Chapter 53: Biliary Tract Flashcards
what are the small ducts that drain bile directly into the galbladder from the liver
Ducts of Luschka
what aretery is susceptible to injury during cholecystectomy
RIght hepatic artery because of its proximity to the cystic artery and calot’s triangle
where is the infundibulum of the gallbladder
near the cystic duct
where is the fundus of the gallbladder
at the end of the gallbladder
what are the boundaries of the triangle of calot
- common hepatic duct
- liver
- cystic duct
what is the source of ALP
bile duct epithelium therefore expected to be elevated in bile duct obstruction
what is in bile
cholesterol, lecthin(phospholipid), bile acids, bilrubin
what does bile do
emulsifies fat
what is the enterohepatic circulation
circulation of bile acids from the liver to the gut and back to the liver
where are most of the bile acids absorbed
terminal ileum
what stimulates gallbladder emptying
- CCK
- vagal imput
what is the source of cck
duodenal mucosal cells
cck actions
- gallbladder emptying
- opening of ampula of vater
- slowing of gastric emptying
- pancreatic acinar cell growth and release of exocrine products
at what level of serum bilrubin does one start to get jaundiced
2.5
where does one first find evidence of jaundice
under the tongue because UV breaks down bilrubin at other sites
what are the signs and symptoms of obstructive jaundice
- jaundice
- dark urine
- clay colored stool
- pruritus
- loss of apetite
- nausea
what causes the itching in obstructive jaundice
BILE SALTS in dermis
cholangitis
infection of the biliary tract
klatskins tumor
cholangiocarcinoma of bile duct at the junction of the right and left hepatic ducts
what is a biloma
intraperitoneal bile fluid collection
what is a choledochojejunostomy
anastamosis between cbd and jejenum
what is a hepaticojejunostomy
anastamosis of hepatic o common hepatic ducts to jejenum
what is the intial diagnostic study of choice for evaluation of bening gallbladder
US
what is ERCP
Endoscopic Retrograde CholangioPancreatography
what is PTC
Percutaneous Transhepatic Cholangiogram
what is IOC
Intraoperative cholangiogram
- done laproscopically or open
- rule out choledocholithiasis
what is HIDA/PRIDA scan
- radioisotope study
- the isotope is concentrated in the liver and secreted into bile
- demonstrates:
- cholecystitis
- nonopacification of the galbladder from obstruction of the cystic duct
- bile leak
- CBD obstruction
- cholecystitis
- bile flows into hepatic ducts to the cb ,d thru the cyustic duct into gallbladder
what is a cholecystectomy
removal of galbladder laproscopically or through a standard kocher incision
what is a sphincterotomy
Cut through sphincter of Oddi to allow passage of gallstones from the commonbile duct; most often done at ERCP; a.k.a. “papillotomy
How should postoperative biloma be treated after a lap chole?
- Percutaneous drain bile collection
- ERCP with placement of biliary stent past leak (usually cystic duct remnantleak)
What is the treatment of major CBD injury after a lap chole?
Choledochojejunostomy
