Surgery of the Biliary Tract, Pancreas, Liver, and Spleen Flashcards
A trumpet-mouthed dilatation of the duodenal wall at the opening of the fused pancreatic and common bile ducts.
Ampulla, or papilla, of Vater
Manufactured by the hepatocytes of the liver. Contains bile salts, which facilitate digestion and absorption and various waste products.
Bile
Removal of the gallbladder; performed for the treatment of diseases such as acute or chronic inflammation or stones
Cholecystectomy
Inflammation of the gallbladder
Cholecystitis
Establishes an opening into the gallbladder to drain the organ and remove stones.
Cholecystostomy
Stone formation in the gallbladder.
Cholelithiasis
A disease of the liver in which the tissue hardens and the venous drainage becomes blocked. It usually is caused by chronic alcoholism but may result from other disease conditions.
Cirrhosis
A descriptive term for tissue that means fragile and easily torn, and may bleed profusely. Some disease states produce this type of tissue. The liver and spleen normally are in this state.
Friable
The external covering of the liver composed of this dense connective tissue (visceral peritoneum) that extends over the entire surface of the liver, except at the point of posterior attachment to the diaphragm.
Glisson’s Capsule
Glisson’s Capsule is the external covering of the liver composed of this dense connective tissue (visceral peritoneum) that extends over the entire surface of the liver, except at the point of posterior attachment to the ________.
diaphragm
A small tube (catheter) is placed into the cystic duct, which drains bile from the gallbladder into the common bile duct. A dye that blocks X-rays is injected into the common bile duct and then X-rays are taken. This procedure is done to look for gallstones that may be in the common bile duct or to allow the surgeon to see the anatomy of the bile duct system from the liver to the small intestine.
Intraoperative Cholangiogram
Surgical removal of one or more anatomical sections of the liver.
Lobectomy
Excision of a segment of an organ (for example the excision of a portion of a lobe of a lung aka “segmentectomy”)
Segmental Resection
Contains the cystic artery (and possibly the right hepatic artery) and is a landmark in surgical removal of the gallbladder. Its boundaries may be remembered as “the 3 Cs”: Cystic duct, Common hepatic duct, and Cystic artery.
Triangle of Calot
Pancreatic transplant patients may remain on immunosuppression drugs postoperatively for:
indefinitely
A patient with end-stage liver disease caused by biliary artesia will require what procedure in conjunction with their liver transplant?
choledochoenterostomy
The pancreas lies directly on top of what two blood vessels?
Superior mesenteric artery and vein
Severe portal hypertension, uncorrectable coagulopathy, severe ascites, extensive adhesions, uncorrectable coagulopathy, extreme splenomegaly, most traumatic injuries to the spleen, are all contraindications for ________.
laparoscopic splenectomy
What is the most common nonemergent abdominal surgery performed today?
Cholecystectomy
A cholangiogram setup must be free of bubbles because they might be interpreted as…
gall duct stones on the x-ray film.
Any procedure in which the alimentary tract is entered under controlled conditions and without unusual contamination is considered a ________ wound. If there is gross spillage, however, the wound is classified as ________. Proper wound classification is considered an important predictor of ________.
clean-contaminated
contaminated
postoperative SSI (surgical site infection)
The ________ procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct.
Whipple
________ surgical wounds show no signs of inflammation and do not involve the respiratory, gastrointestinal or genitourinary tracts. Laparoscopic surgeries, surgeries involving the skin (such as biopsies), eye or vascular surgeries are good examples.
Clean
________ wounds are clean wounds with a higher risk of infection such as those involving the gastrointestinal, respiratory or genitourinary tracts, as long as the surgery is uncomplicated. Any wound opened to remove pins or wires, chest procedures, ear surgeries or gynecologic procedures are considered this type of wound.
Clean-contaminated
Surgical Anatomy-
The ________ is in the right upper
quadrant of the abdominal cavity, beneath the dome of the diaphragm and directly above the stomach, duodenum, and hepatic flexure of the colon.
liver
________ surgical wounds include those with a foreign object lodged in the wound (such as a bullet or other debris). This class also includes traumatic wounds from a dirty source where the treatment was delayed, infected surgical wounds or any wound that has been exposed to pus or fecal matter.
Dirty-infected
A ________ incision is used for surgical procedures of the liver.
midline
A ________ incision is used for surgical procedures of the pancreas.
.paramedian
A ________ incision is used for surgical procedures of the spleen.
midline, occasionally subcostal
Chemical hemostatic agents that may be used during surgery of the biliary tract (6):
Absorbable gelatin
Collagen
Oxidized cellulose
Epinephrine
Thrombin
Dermabond
Thermal hemostatic agents that may be used during surgery of the biliary tract (4):
Electrosurgical unit (monopolar and/or bipolar)
Harmonic scalpel
Argon beam coagulator
Smoke evacuator
Which structure is identified and divided during a Cholecystectomy?
Cystic duct
To inflate the abdomen with CO2 gas for visualization
Pneumoperitoneum
________ wounds are created when an outside object comes in contact with the wound. This could be a bullet, knife blade or other pointy object. Or the contamination could be caused by large amounts of spillage from the GI tract into the wound. Any highly inflamed or infected tissue around a surgical wound is considered this.
Contaminated
Surgical Anatomy-
Where is the porta hepatis located and what is it’s functions?
On the inferior surface of the liver
Provides entry and exit for the major vessels, ducts, and nerves.
Surgical Anatomy-
The ________ maintains the arterial blood supply while venous blood from the stomach, intestines, spleen, and pancreas travels to the ________ by the portal vein and its branches. The hepatic venous system returns blood to the heart via the inferior vena cava.
hepatic artery
liver
Surgical Anatomy (Liver)-
The sinusoids have a thin epithelial lining composed primarily of ________- ________ cells that engulf bacteria and toxins.
Kupffer cells
phagocytic
Surgical Anatomy-
Bile is manufactured by the ________ ________.
liver’s hepatocytes.
Surgical Anatomy (Liver)-
Order of operations of bile through the liver:
#1 Bile flows into the ________
#2 These join to form ________
#3 These merge with ________ from the ________ to form the ________
#4 This opens into ________ below the ________ opening from the ________
1 hepatic ducts
#2 common hepatic duct
#3 cystic duct, gallbladder, common bile duct
#4 duodenum, pyloric, stomach
Surgical Anatomy (Liver)-
Bile contains ________, which facilitate digestion and absorption, and various waste products.
bile salts
Surgical Anatomy (Liver)-
The liver is essential in the metabolism of ________, ________, and ________.
carbohydrates, proteins, and fats.
Surgical Anatomy (Liver)-
The liver metabolizes nutrients into stores of ________, used for regulation of ________ levels and as ________ sources for the brain and body functions.
glycogen
blood glucose
energy
Surgical Anatomy (Liver)-
The liver plays several important roles in the ________ mechanism. It is the organ that synthesizes ________ including prothrombin and fibrinogen. It also synthesizes ________ and ________.
blood-clotting
plasma proteins
lipoproteins
cholesterol
Surgical Anatomy (Liver)-
As a result of bile formation by the liver, ________ is absorbed by the metabolism of fats in the intestinal tract.
vitamin K
Surgical Anatomy (Gallbladder)-
Where does the gallbladder lie and where does it terminate?
Lies on the undersurface of the right lobe of the liver and terminates in the cystic duct.
Surgical Anatomy (Gallbladder)-
The ductal system provides a channel for the flow of bile to the gallbladder, where it becomes highly concentrated during storage. As the musculature of the gallbladder contracts the bile is forced into the ________ and through the ________. As the sphincter of the Oddi in the ________ relaxes, the bile is released, flowing into the ________ to aid in ________ by emulsification of fats.
cystic duct
common duct
ampulla of Vater
duodenum
digestion
Surgical Anatomy (Gallbladder)-
The gallbladder receives its blood from the ________, a branch of the ________.
cystic artery
right hepatic artery
Surgical Anatomy-
The ________ is located transversely behind the stomach in the left upper abdomen.
pancreas
Surgical Anatomy-
The ________ is located in the upper left abdominal cavity and the tenth, eleventh, and twelfth ribs gives it protection.
spleen
Surgical Anatomy (Pancreas)-
The pancreas also contains groups of cells (“islets”, “islands”, “Langerhans”) that secrete ________ into the blood capillaries instead of into the duct. These hormones are ________ and ________, and both are involved in ________ metabolism.
hormones
insulin
glucagon
carbohydrate
Surgical Anatomy (Spleen)-
What quadrant is the Spleen located in?
LUQ
Surgical Anatomy (Spleen)-
What is the danger if the splenetic artery is punctured/nicked?
Patient could quickly bleed out
4 main functions of the Spleen
- Defense of the body by phagocytosis of microorganisms
- Formation of nongranular leukocytes and plasma cells
- Phagocytosis of damaged red blood cells
- Acts as a blood reservoir
________ usually results from obstruction of the cystic duct from gallstones. However, in a few patients, it results from stasis, bacteria, or sepsis.
Cholecystitis
________ & ________ create an anastomosis between the gallbladder and duodenum or the gallbladder and jejunum, respectively, to relieve and obstruction in the distal end of the common duct.
Cholecystoduodenostomy
Cholecystojejunostomy
An indication for Transduodenal Sphincteroplasty is ________ dysfunction.
sphincter of Oddi
A ________ procedure is also known as a Pancreaticoduodenectomy.
Whipple
In a Pancreaticoduodenectomy (Whipple Procedure) the ________ is mobilized using the ________ maneuver.
duodenum
Kocher
What does CUSA stand for?
CUSA (Cavitron Ultrasonic Surgical Aspirator)
What anatomy is in the RUQ?
Liver, gall bladder and biliary tree, duodenum, head of pancreas, right kidney and adrenal gland, hepatic flexure of colon.
What anatomy is in the LUQ?
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, splenic flexure of colon, parts of transverse and descending colon.
What is the name of the node in Calot’s triangle
Calot’s node
What are the small ducts that drain bile directly into the gallbladder from the liver
Ducts of Luschka
Which artery is susceptible to injury during cholecystectomy
Right hepatic artery - because of it’s proximity to the cystic artery and Calot’s triangle
Where is the infundibulum of the gallbladder
Near the cystic duct
Where is the fundus of the gallbladder
At the end of the gallbladder
What stimulates gallbladder emptying
Cholecystokinin and vagal input
What is the initial diagnostic study of choice for evaluation of the biliary tract/gallbladder/cholelithiasis
Ultrasound
What is the treatment of major CBD injury after a lap chole
Choledochojejunostomy
What are the “Big 4” risk factors for cholelithiasis
Female
Fat
Forty
Fertile
What is the major feared complication of ERCP
Pancreatitis
Flexure at the junction of the duodenum and jejunum
Ligament of Tretiz
Left subcostal incision indicates surgery of the
Spleen
Two arteries that must be preserved during pancreas retrieval
Splenic, superior mesenteric
To preserve the hepatic artery during liver and pancreas procurement, what artery must be identified and ligated
Gastroduodenal
Must be anastomosed during a liver transplant
Hepatic artery
If the head of the pancreas becomes compressed, can result in jaundice, because of compression of the
Bile duct
Identifiable pathology of portal hypertension
Splenomegaly
To perform cholangiography, which duct is incised for placement of the catheter
Cystic
Using the diagram, identify the following structures:
Common bile duct; Ampulla of Vater; Intrahepatic ducts; Right hepatic duct; Left hepatic duct; Gallbladder; Cystic duct; Common hepatic duct
- Intrahepatic ducts
- Left hepatic duct
- Right hepatic duct
- Common hepatic duct
- Gallbladder
- Cystic duct
- Common bile duct
- Ampulla of Vater
In the diagram, identify the following nerves in the axillary region:
- Thoracodorsal
- Long thoracic
- Medial pectoral
- Lateral pectoral
