chole and appy Flashcards
What is the normal diameter
of the common bile duct
with gallbladder present?
4 mm until age 40, then add 1 mm per
decade (e.g., 7 mm at age 70)
What is the normal common
bile duct diameter after
removal of the gallbladder?
8 to 10 mm
What U/S findings are
associated with acute
cholecystitis?
Gallstones, thickened gallbladder wall
(>3 mm), distended gallbladder (>4 cm
A-P), impacted stone in gallbladder neck,
pericholecystic fluid
What is an IOC?
IntraOperative Cholangiogram (done
during a lap chole to evaluate the
common bile duct anatomy and to look
for any retained duct stone)
McBurney’s point
Point one third from the anterior
superior iliac spine to the umbilicus
(often the point of maximal tenderness)
Which antibiotic is used
for NONPERFORATED
appendicitis?
Anaerobic coverage: Cefoxitin®,
Cefotetan®, Unasyn®, Cipro®, and Flagyl®
What antibiotic is used for a
PERFORATED appendix?
Broad-spectrum antibiotics (e.g.,
Amp/ Cipro®/Clinda or a penicillin such
as Zosyn®)
How long do you give
antibiotics for perforated
appendicitis?
Until the patient has a normal WBC
count and is afebrile, ambulating, and
eating a regular diet (usually 3–7 days)
What is the risk of
perforation?
25% by 24 hours from onset of
symptoms, 50% by 36 hours, and
75% by 48 hours
What are the possible
complications of
appendicitis?
Pelvic abscess, liver abscess, free
perforation, portal pylethrombophlebitis
(very rare)
What bacteria are associated
with “mesenteric adenitis”
that can closely mimic acute
appendicitis?
Yersinia enterolytica
What are complications of
an appendectomy?
SBO, enterocutaneous fistula, wound
infection, infertility with perforation in
women, increased incidence of right
inguinal hernia, stump abscess
What is the blood supply to the rectum: Proximal? Middle? Distal?
Superior hemorrhoidal (or superior rectal) from the IMA
Middle hemorrhoidal (or middle rectal) from the hypogastric (internal iliac)
Inferior hemorrhoidal (or inferior rectal)
from the pudendal artery (a branch of
the hypogastric artery)
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 its
proximity to the cystic artery and Calot’s
triangle
