Fiser ABSITE Ch. 32 Gallbladder Flashcards Preview

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Flashcards in Fiser ABSITE Ch. 32 Gallbladder Deck (64):
1

the gallbladder lies between these 2 liver segments

segment 4 and 5

2

cystic artery is a branch off of this

right hepatic artery

3

name the boundaries of callot triangle

cystic duct laterally, common bile duct medially, liver superior

4

these arteries were considered longitudinal blood supply to the hepatic and common bile duct, lies in a 3 and 9:00 position

right hepatic, retroduodenal, (branches of gastroduodenal artery)

5

where the cystic veins drain

right branch of the portal vein and into the liver

6

where the biliary lymphatics located with respect to the common bile duct

right side

7

name the parasympathetic and sympathetic innervation to gallbladder

parasympathetic: Left (anterior) the trunk of the vagus, sympathetic from T7-T10

8

which epithelial layer as the gallbladder lack compared to the rest of the GI tract

no submucosa

9

this hormone relaxes the sphincter of oddi

glucagon

10

give the normal size for: common bile duct, gallbladder wall, pancreatic duct

common bile duct -less than 8 mm; Gallbladder wall - less than 4 mm; pancreatic duct - less than 4 mm

11

where is the highest concentration of CCK and secretin cells

duodenum

12

these are invagination of the epithelium of the wall of the gallbladder, formed by increased gallbladder pressure

Rokitansky-Aschoff sinuses

13

name 3 things that increase bile excretion

CCK, Secretin, Vagal input

14

name 3 things that decrease bile excretion

VIP, Somatostatin, Sympathetics

15

name 3 essential functions of bile

fat-soluble vitamin absorption, bilirubin excretion, cholesterol excretion

16

where does bile become concentrated and how

in the gallbladder, resorption of sodium and water

17

where does the active resorption of conjugated bile acids occur

terminal ileum

18

name the 2 cells which secrete bile

bilateral canalicular cells, 20%; hepatic sites, 80%

19

we gives bile its green color

conjugated bilirubin

20

this is a breakdown product of conjugated bilirubin in the gut, it gives stool a brown color

stercobilin

21

breakdown product of conjugated bilirubin, gives urine its yellow color

urobilin

22

this is the rate limiting step in cholesterol synthesis

HMG coA reductase

23

name the 2 enzymes in bile acids synthesis

HMG coA reductase, 7-alpha- hydroxylase

24

give cause of cholesterol stone formation in thin versus overweight people

thin, underactive 7-alpha- hydroxylase; overweight, overactive HMG coA reductase

25

name 4 factors that increased cholesterol insoluabilization

1) stasis 2) calcium nucleation 3) increased water absorption in the gallbladder 4) decreased lecithin and bile acids

26

which gallstone is more common in United States

nonpigmented, cholesterol

27

black pigmented gallstones: 4 common causes

1) hemolytic disorders 2) cirrhosis 3) chronic TPN 4) status post ileal resection

28

black pigmented gallstones: 3 key factors for development

increased bilirubin load, decreased hepatic function, bile stasis

29

black pigmented gallstones: where do they form, treatment

within the gallbladder, cholecystectomy

30

brown pigmented gallstones: pathophysiology of formation

infection causing deconjugation of bilirubin

31

brown pigmented gallstones: most common cause, commonly seen in this population

E. coli, Asian

32

brown pigmented gallstones: where do they form

common bile duct

33

these 2 gallstones are considered secondary common bile duct stones. (formed in the gallbladder)

cholesterol stones, black stones

34

3 most common bacteria in cholecystitis

1) E. coli 2) Klebsiella 3) Enterococcus

35

name 4 preemptive conditions which increased risk for acalculus cholecystitis

1) Severe burns 2) Prolonged TPN 3) Trauma 4) Major surgery

36

emphysematous gallbladder disease: Describe, Seen in this population, Most common etiology

gas within the gallbladder wall; diabetics; Clostridium perfringens

37

emphysematous gallbladder disease: Signs and symptoms, Treatment

severe, rapid onset abdominal pain, nausea, vomiting and sepsis; Emergency cholecystectomy or percutaneous drainage if unstable

38

pathophysiology of gallstone ileus

fistula between the gallbladder and duodenum, releases stone causing small bowel obstruction... seen in the elderly

39

gallstone ileus: Common finding on plain film, Most common site of obstruction

pneumobilia; terminal ileum

40

gallstone ileus: Treatment

enterotomy and possible resection to remove stone, cholecystectomy with fistula resection

41

pelvis common bile duct injury treatment differentiated

if greater than 2 mm will need hepaticojejunostomy

42

this is the most important cause of the leak postoperative biliary stricture

ischemia

43

name 2 treatments for common bile duct or hepatic duct strictures

ERCP with sphincterotomy and stent placement; PTC tube

44

most common cancer of the biliary tract: First site of metastasis, Typical symptoms

gallbladder adenocarcinoma; Segments 4 and 5 of the liver; Jaundice first then right upper quadrant pain

45

differentiate stage I versus stage II gallbladder: adenocarcinoma, treatment for each

1-limited to the gallbladder mucosa; cholecystectomy; 2-into the muscle; wide resection around liver bed with possible Whipple

46

choledochal cyst: common etiology, signs and symptoms

female, Asian, 90% extrahepatic, 15% cancer risk; episodic pain, fever, jaundice, cholangitis

47

choledochal cyst: most common type, describe

1, fusiform or saccular dilation of extrahepatic ducts

48

give treatment for type one choledochal cyst

cyst excision with hepaticojejunostomy and cholecystectomy

49

described type 4 and type V choledochal cysts

4-partially intrahepatic, 5-caroli's disease, total he intrahepatic requiring partial liver resection

50

30-40-year-old male patient presents with fatigue, fluctuating jaundice, pruritis, weight loss, right upper quadrant pain

primary sclerosing cholangitis

51

in 2 complications of primary sclerosing cholangitis

cirrhosis; cholangiocarcinoma

52

2 medications which can be used in primary sclerosing cholangitis, give affect of each

cholestyramine -- decrease pruritis symptoms by decreasing bile acids; UDCA -- decrease symptoms and improve liver function

53

primary biliary cirrhosis: Most common in, Symptoms, Key lab value

women; Fatigue, itching, jaundice, xanthomas; Positive antimitochondrial antibodies

54

Charcot's triad

right upper quadrant pain, Fever, Jaundice

55

reynolds Pentad

1) Right upper quadrant pain 2) Fever 3) Jaundice 4) Altered mental status 5) Shock

56

2 most common pathogens associated with cholangitis

Escherichia coli, Klebsiella

57

give differential diagnoses for shock following laparoscopic cholecystectomy: Early-first 24 hours, Late-after 24 hours

early hemorrhagic shock from clip falling off the cystic artery; Late-septic shock from accidental clip the common bile duct with subsequent cholangitis

58

thickened nodule the mucosa and muscle associated with Rokitansky Ashcroft sinuses, Not premalignant; Give treatment

adenomyomatosis; Cholecystectomy

59

benign neuroectoderm tumor of gallbladder, Can occur in biliary tract with signs of cholecystitis; Give treatment

granular cell myoblastoma; Cholecystectomy

60

speckled cholesterol deposits on the gallbladder wall

cholesterolosis

61

2 signs concerning for malignancy and gallbladder polyps

greater than 1 cm; Patient greater than 60 years old

62

type of bilirubin down to albumin covalently, half-life of 18 days

delta bilirubin

63

compression of the common hepatic duct by a stone in the infundibulum of the gallbladder or inflammation arising from the gallbladder or cystic duct extending to the contiguous hepatic duct causing stricture and hepatic duct obstruction

mirizzi syndrome

64

this antibiotic can cause gallbladder sludge and cholestatic jaundice

ceftriaxone