Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Chapter 13 > Flashcards

Chapter 13 Flashcards

1
Q

What is extremely prevalent?

A

Hepatic arterial anatomic variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are the liver and gallbladder located?

A

RUQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does bile do?

A

Produced by the liver and stored in the gallbladder

Critical for the absorption of fats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Function of CCK

A

Released by the intestine in response to ingested fats
Causes the gallbladder to contract and propel bile through the cystic duct, into the common bile duct, and eventually into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Central roles of the liver

A

Nutrient and drug metabolism
Synthesis of coagulation proteins
Detoxification of the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathway of the blood supply of the liver in m.ost people

A

Arterial blood from the aorta reaches hepatobiliary system via the right and left hepatic arteries, which are terminal branches of the proper hepatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blood supply of the gallbladder

A

Supplied by the cystic artery, which commonly arises from the right hepatic artery
Cystic artery courses through the triangle of Calot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the triangle of Calot composed of?

A

Inferior border of the liver
Common hepatic duct
Cystic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathway of replaced or recurrent left hepatic artery

A

Courses from the left gastric artery through the hepatogastric ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathway of replaced or recurrent right hepatic artery

A

When it branches off the SMA, frequently travels to the right of the common bile duct in the lateral hepatoduodenal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Venous blood supply of the liver

A

70% of its blood supply via the portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is deoxygenated blood from the liver drained?

A

Drained by three large intraparenchymal hepatic veins (right, middle, left) that empty in the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where do veins of the gallbladder penetrate?

A

Penetrate the hepatic parenchyma in the vicinity of the gallbladder fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Morphologic vs functional classification of the liver

A

Morphologic: Divides liver into four lobes; lobes are separated by external fissures or ligaments
Functional: Divides liver into eight segments that are supplied by distinct branches of the arterial and portal blood supply.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are segments of the liver separated according to the functional classification?

A

By the vertically oriented portal scissurae containing the hepatic veins and the transversely oriented portal pedicles containing the portal vein branches within the hepatic parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In the functional classification of the liver, what constitutes the right hemiliver?
What constitutes the left hemiliver?

A

Segments 5-8

Segments 2-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the surgeon’s initial priority in evaluating the patient with hepatobiliary dz?

A

Determine whether pt has necrotic or infected tissue
If biliary obstruction with infection is present
If there is acute liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two frequently utilized diagnostic modalities in the pt who is acutely ill in order to determine if infection, a bile leak or biliary obstruction is present?

A

Serum bilirubin level

HIDA or DISIDA scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RFs for the development of symptomatic gallstone dz

A

Obesity
Rapid weight loss or gain
Estrogen exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Classification of gallstones

A

Classified by their composition:

  • Cholesterol stones
  • Pigment stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Further subdivision of pigment stones

A

Black or brown pigment stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do gallstones become symptomatic?

A

When they obstruct ductal structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of biliary colic

A

RUQ pain, nausea and vomiting that commonly begins a few hours after a fatty meal but ultimately regresses spontaneously once the gallstone dislodges from the cystic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the term when gallstones intermittently obstruct the cystic duct?

A

Biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx of choice for cholelithiasis

A

Elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sx of cholecystitis

A

Initially resemble those of biliary colic; however the pain persists for hours to days without resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

PE of cholecystitis

A

Murphy’s sign
Febrile
Leukocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is often diagnostic of cholecystitis?

A

U/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is cholecystitis definitively diagnosed?

A

HIDA scan

30
Q

When can a HIDA scan be frequently falsely negative?

A

Acalculus cholecystitis

31
Q

Emphysematous cholecystitis

A

Persistent cystic duct obstruction leads to increased intraluminal pressure in the gallbladder, which can lead to ischemia of the gallbladder wall with subsequent perforation or necrosis

32
Q

When should laparoscopic cholecystectomy be performed?

A

Within 24-72 hrs of hospital admission

33
Q

Pattern of complication rates with cholecystectomy

A

Increase with greater delays before cholecystectomy

34
Q

What is a possible definitive therapy for acalculous cholecystitis?

A

Cholecystotomy drainage

Also an option for inoperable cholecystitis pt

35
Q

What is pathognomonic for gallstone ileus and should prompt exploratory laparotomy?

A

Plain radiograph demonstrating small bowel obstruction and air in the biliary system

36
Q

What should be performed after the discovery of a gallstone ileus?

A

Enterolithotomy to remove the gallstone or resection of the affected intestinal segment

37
Q

What is usually delayed in a gallstone ileus?

A

Cholecystectomy

38
Q

Tx for suspected choledocholithiasis

A

Common duct stones may be retrieved via urgent ERCP

Alternatively, surgeon may explore the bile duct at time of either laparoscopic or open cholecystectomy

39
Q

What may be useful in cases with complex ductal anatomy and to evaluate for choledocholithiasis and bile duct injury or pathology?

A

Intraoperative cholangiography

40
Q

In a laparoscopic cholecystectomy, what should be done prior to division of structures?

A

Obtain the critical view of safety

41
Q

When is conversion to open approach indicated in cholecystectomy?

A

When the delineation of ductal anatomy is difficult or if significant bleeding develops

42
Q

Complications of laparoscopic cholecystectomy

A

Cystic duct stump leaks

Iatrogenic injury to surrounding ductal structures

43
Q

Presentation of cystic duct stump leaks

A

Present 3 days after procedure with abd pain, fever, and/or vomiting

44
Q

Confirmation of cystic duct stump leaks

A

HIDA scan

ERCP

45
Q

Management of cystic duct stump leaks

A

ERCP stenting of the common bile duct as well as percutaneous drainage of the resulting biloma(s)

46
Q

What are common iatrogenic complications of a cholecystectomy?

A

Injury to the common bile duct occurs more frequently during laparoscopic vs open approach
Electrocautery injuries
Inadvertent ligation of the common bile or hepatic duct

47
Q

What should happen if the surgeon recognizes ductal injury intraoperatively?

A

Termination of the procedure and transfer of the pt to a tertiary care center for definitive management

48
Q

What do 90% of bile duct injuries require?

A

Operative bile duct reconstruction via Roux-en-Y hepaticojejunostomy

49
Q

How are gallbladder polypoid lesions commonly detected

A

U/s

50
Q

Management of asymptomatic gallbladder lesions

A

Expectantly with ultrasonographic surveillance performed every 3-6 mos

51
Q

When is laparoscopic cholecystectomy recommended in a pt with gallbladder polyps?

A

Any pt who has a gallbladder polyp that is >10 mm in size

52
Q

When is open cholecystectomy recommended for gallbladder polyps?

A

Removal of larger lesions to avoid dissemination of malignancy

53
Q

When are choledochal cysts more common?

A

Pts of Asian ethnicity

54
Q

A minority of pts with choledochal cysts present with what sx?

A

Triad of jaundice, abd pain, and a RUQ mass

55
Q

More common adult presentation of choledochal cysts

A

Complications such as cholangitis or pancreatitis

56
Q

Imaging modality of choice for choledochal cysts

A

MRCP

57
Q

Tx of choledochal cysts

A

Cyst excision with hepaticoenterostomy

58
Q

Tx for type V choledochal cysts

A

These pts may require liver transplantation

59
Q

Tx for type III choledochal cysts

A

Some authors advocate therapeutic transduodenal sphincteroplasty

60
Q

What is the most common cause of biliary strictures?

A

Iatrogenic injuries

61
Q

Tx of distal biliary strictures

A

Biliary-enteric bypass

62
Q

Tx for primary sclerosing cholangitis

A

Biliary-enteric anastomosis

63
Q

Characteristics of primary sclerosing cholangitis

A

Affects men more commonly than women

May progress to biliary cirrhosis and end-stage liver dz necessitating liver transplantation

64
Q

Tx of biliary structures initially in pts with primary sclerosing cholangitis

A

Either ERCP or percutaneous biliary stenting

65
Q

Presentation of pyogenic hepatic abscess

A

Most will have fever
Only half of pts will have abd pain
Jaundice is infrequent

66
Q

What is the most sensitive and specific test for the dx of pyogenic hepatic abscess?

A

CT scan

67
Q

What can help distinguish between pyogenic bacterial abscesses from parasitic abscesses?

A

Indirect hemagglutination or ELISA

68
Q

When do iatrogenic pyogenic liver abscesses occur?

A

Following therapeutic interventions, such as:

  • Radiofrequency ablation (RFA)
  • Hepatic artery chemoembolization
69
Q

Organisms of pyogenic liver abscess

A 
Usually polymicrobial
K. pneumoniae
E. coli
Streptococci
B. fragilis
70
Q

Tx of pyogenic liver abscess

A

Image-guided percutaneous drainage coupled with appropriate broad-spectrum abx therapy

Surgery (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions