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Surgery > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

Anatomy of the GB

A

RUQ of abd under liver
Cystic duct exits and joins common hepatic duct to form common bile duct
CBD empties into the duodenum at ampulla of Vader, which is surrounded by the sphincter of Oddi

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2
Q

What stimulates bile rls from the GB

A

CCK (cholecystokinin) causes the GB to contract, which rls’s bile into the duod.

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3
Q

Why isn’t there bile reflux back into the GB?

A

spiral valves of Heister

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4
Q

Arterial supply to the GB

A

cystic artery, which usu comes from the R hepatic artery

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5
Q

What is the triangle of calot?

A

cystic duct
common hepatic duct
cystic artery (some say edge of liver and the cystic artery goes through the triangle)

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6
Q

What is cholelithiasis

A

Gallstones

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7
Q

What is biliary colic

A

Pain produced when the GB contracts against a stone in the neck of the GB or as a stone passes through the bile duct

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8
Q

What is acute cholecystitis

A

inflammation and infection of the GB

usu w total or partial obstruction of the cystic duct

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9
Q

What are the most common organisms cultured during an episode of acute cholecystis?

A 
E. coli
Klebsiella
enterococci
Bacteroidies fragilis
Pseudomonas
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10
Q

What is cholodocholithiasis

A

Stone in the CBD

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11
Q

What are stones made of?

A

Cholesterol (80%)
Calcium carbonate
or both

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12
Q

How do stones form?

A

Bile becomes supersaturated with cholesterol, stones precipitate out of soln.
High cholesterol diet can be a cause of cholesterol stones.

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13
Q

Calcium bilirubinate stones are found in a/w which diseases?

A

chronic biliary infection
cirrhosis
hemolytic processes- sickle cell anemia, thalassemia, spherocytosis

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14
Q

T/F Spinal cord injury predisposes to pigment stones (calcium bilirubinate)

A

False- predisposes to cholesterol stones

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15
Q

Px of gallstones

A

most pts are asx

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16
Q

Px of biliary colic

A

RUQ or epigastric pain, often radiates to right side or back
Usu postprandial, precipitated by fatty food intake
Lasts several hours before resolving
Also nausea/vom with it
But NO fever

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17
Q

Px of cholecystitis

A

Constant pain w progressive worsening. Fever chills sweats. It’s inflam/infection, so it’s signs of that- signs of peritoneal irritation, including RUQ rebound and guarding.
Murphy’s sign- arrest of inspiration on deep palpation of RUQ

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18
Q

Px of choledocholithiasis

A

Dark urine or light colored stools- since the CBD is blocked, bile pigments can’t get to the GI tract- so it’s not cleared in stool, and instead it’s cleared renally.
Also a/w jaundice and signs of biliary colic

19
Q

Ascending cholangitis px

A

RUQ pain plus fever and chills. It’s infection of bile duct from ascending bacteria.

20
Q

Gallstone pancreatitis px

A

epigastric tenderness/pain radiating to the back

pancreatitis is dt choledocholithiasis- stone in the CBD

21
Q

WHat is the Charcot triad?

A

For cholangitis

  1. Fever
  2. RUQ pain
  3. Jaundice
22
Q

What is the Reynolds pentad

A

For cholangitis that progressed to sepsis- charcot plus hypotension and mental status chgs
(charcot - fever, RUQ, jaundice)

23
Q

Dx eval for cholecystitis

A

increased WBC
US- fluid around GB, thickened GB wall, GB distention
if it’s acalculus cholecystitis, use HIDA (cholescintigraphy)- inject radioactive nucelotide into liver, it’s excreted into biliary tree- if it’s acute cholecystitis, then the cystic duct is obstructed so the GB will not fill- all radionucelotide will go out to the duodenum

24
Q

Dx eval for cholodocholithiasis

A

Increased serum bilirubin and alk phos
US- detects stones
Best for CBD stones is ERCP- use endoscope to visualize ampulla, put contrast in retrograde. Can also extract stones.
MRCP good for detecting CBD stones but not therapeutic like ERCP

25
Q

Dx eval for Cholangitis

A

Elevated serum bilirubin and transaminase levels

26
Q

Dx eval for Gallstone pancreatitis

A

Elevations in serum amylase and lipase

US-detects stones

27
Q

What happens if the dx of cholecystitis is delayed?

A

GB necrosis

28
Q

What kind of cholecystitis is seen in diabetic pts?

A

Emphysematous cholecystitis d/t Clostridium perfringens

29
Q

What is gallstone illeus?

A

Large gallstone erodes wall bt GB and bowel, making a fistula. The stone goes into the bowel and then down to the ileo-cecal junction, where it gets caught and causes distal bowel obstruction.

30
Q

Rx for pts w asx stones

A

Usu not surgery. Incidence of complications only 2% per year.

31
Q

Rx for biliary colic

A

Lap chole- elective

32
Q

Rx for common duct stones

A

ERCP or intraop cholangiography (+ lap chole if colic)

33
Q

Rx for acute cholecystitis

A

Fluids (vom/d cause dehydration)
IV abx
Lap chole
If pts too sick for surg, place a cholecystostomy tube for decompression/drainage, do surg when they are stable

34
Q

Rx for gallstone pancreatitis

A

Fluids and observation
80% of cases are mild
Severe cases (necrosis, infection complications) get abx
Do early ERCP if signs of CBD obstruction.
After pancr is less inflamed, do cholecystectomy w intraop cholangiography.
Recurs a lot.

35
Q

Rx for cholangitis d/t choledocholithiasis

A

Rapid dx and Rx!
IV abx and urgent biliary decompression and drainage.
ERCP with sphincterotomy is main Rx.
Can also do percutaneous or open surgical drainage.

36
Q

Risk factors for cancer of GB

A

gallstones, porcelain GB, adenoma

females have 3x risk

37
Q

What kind of ca is GB ca?

A

80% adenocarcinoma
10% anaplastic
5% sq cell

38
Q

HPE for GB ca

A

vague RUQ pain
weight loss, anorexia
RUQ mass may be palpated
If jaundice- means invasion/compression of biliary system

39
Q

Rx for GB ca

A

Radical resection of GB
+ partial hepatic resection
other palliative op- pgx is really bad. 4% 5yrs.

40
Q

Risk factors for bile duct cancer

A

UC, sclerosing cholangitis, infection w Clonorchis sinensis (liver fluke)

41
Q

HPE for bile duct ca

A

RUQ pain in advanced dz

Distended GB or jaundice (tumor obstructs biliary tree)

42
Q

Dx eval for bile duct ca

A

US or CT can show obstruction, but need PTC or ERCP usu necessary to see lesion

43
Q

Rx and pgx for bile duct ca

A

Rx surgical resection

Pgx really bad. 90% mortality at 5 years.

Surgery (20 decks)

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