Gallbladder Flashcards
1
Q
the capacity of the gallbladder is ____
A
30 to 50 mL
2
Q
The GB lacks the following smooth muscle layer
A
muscularis mucosa
submucosa
3
Q
What is the main blood supply of the gallbladder?
A
Cystic artery
4
Q
The cystic artery is a branch of?
A
right hepatic artery
5
Q
What passes through the triangle of callot?
A
Cystic artery
6
Q
That are the borders of the traingle of callot?
A
Cystic duct
common hepatic duct
cystic artery
7
Q
The budd triangle is bordered by
A
R: cystic duct
L: common hepatic
Superior: margin of the right lobe of liver
8
Q
This refers to a circular area that fits into the hepatocystic duct angle
A
moosman area
9
Q
The opening of the pancreatic duct is called ___
A
ampulla of Vater
10
Q
The ampulla of vater is surrounded by ____
A
sphincter of oddi
11
Q
The ampulla of vater is ___ cm distal to pylorus
A
10cm
12
Q
The primary bile salt is composed of _____
A
chenodeoxycholate/cholate
13
Q
The secondary bile salt is composed of ____
A
deoxycholate/lithocholate
14
Q
What is the rate of feed forward secretion of per day of bile?
A
30g/day
15
Q
How many grams of bile sals is secreted in the feces per day?
A
0.2-0.6g/day
16
Q
The liver produces how many grams of liver per day?
A
0.2 to 0.6g
17
Q
The primary bile salts are conjugated with these:
A
glycine and taurine
18
Q
[Neurohormonal Regulation]
Nerve that stimulates GB contraction
A
vagus
19
Q
[Neurohormonal Regulation]
inhibits GB contraction
A
VIP, somatostatin
20
Q
[Neurohormonal Regulation]
GB contraction
A
CCK
21
Q
[Neurohormonal Regulation]
This stimulates the relaxation of the sphincter of oddi
A
CCK
22
Q
[Neurohormonal Regulation]
stimulates liver ductal secretion
A
Secretin
23
Q
What are the UTZ characteristics of gallstone?
A
Acoustically dense
Produce posterior shadow
Move with changes in position
24
Q
[diagnose]
Stone
GB thickening
Pericholecystic fluid
sonographic murphy sign
A
acute cholecystitis
25
[Color of Gallstone ]
hemolytic disorders, cirrhosis can have this type of stone
pigment stone
26
[Type of Gallstone ]
radiolucent stone in UT
cholesterol
27
[Type of Gallstone ]
mulberry-shaped stone is composed of___
cholesterol + pigment
28
[Type of Gallstone ]
small, brittle, spiculated
supersaturation of Ca bilirubinated, carbonate and phosphate
due to hemolytic disorders and cirrhosis
black pigment stones
29
[Type of Gallstone ]
soft, mushy
usually secondary to bacterial infection or bile stasis
brown pigment stones
30
What are the indications for Prophylactic Cholecystectomy?
1. Hemoglobinopathies (sickle cell)
2. Hereditary spherocytosis and thalassemia at the time of splenectomy
3. Transplant recipients (Cardiac and Lung)
31
Porcelain bladder leading to GB CA has an incidence rate of ___
0
32
What are the absolute contraindications of laparoscopic cholecystectomy?
1. Refractory coagulopathy
2. Inability to tolerate general anesthesia
3. Diffuse peritonitis with hemodynamic compromise
4. Cholangitis
5. Potentially curable GB CA
33
What are the relative contraindications of cholecystectomy?
1. Previous upper abdominal surgery with extensive adhesions
2. Cirrhosis
3. Portal hypertension
4. Severe cardiopulmonary disease
5. Pregnancy
34
[diagnosus]
RUQ pain, unremitting
fever, anorexia, nausea, vomiting
(+) murphy
Acute cholecystitis
35
[PE in Acute cholecystitis]
examiner hooks fingers under right costal margin and asks patient to deeply inhale. patient stops inhaling due to sudden pain
Murphy sign
36
[PE in Acute cholecystitis]
hyperesthesia in the RUQ or R infrascapular region
Boas sign
37
[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
Collins Sign
38
[PE in Acute cholecystitis]
the most typical clincal sign of acute cholecystitis is
abdominal paon
39
[Diagnosis of Acute cholecystitis]
In Tokyo Guidelines, what are the local signs?
1. Murphy
| 2. RUQ mass or pain or tenderness
40
[Diagnosis of Acute cholecystitis]
In Tokyo Guidelines, what are the systemic signs?
1. Fever
2. Elevated CRP
3. Elevated WBC
41
[Diagnosis of Acute cholecystitis]
In Tokyo Guidelines, how will you say that it is a suspected case of Acute Cholecystitis?
One Item in A + One item in B
42
[Diagnosis of Acute cholecystitis]
In Tokyo Guidelines, how will you say that it is a definite case of Acute Cholecystitis?
One item in A
One item in B
One Imaging findings of Acute cholecystitis
43
What are the UTZ findings in Acute cholecystitis?
1. Enlarged GB
2. >5 mm thich GB wall
3. GB stones
4. Debri echo
5. Ultrasonographic Murphy sign positive
44
[Imaging in Acute Cholecystitis]
In HIDA Scan
___ refers to the blush of increased pericholecystic radioactivity in cholecystitis
Rim Sign
45
[Imaging in Acute Cholecystitis]
In HIDA Scan
Failure of the tracer to fill within ___ minutes means that the cystic duct is obstructed
60 mins
46
[Severity grading for acute cholecystitis]
Cholecystitis + organ dysfunction
Grade III
47
[Severity grading for acute cholecystitis]
Cholecystitis without organ dysfunction
Grade II
48
Severe Acute cholecystitis is associated with what organ dysfunctions?
1; Hypotension requiring dopamine >5ug/kg/min
2. Decreased consciousness
3. PaO2/FiO2 ration <300
4. Oliguria, Crea >2.0
5. PT-INR > 1.5
6. PC <100,000
49
Moderate Acute cholecystitis is associated with what?
1. Palpable tender mass in RUQ
2. Duration of complaints >72 hours
3. Marked local inflammation
4. Elevated WBC >18,000
50
What are the analgesic of choice in patients with acute cholecystitis?
1. Meperidine
| 2. NSAIDS
51
What is the definitive management for acute cholecystitis?
Early cholecystectomy - 2-3 days
52
What is the best initial management for acute cholecystitis?
NPO, IV fluids
53
What is the definitive management for Grade I Acute Cholecystitis?
Early laparoscopic cholecystectomy (within 72 hours)
54
What is the definitive management for Grade II Acute Cholecystitis?
Early cholecystectomy (lap or open)
55
What is the definitive management for Grade III Acute Cholecystitis?
Urgent management of organ dysfunction and GB drainage
Delayed cholecystectomy (2-3 months after)
56
[Choledocholithiasis]
This type is formed primarily in the CBD
primary
57
[Choledocholithiasis]
This type is formed in the GB then migrate to CBD
secondary (most common)
58
[Type of Choledocholithiasis based on the timing]
Identified by cholangiography shortly after cholecystectomy
retained
59
[Type of Choledocholithiasis based on the timing]
found <2 years after cholecystectomy
residual
60
[Type of Choledocholithiasis based on the timing]
> 2 years after cholecystectomy
recurrent
61
[Diagnosis of Choledocholithiasis]
gold standard for diagnosis
ERCP
62
[Diagnosis of Choledocholithiasis]
initial test
abdominal UTZ
63
[Diagnosis of Choledocholithiasis]
UTZ characteristics suggestive of choledocholithiasis
1. GB stones
| 2. Dilated CBD > 8mm
64
What are the indications for IOC during laparoscopy during cholecystectomy
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
[Treatment of choledocholithiasis]
If diagnosis is known pre-operatively, the treatment options are as follows:
1. ERCP plus sphincterotomy
2. Ductal clearance of stones
3. Lap cholecystectomy
66
[Treatment of choledocholithiasis]
If diagnosis is known pre-operatively, the treatment options are as follows:
1. Lap cholecystectomy
2. Intraoperative cholangiography
3. Lap CBDE or sphincterotomy (next day)
67
[Treatment of choledocholithiasis]
If the endoscopic management fails,
OPEN CBDE
68
[Treatment of choledocholithiasis]
if with impacted stones at the ampulla
Choledochoduodenostomy
| Roux-en-Y choledochojejunostomy
69
[Treatment of choledocholithiasis]
Surgical management of retained stones
Extract stone through the T Tube tract at 2-4 weeks
OR
ERCP + sphincterotomy
70
___ syndrome is caused by an extrinsic compression from an impacted stone in the cystic duct or hartmann's pouch of the GB
Mirrizi Syndrome
71
____ syndrome
Gallstone ileus of the duodenum
Bouveret syndrome
72
___ triad
pneumobilia, small bowl obstruction, ectopic gallstone
Rigler triad
73
[diagnosis]
ascending bacterial infection of the biliary in association with partial or complete blockage of the bile duct
cholangitis
74
the most common cause of cholangitis
gallstone
75
[Tokyo Guideline for Acute Cholangitis]
clinical context for acute cholangitis
1. History of biliary disease
2. Fever or chills
3. Jaundice
4. Abdominal pain (RUQ or upper abdomen)
76
[Tokyo Guideline for Acute Cholangitis]
laboratory data for acute cholangitis
1. leukocytosis
2. High CRP
3. Abnormal liver function test
