Gallbladder

Question 1

Name of the node in Calot’s triangle

Answer 1

Calot’s node

Question 2

Small ducts that drain bile directly into the gallbladder from the Liver

Answer 2

Ducts of Luschka

Question 3

What artery is susceptible to injury during Cholecystectomy?

Answer 3

Right hepatic artery

bc of its proximity to cystic artery and calots triangle

Question 4

Where is the infindibulum of gallbladder

Answer 4

Near cystic duct

Question 5

Boundaries of triangle of Calot

Answer 5

3 C’s

Cystic duct
Common hepatic duct
Cystic artery

Duct coming from Liver, GB, and the Cystic Artery

Question 6

What is in bile?

Answer 6

Cholesterol
Lecithin (phospholipid)
Bile acids
Bilirubin

Question 7

What does bile do?

Answer 7

Emuslify fat

Question 8

Enterohepatic circulation

Answer 8

circulation of bile acids frm Liver to Gut, and back to Liver

Question 9

What stimulates GB emptying?

Answer 9

CCK (cholecystokinin) and vagal input

Question 10

CCK action

Answer 10

GB emptying
opening Ampulla of Vater (into duodenum)
Slow gastric emptying
Pancreas acinar cell growth and release of exocrine products

Question 11

What serum level of Bilirubin does one start to get jaundiced?

Answer 11

2.5

Question 12

Where can you first find evidence of jaundice

Answer 12

Under the tongue

bc UV light breaks down bilirubin at other sites

Question 13

Signs/sx of Obstructive Jaundice

Answer 13

Jaundice
Dark urine
Clay colored stools 
Pruritis 
Loss of appetite
Nausea

Question 14

What causes itching in obstructive jaundice

Answer 14

Bile salts in dermis

Question 15

Diff b/w MRCP and ERCP

Answer 15

MRCP: only diagnostic

ERCP: BOTH diagnostic and therapeutic

Question 16

ERCP

Answer 16

Endoscopic retrograde cholaniopancreatography

gold standard for dx of biliary obstruction

Question 17

MRCP

non-invasive

Answer 17

Magnetic resonance cholangiopancreatography

Question 18

ERCP

Answer 18

investigate Bile duct, Pancreatic duct, and Ampulla using an endoscope

Question 19

ERCP endoscope

Answer 19

goes all the way into small intestine in the duodenum

Question 20

What can ERCP do

Answer 20

Biopsies
Clear stones
Dilate narrowing
Place stent

Question 21

ERCP requires

Answer 21

deep sedation or

general anesthesia

Question 22

MRCP

Answer 22

specialized MRI that evaluates hepatobiliary and pancreatic systems involving liver, gallbladder, and bile ducts

Question 23

First diagnostic study of choice for eval of Biliary tract/ GB/ Gallstone

Answer 23

Ultrasound

Question 24

PTC

Answer 24

Percutaneous Transhepatic Cholangiogram

Question 25

IOC- Intraoperative Cholangiogram

Answer 25

done laparoscopically or open to r/o choledocholithiasis

Question 26

HIDA/PRIDA scan

Answer 26

Radioisotope study, isotope concentrated in liver and secreted into bile; will demonstrate cholecystitis, bile leak, or CBD obstruction

Question 27

Sphincter of Oddi (opening of pancreatic duct and common bile duct) is on the other side of:

Answer 27

Ampulla of Vater | in the duodenum

Question 28

Obstructive jaundice

Answer 28

Hyperbilirubinemia >2.5 from obstruction of bile flow to the Duodenum

Question 29

What are the indications for Cholecystectomy in an A-sx patient?

Answer 29

Sickle cell dz Calcified gallbladder (porcelain gallbladder) Pt is a child

Question 30

Major feared complication of ERCP

Answer 30

Pancreatitis

Question 31

Med used to dissolve Cholesterol gallstone

Answer 31

``` Chenodeoxycholic acid Ursodeoxycholid acid (Actigall) ``` but if med stopped, gallstones often recur

Question 32

Cholangitis

Answer 32

infection of biliary tract can be life threatening

Question 33

Common cause of Cholangitis | inf of bil tract

Answer 33

mostly CholeDOCHOlithiasis stone in common bile duct

Question 34

Charcot's triad of Cholangitis

Answer 34

Fever RUQ pain Jaundice

Question 35

Reynolds pentad

Answer 35

Fever, RUQ pain, Jaundice + Hypotension AMS