Billiary tract

Question 1

Name strucutre #1

Answer 1

intrahepatic ducts

Question 2

Name strucutre #2

Answer 2

Left hepatic duct

Question 3

Name strucutre #3

Answer 3

Right hepatic duct

Question 4

Name strucutre #4

Answer 4

Common hepatic duct

Question 5

Name strucutre #5

Answer 5

Gallbladder

Question 6

Name strucutre #6

Answer 6

Cystic duct

Question 7

Name strucutre #7

Answer 7

Common bile duct

Question 8

Name strucutre #8

Answer 8

Ampulla of Vator

Question 9

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

Answer 9

Calot’s node

Question 10

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

Answer 10

Ducts of Luschka

Question 11

Which artery is susceptible to injury during cholecystectomy?

Answer 11

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

Question 12

Where is the infundibulum of the gallbladder?

Answer 12

Near the cystic duct

Question 13

Where is the funduc of the gallbladder?

Answer 13

At the end of the gallbladder

Question 14

What are the boundaries of the triangle of Calot?

Answer 14

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

Question 15

What is the source of alkaline phosphatase?

Answer 15

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

Question 16

What is bile?

Answer 16

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

Question 17

What does bile do?

Answer 17

Emulsifies fats

Question 18

What is the enterohepatic circulation?

Answer 18

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

Question 19

Where are most of the bile acids absorbed?

Answer 19

terminal ileum

Question 20

What stimulates gallbladder emptying?

Answer 20

Cholecystokinin and vagal input

Question 21

What is the source of Cholecystokinin (CCK)?

Answer 21

Duodenal mucosal cells

Question 22

What are the actions of CCK?

Answer 22

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

Question 23

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

Answer 23

2.5

Question 24

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

Answer 24

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

Question 25

What are the signs and symptoms of obstructive jaundice?

Answer 25

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

Question 26

What causes the itching in obstructive jaundice?

Answer 26

Bile salts in the dermis (not bilirubin!!)

Question 27

Define: cholelithiasis

Answer 27

gallstones in gallbladder

Question 28

Define: choledocholithiasis

Answer 28

gallstones in the common bile duct

Question 29

Define: cholecystitis

Answer 29

inflammation of gallbladder

Question 30

Define: cholangitis

Answer 30

infection of biliary tract

Question 31

Define: cholangiocarcinoma

Answer 31

adenocarcinoma of bile ducts

Question 32

Define: Klatskin's tumor

Answer 32

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

Question 33

Define: Biliary colic

Answer 33

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

Question 34

Define: Biloma

Answer 34

intraperitoneal bile fluid collection

Question 35

Define: choledochojejunostomy

Answer 35

anastomosis between common bile duct and jejunum

Question 36

hepaticojejunostomy

Answer 36

anastomosis of hepatic ducts or common hepatic duct to jejunum

Question 37

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

Answer 37

ULTRASOUND

Question 38

Define: ERCP

Answer 38

Endoscopic Retrograde CholangioPancreatography

Question 39

Define: PTC

Answer 39

Percutaneous Transhepatic Cholangiogram

Question 40

Define: IOC

Answer 40

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

Question 41

Define: HIDA/PRIDA scan

Answer 41

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

Question 42

How does the HIDA scan reveal cholecystitis?

Answer 42

nonopacification of the gallbladder from obstruction of the cystic duct

Question 43

what is a cholecystectomy?

Answer 43

removal of the gallbladder laparoscopically or through a standard Kocher incision

Question 44

What is a "lap chole"?

Answer 44

LAProscopic CHOLEcystectomy

Question 45

What is a sphincterotomy?

Answer 45

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

Question 46

How should postoperative biloma be treated after a lap chole?

Answer 46

- percutanceous drain bile collection - ERCP with placement of biliary stent past leak (usually cystic duct remnant leak)

Question 47

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

Answer 47

Choledochojejunostomy

Question 48

What is obstructive jaundice?

Answer 48

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

Question 49

What is the differential diagnosis of proximal bile duct obstruction?

Answer 49

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

Question 50

What is the differential diagnosis of distal bile duct obstruction?

Answer 50

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

Question 51

What is the initial study of choice for obstructive jaundice?

Answer 51

Ultrasound