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Gallbladder Flashcards

1
Q

the capacity of the gallbladder is ____

A

30 to 50 mL

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2
Q

The GB lacks the following smooth muscle layer

A

muscularis mucosa

submucosa

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3
Q

What is the main blood supply of the gallbladder?

A

Cystic artery

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4
Q

The cystic artery is a branch of?

A

right hepatic artery

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5
Q

What passes through the triangle of callot?

A

Cystic artery

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6
Q

That are the borders of the traingle of callot?

A

Cystic duct
common hepatic duct
cystic artery

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7
Q

The budd triangle is bordered by

A

R: cystic duct
L: common hepatic
Superior: margin of the right lobe of liver

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8
Q

This refers to a circular area that fits into the hepatocystic duct angle

A

moosman area

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9
Q

The opening of the pancreatic duct is called ___

A

ampulla of Vater

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10
Q

The ampulla of vater is surrounded by ____

A

sphincter of oddi

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11
Q

The ampulla of vater is ___ cm distal to pylorus

A

10cm

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12
Q

The primary bile salt is composed of _____

A

chenodeoxycholate/cholate

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13
Q

The secondary bile salt is composed of ____

A

deoxycholate/lithocholate

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14
Q

What is the rate of feed forward secretion of per day of bile?

A

30g/day

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15
Q

How many grams of bile sals is secreted in the feces per day?

A

0.2-0.6g/day

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16
Q

The liver produces how many grams of liver per day?

A

0.2 to 0.6g

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17
Q

The primary bile salts are conjugated with these:

A

glycine and taurine

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18
Q

[Neurohormonal Regulation]

Nerve that stimulates GB contraction

A

vagus

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19
Q

[Neurohormonal Regulation]

inhibits GB contraction

A

VIP, somatostatin

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20
Q

[Neurohormonal Regulation]

GB contraction

A

CCK

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21
Q

[Neurohormonal Regulation]

This stimulates the relaxation of the sphincter of oddi

A

CCK

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22
Q

[Neurohormonal Regulation]

stimulates liver ductal secretion

A

Secretin

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23
Q

What are the UTZ characteristics of gallstone?

A

Acoustically dense
Produce posterior shadow
Move with changes in position

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24
Q

[diagnose]

Stone
GB thickening
Pericholecystic fluid
sonographic murphy sign

A

acute cholecystitis

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25
Q

[Color of Gallstone ]

hemolytic disorders, cirrhosis can have this type of stone

A

pigment stone

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26
Q

[Type of Gallstone ]

radiolucent stone in UT

A

cholesterol

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27
Q

[Type of Gallstone ]

mulberry-shaped stone is composed of___

A

cholesterol + pigment

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28
Q

[Type of Gallstone ]

small, brittle, spiculated

supersaturation of Ca bilirubinated, carbonate and phosphate

due to hemolytic disorders and cirrhosis

A

black pigment stones

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29
Q

[Type of Gallstone ]

soft, mushy

usually secondary to bacterial infection or bile stasis

A

brown pigment stones

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30
Q

What are the indications for Prophylactic Cholecystectomy?

A
  1. Hemoglobinopathies (sickle cell)
  2. Hereditary spherocytosis and thalassemia at the time of splenectomy
  3. Transplant recipients (Cardiac and Lung)
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31
Q

Porcelain bladder leading to GB CA has an incidence rate of ___

32
Q

What are the absolute contraindications of laparoscopic cholecystectomy?

A
  1. Refractory coagulopathy
  2. Inability to tolerate general anesthesia
  3. Diffuse peritonitis with hemodynamic compromise
  4. Cholangitis
  5. Potentially curable GB CA
33
Q

What are the relative contraindications of cholecystectomy?

A
  1. Previous upper abdominal surgery with extensive adhesions
  2. Cirrhosis
  3. Portal hypertension
  4. Severe cardiopulmonary disease
  5. Pregnancy
34
Q

[diagnosus]

RUQ pain, unremitting
fever, anorexia, nausea, vomiting

(+) murphy

A

Acute cholecystitis

35
Q

[PE in Acute cholecystitis]

examiner hooks fingers under right costal margin and asks patient to deeply inhale. patient stops inhaling due to sudden pain

A

Murphy sign

36
Q

[PE in Acute cholecystitis]

hyperesthesia in the RUQ or R infrascapular region

37
Q

[PE in Acute cholecystitis]

Present when the patient points to the right scapular tip with a fist and thumb pointing upwards to describe the pain

A

Collins Sign

38
Q

[PE in Acute cholecystitis]

the most typical clincal sign of acute cholecystitis is

A

abdominal paon

39
Q

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, what are the local signs?

A
  1. Murphy

2. RUQ mass or pain or tenderness

40
Q

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, what are the systemic signs?

A
  1. Fever
  2. Elevated CRP
  3. Elevated WBC
41
Q

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, how will you say that it is a suspected case of Acute Cholecystitis?

A

One Item in A + One item in B

42
Q

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, how will you say that it is a definite case of Acute Cholecystitis?

A

One item in A
One item in B
One Imaging findings of Acute cholecystitis

43
Q

What are the UTZ findings in Acute cholecystitis?

A
  1. Enlarged GB
  2. > 5 mm thich GB wall
  3. GB stones
  4. Debri echo
  5. Ultrasonographic Murphy sign positive
44
Q

[Imaging in Acute Cholecystitis]

In HIDA Scan
___ refers to the blush of increased pericholecystic radioactivity in cholecystitis

45
Q

[Imaging in Acute Cholecystitis]

In HIDA Scan

Failure of the tracer to fill within ___ minutes means that the cystic duct is obstructed

46
Q

[Severity grading for acute cholecystitis]

Cholecystitis + organ dysfunction

47
Q

[Severity grading for acute cholecystitis]

Cholecystitis without organ dysfunction

48
Q

Severe Acute cholecystitis is associated with what organ dysfunctions?

A

1; Hypotension requiring dopamine >5ug/kg/min

  1. Decreased consciousness
  2. PaO2/FiO2 ration <300
  3. Oliguria, Crea >2.0
  4. PT-INR > 1.5
  5. PC <100,000
49
Q

Moderate Acute cholecystitis is associated with what?

A
  1. Palpable tender mass in RUQ
  2. Duration of complaints >72 hours
  3. Marked local inflammation
  4. Elevated WBC >18,000
50
Q

What are the analgesic of choice in patients with acute cholecystitis?

A
  1. Meperidine

2. NSAIDS

51
Q

What is the definitive management for acute cholecystitis?

A

Early cholecystectomy - 2-3 days

52
Q

What is the best initial management for acute cholecystitis?

A

NPO, IV fluids

53
Q

What is the definitive management for Grade I Acute Cholecystitis?

A

Early laparoscopic cholecystectomy (within 72 hours)

54
Q

What is the definitive management for Grade II Acute Cholecystitis?

A

Early cholecystectomy (lap or open)

55
Q

What is the definitive management for Grade III Acute Cholecystitis?

A

Urgent management of organ dysfunction and GB drainage

Delayed cholecystectomy (2-3 months after)

56
Q

[Choledocholithiasis]

This type is formed primarily in the CBD

57
Q

[Choledocholithiasis]

This type is formed in the GB then migrate to CBD

A

secondary (most common)

58
Q

[Type of Choledocholithiasis based on the timing]

Identified by cholangiography shortly after cholecystectomy

59
Q

[Type of Choledocholithiasis based on the timing]

found <2 years after cholecystectomy

60
Q

[Type of Choledocholithiasis based on the timing]

> 2 years after cholecystectomy

61
Q

[Diagnosis of Choledocholithiasis]

gold standard for diagnosis

62
Q

[Diagnosis of Choledocholithiasis]

initial test

A

abdominal UTZ

63
Q

[Diagnosis of Choledocholithiasis]

UTZ characteristics suggestive of choledocholithiasis

A
  1. GB stones

2. Dilated CBD > 8mm

64
Q

What are the indications for IOC during laparoscopy during cholecystectomy

A
  1. Jaundice
  2. Elevated LFTs
  3. CBD larger than 5-7mm
  4. cystic duct larger than 3mm
  5. Multiple GB stones
  6. CBD visualized on preoperative UTZ
  7. Palpable CBD intraop
  8. Short cystic duct
65
Q

[Treatment of choledocholithiasis]

If diagnosis is known pre-operatively, the treatment options are as follows:

A
  1. ERCP plus sphincterotomy
  2. Ductal clearance of stones
  3. Lap cholecystectomy
66
Q

[Treatment of choledocholithiasis]

If diagnosis is known pre-operatively, the treatment options are as follows:

A
  1. Lap cholecystectomy
  2. Intraoperative cholangiography
  3. Lap CBDE or sphincterotomy (next day)
67
Q

[Treatment of choledocholithiasis]

If the endoscopic management fails,

68
Q

[Treatment of choledocholithiasis]

if with impacted stones at the ampulla

A

Choledochoduodenostomy

Roux-en-Y choledochojejunostomy

69
Q

[Treatment of choledocholithiasis]

Surgical management of retained stones

A

Extract stone through the T Tube tract at 2-4 weeks

OR

ERCP + sphincterotomy

70
Q

___ syndrome is caused by an extrinsic compression from an impacted stone in the cystic duct or hartmann’s pouch of the GB

A

Mirrizi Syndrome

71
Q

____ syndrome

Gallstone ileus of the duodenum

A

Bouveret syndrome

72
Q

___ triad

pneumobilia, small bowl obstruction, ectopic gallstone

A

Rigler triad

73
Q

[diagnosis]

ascending bacterial infection of the biliary in association with partial or complete blockage of the bile duct

A

cholangitis

74
Q

the most common cause of cholangitis

75
Q

[Tokyo Guideline for Acute Cholangitis]

clinical context for acute cholangitis

A
  1. History of biliary disease
  2. Fever or chills
  3. Jaundice
  4. Abdominal pain (RUQ or upper abdomen)
76
Q

[Tokyo Guideline for Acute Cholangitis]

laboratory data for acute cholangitis

A
  1. leukocytosis
  2. High CRP
  3. Abnormal liver function test

Pathology (36 decks)

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