Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Gallstones > Flashcards

Gallstones Flashcards

1
Q

normal capacity of gallbladder

A

50ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bile is made by

A

hepatocytes against concentration gradient under pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does gall bladder do to bile

A

increases concentraation 5-10%
through active uptake of electrolytes from the bile causing water to also flow out of the bile (osmotic gradient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

bilirubin is generated from sequential catalytic degradation of haem mediated by two groups of enzymes:

A

haem oxygenate
biliverdin reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

bilirubin is poorly soluble in

A

water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does bilirubin stay in solution in plasma

A

by binding albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does albumin binding help bilirubin

A

keeps it in the vascular space
prevents it from depositing into extra hepatic tissues such as the brain or kidney (toxic)
transports bilirubin into the sinusoidal surface of the hepatocyte, where the pigment dissociates from albumin and enters the hepatocyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

before excreted in bile and urine, bilirubin must be

A

conjugated in the liver to make it more water soluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

urine symptoms of uncongugated hyperbilirubinaemia

A

not water soluble, therefore doesn’t appear in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

urine symptoms of conjugated hyperbilirubinaemia

A

can pass into urine as urobilinogen, causing urine to become darker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

breakdown of haem

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

haem is broken down by

A

haem oxygenase
into biliverdin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

biliverdin is broken down by

A

biliverdin reductase
into bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

bile acids/salts are made up of

A

chenodeoxycholic acid, cholic acid
secondary bile acids, deoxycholic acid and lithocholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

some qualities of bile acids/salts

A

forms micelles with fat
allow digestion with lipase
recycled in enterohepatic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

lethicin helps dissolve

A

cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

things that cause predisposition to gallstones

A

western societies: cholesterol stones F>M
non western societies: brown pigment stones, chronic infection w biliary flukes
blood disorders: black pigment stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what predisposes to black pigment stones

A

form in conditions of excess unconjugated bilirubin which may be caused by haemolysis in blood disorders like thalassaemia, spherocytosis, sickle cell
or in conditions like cirrhosis and splenomegaly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

which type of gallstones do people in western societies typically get

A

cholesterol

20
Q

nature of biliary colic pain

A

post prandial
persistant
epigastric (visceral) pain
severe

21
Q

cholecystitis

A

the primary insult is the impaction of the stone
combined mechanical, chemical and infectious process
bile culture is positive in 75% of cases

22
Q

possible complications of cholecystitis

A

gangrene
perforation
empyema
mucocoele
gas producing infection
chronic cholecystitis

23
Q

gangrene in gall bladder

A

GB wall dies as inflammation causes thrombosis and perfusion falls

24
Q

empyema in gall bladder

A

pus is trapped in the GB

25
Q

mucocoele in gall bladder

A

sterile mucous trapped in GB

26
Q

chronic cholecystitis

A

fibrosis
fistulation
formation of large stone called mirizzi syndrome

27
Q

choledocholithiasis

A

common bile duct stones

28
Q

complications of choledocholithiasis

A

obstructive jaundice
cholangitis
pancreatitis

29
Q

jaundice is caused by

A

impaired bilirubin excretion
raised conjugated bilirubin level
becomes present in urine (normal urobilinogen)
becomes absent in stool (normal stercobilinogen)

30
Q

jaundice leads to

A

bile salts cause itch
steatorrhoea from failure to emulsify fats
vit K malabsorption causes coagulopathy
eventually liver and kidney failure

31
Q

jaundice is caused by raised levels of

A

serum conjugated bilirubin level

32
Q

charcots triad is used to indicate the presence of

A

acute cholangitis

33
Q

the symptoms of chariots triad

A

jaundice, fevers (usually with rigors), RUQ pain

34
Q

what are the symptoms of reynold’s pentad

A

jaundice, fevers (usually with rigors), RUQ pain, confusion, shock

basically charcots triad but with the mental status changes of confusion and shock

35
Q

Reynolds pentad is indicative of

A

acute cholangitis

36
Q

how does the location of the stone affect the diagnosis

A
37
Q

GB cancer is increased risk in

A

First Nations Americans, Pakistan, India, Maori, Indigenous Australians
risk increases x4 in people with stones

38
Q

prognosis for GB cancer

A

rarely curable
required radical resection as it infiltrates deeply

39
Q

GB cancer may present as

A

may present as a very early polyp, a mass on imaging, or most commonly with advanced disease, jaundice from hilarity infiltration and metastases

40
Q

cholangiogram may help you visualise

A

stones and blockage

41
Q

complications of cholecystectomy

A

bile duct injury
death
bike leak
bleeding
retained stones
infection in ports
lap injury to bowel
pneumoperitoneum
general post op complications eg. DVT, PE, pneumonia

42
Q

what could be done instead of cholecystectomy?

A

ERCP
cholecystostomy

43
Q

ERCP

A

endoscopic retrograde cholangiopancreatography
camera to duodenum, wire up ampulla into the bile duct, removes stone and places stent

44
Q

problems with ERCP

A

have to cut ampullarf muscle, allows duodenal reflux into CBD, can cause chronic inflammation, cancer risk is low but isn’t 0

45
Q

cholecystostomy

A

needle into GB under USS guidance to decompress bile/pus

46
Q

post cholecystectomy syndrome

A

altered fat absorption
diarrhoea with high fat content meals
rare in gallstone pathology
common if missed original diagnosis

Surgery (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions