Gallbladder pancreas Flashcards
Nerve supply of gallbladder
T8 and T9 (epigastric)
Vagus and sympa
How much bile formed per day
500-1000 ml
CCK action to gallbladder and sphincter of oddi?
GB Contraction
Sphincter of Oddi relaxation
Diagnostic studies for proximal and distal biliary ducts respectively:
Proximal bile duct: PTC (percutaneous transhepatic cholangiography)
Distal bile duct: ERCP
Sonographic signs of acute cholecystitis:
Gallbladder thickening
Pericholecystic fluid
Sonographic murphy’s
Most common type of gallstone
Cholesterol type
Gallstone type: SINGLE, large smooth
Pure cholesterol
Gallstone type: MULTIPLE, multifaceted “mulberry shaped”
Mixed type (>70% cholesterol)
Gallstone type: small brittle spiculated, calcium bilirubinate, carbonate and phosphate
Due to HEMOLYSIS and CIRRHOSIS
Black pigment stones
Gallstone type: soft and mushy, only stone that can arise from the bile ducts
Due to BACTERIAL INFXN or BILE STASIS
Brown pigment stones
Characterized by recurrent biliary colic and due to partial obstruction of the cystic duct
Chronic cholecystitis
Initiating event of acute checystitis
Obstruction of cystic duct
Cystic artery is a branch of
Right hepatic artery
Most specific test for gallstone
HIDA scan
Gold standard diagnostic test for chiledocholithiasis
ERCP
Two combination for cholangitis to occur
Bacterial contamination (gram negative aerobes) Obstruction
What is charcot’s triad?
Fever
Pain
Jaundice
Reynold’s pentad
Fever Pain Jaundice Disorientation Septoc shock
Most common form of choledochal cyst
Fusiform
Triad of choledochal cyst
Abdominal pain
Jaundice
Mass
Choledochal cyst in intrahepatic ducts
CAROLI’s disease
Tx: liver transplant
May develop to form cholangiocarcinoma
Most common in men
Primary Sclerosing Cholangitis
2 liver disease that requires liver transplantation
Primary sclerosing cholangitis
CAROLI’s disease
Treatment of gallbladder CA with extension to perimuscular connective tissue (T2)
Extended cholecystectomy Liver resection (4a and 5)
Treatment of gallbladder CA with extension beyond serosa
Extended right hepatectomy Liver resection (4 to 8)
Most common presentation of bile duct carcinoma
Painless jaudice
Tumor marker for bile duct carcinoma
CA 19-9
CA 125 CEA
Most common congenital anomaly
Functional obstruction of duct of santorini
Pancreas Divisum
2nd part if duodenum surrounded by a rim of pancreatic tissue
May cause proximal small intestinal obstruction
Annular pancreas
Flank ecchymosis
Grey turner’s sign
Periumbilical ecchymosis
Cullen’s sign
Ranson’s prognostic signs
At admission
Age >55 years old Wbc count FBS LDH SGOT
Ranson’s prognostic signs
Initial 48 hours
Hct Elevated BUN serum Ca PO2 Base deficit Fluid deficit
