bile duct and jejunum

36
Q

hepaticojejunostomy

A

anastomosis of hepatic ducts or common hepatic duct to jejunum

37
Q

What is the initial diagnostic study of choice for the evaluation of the biliary tract, gallbladder, cholelithiasis

A

ULTRASOUND

38
Q

Define: ERCP

A

Endoscopic Retrograde CholangioPancreatography

39
Q

Define: PTC

A

Percutaneous Transhepatic Cholangiogram

40
Q

Define: IOC

A

IntraOperative Cholangiogram (done laparoscopically or open to rule out choledocholithiasis)

41
Q

Define: HIDA/PRIDA scan

A

radioisotope study; isotope concentrated in liver and secreted into bile; will demonstrate cholecystitis, bile leak, or CBD obstruction

42
Q

How does the HIDA scan reveal cholecystitis?

A

nonopacification of the gallbladder from obstruction of the cystic duct

43
Q

what is a cholecystectomy?

A

removal of the gallbladder laparoscopically or through a standard Kocher incision

44
Q

What is a “lap chole”?

A

LAProscopic CHOLEcystectomy

45
Q

What is a sphincterotomy?

A

Cut through sphincter of Oddi to allow passage of gallstones from the common bile duct, most often done at ERCP; aka “papillotomy”

46
Q

How should postoperative biloma be treated after a lap chole?

A
  • percutanceous drain bile collection
  • ERCP with placement of biliary stent past leak (usually cystic duct remnant leak)
47
Q

What is the treatment of major CBD injury after a lap chole?

A

Choledochojejunostomy

48
Q

What is obstructive jaundice?

A

Jaundice (hyperbilirubinemia >2.5) from obstruction of bile flow to the duodenum

49
Q

What is the differential diagnosis of proximal bile duct obstruction?

A

Cholangiocarcinoma
Lymphadenopathy
Metastatic tumor
Gallbladder carcinoma
Sclerosing cholangitis
Gallstones
Tumor embolus
Parasites
Postsurgical stricture
Hepatoma
Benign bile duct tumor

50
Q

What is the differential diagnosis of distal bile duct obstruction?

A

Choledocholithiasis (gallstones)
Pancreatic carcinoma
Pancreatitis
Ampullary carcinoma
Lymphadenopathy
Pseudocyst
Postsurgical stricture
Ampulla of Vater dysfunction/stricture
Lymphoma
Benign bile duct tumor
Parasites

51
Q

What is the initial study of choice for obstructive jaundice?

A

Ultrasound

52
Q
A
53
Q
A

Surgery rotation #1 (2 decks)

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