Hepatobiliary Flashcards
Triangle of calot
Cystic duct
Common hepatic duct
Liver margin
Capacity of gb
30-50 ml but can contain up to 300ml
Gallbladder innervation
Vagus and sympathetic branches of the celiac plexus
Parts of gb
Fundus
Body
Infundibulum (hartmann’s pouch)
Neck
Common bile duct enters what portion of the duodenum
2nd portion of the duodenum through the sphincter of oddi
Average length of common bile duct
7-11 cm in length (if more than 10cm: dilated na common bile duct)
Normal diameter of common bile duct
5-10mm
Larger than 10 means dilatation: probably by a stone
Spiral valves of heisner
Variable number of mucosal folds at the segment of the cystic duct adjacent to the gall bladder
Elevated in cholecystitis
Increased WBC
Tests that will make you suspect cholangitis
Increased bilirubin: obstruction
Increased alkaline phosphate: obstruction
Then do UTZ
Murphy sign
Inspiratory arrest with deep palpation in the right subcostal
Area
Is leukocytosis present in acute cholecystitis?
Yes, mild to moderate
12,000-15, cells/ ml
Tx of acute cholecystitis include
Hydration( IV fluids)
Antibiotics
Analgesia
Charcot’s triad is for?
Cholangitis
Fever, epigastric/RUQ pain, jaundice
Moat important? Fever
Reynold’s pentad indicates
Septicemia
Charcot triad + cns depression and shock
Definitive dx treatment for cholangitis
ERCP
Biliary cysts
Congenital dilatations of the extra/intra hepatic biliary tree
Sclerosing cholangitis
Inflammatory strictures in the intra/extra hepatic biliary tree, puts patient at risk for cholangiocarconoma
Gallbladder carcinoma prognosis
5% 5 year survival rate
5th moat common GI malignancy in the west
10mm polyp places patients at risk
80% adencarcinoma
Most common organisms from bile
Bile from bladder or ducts are almost always sterile
E coli
Klebsiella pneumoniae
Streptococcus fecalis
Bacteroides fragilis
Avearge length of the gall bladder
7-10 cm
