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Surgery > Fiser ABSITE Ch. 32 Gallbladder > Flashcards

Fiser ABSITE Ch. 32 Gallbladder Flashcards

1
Q

the gallbladder lies between these 2 liver segments

A

segment 4 and 5

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2
Q

cystic artery is a branch off of this

A

right hepatic artery

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3
Q

name the boundaries of callot triangle

A

cystic duct laterally, common bile duct medially, liver superior

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4
Q

these arteries were considered longitudinal blood supply to the hepatic and common bile duct, lies in a 3 and 9:00 position

A

right hepatic, retroduodenal, (branches of gastroduodenal artery)

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5
Q

where the cystic veins drain

A

right branch of the portal vein and into the liver

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6
Q

where the biliary lymphatics located with respect to the common bile duct

A

right side

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7
Q

name the parasympathetic and sympathetic innervation to gallbladder

A

parasympathetic: Left (anterior) the trunk of the vagus, sympathetic from T7-T10

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8
Q

which epithelial layer as the gallbladder lack compared to the rest of the GI tract

A

no submucosa

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9
Q

this hormone relaxes the sphincter of oddi

A

glucagon

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10
Q

give the normal size for: common bile duct, gallbladder wall, pancreatic duct

A

common bile duct -less than 8 mm; Gallbladder wall - less than 4 mm; pancreatic duct - less than 4 mm

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11
Q

where is the highest concentration of CCK and secretin cells

A

duodenum

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12
Q

these are invagination of the epithelium of the wall of the gallbladder, formed by increased gallbladder pressure

A

Rokitansky-Aschoff sinuses

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13
Q

name 3 things that increase bile excretion

A

CCK, Secretin, Vagal input

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14
Q

name 3 things that decrease bile excretion

A

VIP, Somatostatin, Sympathetics

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15
Q

name 3 essential functions of bile

A

fat-soluble vitamin absorption, bilirubin excretion, cholesterol excretion

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16
Q

where does bile become concentrated and how

A

in the gallbladder, resorption of sodium and water

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17
Q

where does the active resorption of conjugated bile acids occur

A

terminal ileum

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18
Q

name the 2 cells which secrete bile

A

bilateral canalicular cells, 20%; hepatic sites, 80%

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19
Q

we gives bile its green color

A

conjugated bilirubin

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20
Q

this is a breakdown product of conjugated bilirubin in the gut, it gives stool a brown color

A

stercobilin

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21
Q

breakdown product of conjugated bilirubin, gives urine its yellow color

A

urobilin

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22
Q

this is the rate limiting step in cholesterol synthesis

A

HMG coA reductase

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23
Q

name the 2 enzymes in bile acids synthesis

A

HMG coA reductase, 7-alpha- hydroxylase

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24
Q

give cause of cholesterol stone formation in thin versus overweight people

A

thin, underactive 7-alpha- hydroxylase; overweight, overactive HMG coA reductase

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25
Q

name 4 factors that increased cholesterol insoluabilization

A

1) stasis 2) calcium nucleation 3) increased water absorption in the gallbladder 4) decreased lecithin and bile acids

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26
Q

which gallstone is more common in United States

A

nonpigmented, cholesterol

27
Q

black pigmented gallstones: 4 common causes

A

1) hemolytic disorders 2) cirrhosis 3) chronic TPN 4) status post ileal resection

28
Q

black pigmented gallstones: 3 key factors for development

A

increased bilirubin load, decreased hepatic function, bile stasis

29
Q

black pigmented gallstones: where do they form, treatment

A

within the gallbladder, cholecystectomy

30
Q

brown pigmented gallstones: pathophysiology of formation

A

infection causing deconjugation of bilirubin

31
Q

brown pigmented gallstones: most common cause, commonly seen in this population

A

E. coli, Asian

32
Q

brown pigmented gallstones: where do they form

A

common bile duct

33
Q

these 2 gallstones are considered secondary common bile duct stones. (formed in the gallbladder)

A

cholesterol stones, black stones

34
Q

3 most common bacteria in cholecystitis

A

1) E. coli 2) Klebsiella 3) Enterococcus

35
Q

name 4 preemptive conditions which increased risk for acalculus cholecystitis

A

1) Severe burns 2) Prolonged TPN 3) Trauma 4) Major surgery

36
Q

emphysematous gallbladder disease: Describe, Seen in this population, Most common etiology

A

gas within the gallbladder wall; diabetics; Clostridium perfringens

37
Q

emphysematous gallbladder disease: Signs and symptoms, Treatment

A

severe, rapid onset abdominal pain, nausea, vomiting and sepsis; Emergency cholecystectomy or percutaneous drainage if unstable

38
Q

pathophysiology of gallstone ileus

A

fistula between the gallbladder and duodenum, releases stone causing small bowel obstruction… seen in the elderly

39
Q

gallstone ileus: Common finding on plain film, Most common site of obstruction

A

pneumobilia; terminal ileum

40
Q

gallstone ileus: Treatment

A

enterotomy and possible resection to remove stone, cholecystectomy with fistula resection

41
Q

pelvis common bile duct injury treatment differentiated

A

if greater than 2 mm will need hepaticojejunostomy

42
Q

this is the most important cause of the leak postoperative biliary stricture

A

ischemia

43
Q

name 2 treatments for common bile duct or hepatic duct strictures

A

ERCP with sphincterotomy and stent placement; PTC tube

44
Q

most common cancer of the biliary tract: First site of metastasis, Typical symptoms

A

gallbladder adenocarcinoma; Segments 4 and 5 of the liver; Jaundice first then right upper quadrant pain

45
Q

differentiate stage I versus stage II gallbladder: adenocarcinoma, treatment for each

A

1-limited to the gallbladder mucosa; cholecystectomy; 2-into the muscle; wide resection around liver bed with possible Whipple

46
Q

choledochal cyst: common etiology, signs and symptoms

A

female, Asian, 90% extrahepatic, 15% cancer risk; episodic pain, fever, jaundice, cholangitis

47
Q

choledochal cyst: most common type, describe

A

1, fusiform or saccular dilation of extrahepatic ducts

48
Q

give treatment for type one choledochal cyst

A

cyst excision with hepaticojejunostomy and cholecystectomy

49
Q

described type 4 and type V choledochal cysts

A

4-partially intrahepatic, 5-caroli’s disease, total he intrahepatic requiring partial liver resection

50
Q

30-40-year-old male patient presents with fatigue, fluctuating jaundice, pruritis, weight loss, right upper quadrant pain

A

primary sclerosing cholangitis

51
Q

in 2 complications of primary sclerosing cholangitis

A

cirrhosis; cholangiocarcinoma

52
Q

2 medications which can be used in primary sclerosing cholangitis, give affect of each

A

cholestyramine – decrease pruritis symptoms by decreasing bile acids; UDCA – decrease symptoms and improve liver function

53
Q

primary biliary cirrhosis: Most common in, Symptoms, Key lab value

A

women; Fatigue, itching, jaundice, xanthomas; Positive antimitochondrial antibodies

54
Q

Charcot’s triad

A

right upper quadrant pain, Fever, Jaundice

55
Q

reynolds Pentad

A

1) Right upper quadrant pain 2) Fever 3) Jaundice 4) Altered mental status 5) Shock

56
Q

2 most common pathogens associated with cholangitis

A

Escherichia coli, Klebsiella

57
Q

give differential diagnoses for shock following laparoscopic cholecystectomy: Early-first 24 hours, Late-after 24 hours

A

early hemorrhagic shock from clip falling off the cystic artery; Late-septic shock from accidental clip the common bile duct with subsequent cholangitis

58
Q

thickened nodule the mucosa and muscle associated with Rokitansky Ashcroft sinuses, Not premalignant; Give treatment

A

adenomyomatosis; Cholecystectomy

59
Q

benign neuroectoderm tumor of gallbladder, Can occur in biliary tract with signs of cholecystitis; Give treatment

A

granular cell myoblastoma; Cholecystectomy

60
Q

speckled cholesterol deposits on the gallbladder wall

A

cholesterolosis

61
Q

2 signs concerning for malignancy and gallbladder polyps

A

greater than 1 cm; Patient greater than 60 years old

62
Q

type of bilirubin down to albumin covalently, half-life of 18 days

A

delta bilirubin

63
Q

compression of the common hepatic duct by a stone in the infundibulum of the gallbladder or inflammation arising from the gallbladder or cystic duct extending to the contiguous hepatic duct causing stricture and hepatic duct obstruction

A

mirizzi syndrome

64
Q

this antibiotic can cause gallbladder sludge and cholestatic jaundice

A

ceftriaxone

Surgery (33 decks)

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