GALL BLADDER Flashcards
for GB Contraction
Vagus;
CCK- Sphincter of oddi relaxation
for GB relaxation
VIP
somatostatin
gb stone usually due to hemolytic d/o and cirrhosis
small, spiculated
black pigment stones
GB stones
soft and mushy
form either in gb or BD
usually sec to bacterial infection or bile stasis
brown pigment stones
traditional indications for cholecystectomy for asymptomatic patients
elderly with DM
Isolation from medical care for extended periods
increased risk for GB cancer porcelaine GB
ABSOLUTE contraindications to cholecystectomy
cannot tolerate gen anesthesia refractory coagulopathy diffuse peritonitis with hemodynamic compromise cholangitis potentially curable GB cancer
RID CP
relative contraindication
Previous upper abdomen surgery with extensive adhesions cirrhosis portal HTN severe CP disease morbid obesity pregnancy
the most typical clinical sign of acute cholecystitis
abdominal pain
hyperesthesia in RUQ or right infrascapular region
boas sign
the patient points to the right scapular tip with fist and thumb pointing upwards
collins sign
blush of increased pericholecystic radioactivity in cholecystitis in HIDA scan
rim sign
what are elevated in choledocholithiasis
bilirupin
alk phosph
transaminase
common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct ot hartmann’s pouch of the gb
mirrizi syndrome
gallstone ileus of the duodenum
bouveret syndrome
gastric outlet obstruction caused by passage of stone from gb to pylorus or prox duodenum through cholecystoduodenal fistula
gallstone ileus
riglers triad of gallstone ileus
SBO
Pneumobilia
ectopic gallstone
congenital cystic dilatations of the biliary tree
choledochal cyst
mc choledochal cyst
fusiform
choledochal cyst triad
abdominal pain
jaundice
mass
presence of inflammatory strictures involving both extra and intahepatic biliary tree
more common in MEN
Sclerosing cholangitis
TX Sclerosing cholangitis
Liver transplant
most gb polyps are what type
cholesterol type
malignancy markers in gb polyps
solitary >1cm >50 yo rapid growth sessile adenomatous
most important risk factor of gb carcinoma
gallstones
exposure to azotoluene, nitrosamines
discontinuous mucosa, echogenic mucosa, submucosal echolucency in US
GB carcinoma
tumor markers of GB carcinoma
CEA and CA 19-9
RARE tmor mostly occuring in the hepatic duct bifurcation
bile duct carcinoma
most common microorganism causing bile duct CA
Clonorchis
mc type of bile duct CA
Nodular adenoCA
Perihilar cholangiCA
Klatskin tumor
painless jaundice
BD CA
Elevated tumor markers in bile duct CA
CA 125, CEA CA 19-9
Defines proximal extent in bile duct CA
PTC
