Chapter 53: Biliary Tract

Question 1

what are the small ducts that drain bile directly into the galbladder from the liver

Answer 1

Ducts of Luschka

Question 2

what aretery is susceptible to injury during cholecystectomy

Answer 2

RIght hepatic artery because of its proximity to the cystic artery and calot’s triangle

Question 3

where is the infundibulum of the gallbladder

Answer 3

near the cystic duct

Question 4

where is the fundus of the gallbladder

Answer 4

at the end of the gallbladder

Question 5

what are the boundaries of the triangle of calot

Answer 5

1. common hepatic duct
2. liver
3. cystic duct

Question 6

what is the source of ALP

Answer 6

bile duct epithelium therefore expected to be elevated in bile duct obstruction

Question 7

what is in bile

Answer 7

cholesterol, lecthin(phospholipid), bile acids, bilrubin

Question 8

what does bile do

Answer 8

emulsifies fat

Question 9

what is the enterohepatic circulation

Answer 9

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

Question 10

where are most of the bile acids absorbed

Answer 10

terminal ileum

Question 11

what stimulates gallbladder emptying

Answer 11

1. CCK
2. vagal imput

Question 12

what is the source of cck

Answer 12

duodenal mucosal cells

Question 13

cck actions

Answer 13

1. gallbladder emptying
2. opening of ampula of vater
3. slowing of gastric emptying
4. pancreatic acinar cell growth and release of exocrine products

Question 14

at what level of serum bilrubin does one start to get jaundiced

Answer 14

2.5

Question 15

where does one first find evidence of jaundice

Answer 15

under the tongue because UV breaks down bilrubin at other sites

Question 16

what are the signs and symptoms of obstructive jaundice

Answer 16

1. jaundice
2. dark urine
3. clay colored stool
4. pruritus
5. loss of apetite
6. nausea

Question 17

what causes the itching in obstructive jaundice

Answer 17

BILE SALTS in dermis

Question 18

cholangitis

Answer 18

infection of the biliary tract

Question 19

klatskins tumor

Answer 19

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

Question 20

what is a biloma

Answer 20

intraperitoneal bile fluid collection

Question 21

what is a choledochojejunostomy

Answer 21

anastamosis between cbd and jejenum

Question 22

what is a hepaticojejunostomy

Answer 22

anastamosis of hepatic o common hepatic ducts to jejenum

Question 23

what is the intial diagnostic study of choice for evaluation of bening gallbladder

Answer 23

US

Question 24

what is ERCP

Answer 24

Endoscopic Retrograde CholangioPancreatography

Question 25

what is PTC

Answer 25

Percutaneous Transhepatic Cholangiogram

Question 26

what is IOC

Answer 26

Intraoperative cholangiogram * done laproscopically or open * rule out choledocholithiasis

Question 27

what is HIDA/PRIDA scan

Answer 27

* 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 * bile flows into hepatic ducts to the cb ,d thru the cyustic duct into gallbladder

Question 28

what is a cholecystectomy

Answer 28

removal of galbladder laproscopically or through a standard **kocher** incision

Question 29

what is a sphincterotomy

Answer 29

Cut through sphincter of Oddi to allow passage of gallstones from the commonbile duct; most often done at ERCP; a.k.a. “papillotomy

Question 30

How should postoperative biloma be treated after a lap chole?

Answer 30

* Percutaneous drain bile collection * ERCP with placement of biliary stent past leak (usually cystic duct remnantleak)

Question 31

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

Answer 31

Choledochojejunostomy