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SURGERY > GALL BLADDER > Flashcards

GALL BLADDER Flashcards

1
Q

Treatment of choice for symptomatic gallstones

A

Laparascopic cholecystectomy

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2
Q

measurement of a gallbladder

A

7 to 10 cm long

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3
Q

average capacity

A

30-50ml

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4
Q

Location of gallbaldder

A

anatomic fossa on the inferior surface of the licer

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5
Q

Cantle’s line

A

vertical plane running from the gallbladder fossa anteriorly to the inferior vena canca posteriorly divides left to right lobes

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6
Q

four anatomic areas

A

fundus, body, infundibulum, neck

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7
Q

mucosal lining of GB

A

single, highly redundant, simple, columnar epithelium contains cholesterol and fat globules

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8
Q

Epi lining supported by

A

LAMINA PROPRIA

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9
Q

Gallbladder differs histologicallt from the rest of Gi TRACTS

A

Lacks muscularis, mucosa and submucosa

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10
Q

Cystic arrert supplies GB usually a branch of the right hepatic artery

A
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11
Q

gallbladder lymphatrics drain into nodes

A

neck of the gallbladder

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12
Q

Visible lymph node (Lund’s or Mascagni’s node - overlies rge insertion of cystic artery into gb wall

A

Calot’s node

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13
Q

galllbaldder receives

A

parasympha, sympha, and semsory innervation via nerve fibers runnung largely via GASTRO HEPATIC LIGAMENT

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14
Q

Parasymphatetic cholinergic arise from where

A

HEPATIC BRANCH OF VAGUS NERVE

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15
Q

Vagal nerve branches also have PEPTIDE-CONTAINING NERVES

A

somatostatin, enkephalins, substance P, VIP

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16
Q

extrahepatic biliary tree consist of

A

right and left hepatic ducts, common bile ducrs, cystic duct and other common bile duct

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17
Q

common hepatic duct extends

A

1-4cm

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18
Q

segment of the cystic ducr immediately adjacent to the gallbladder neck bears a variable number of mucosal folds

A

SPIRAL VALVES OF HEISTER

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19
Q

Union of the cystic duct and the common hepatic ducr start of the common bile ducr.

A

7-11cm in length and 5-10 cm in diameter

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20
Q

Union of the cystic duct and the common hepatic ducr start of the common bile ducr.

A

7-11cm in length and 5-10 cm in diameter

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21
Q

Upper third (Supraduodenal portion)

A

passes downward in the free edge of the hepatoduodenal ligament, to the righ of the hepatic artery and anterior to the portal vein.

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22
Q

Middle third (retroduodenal portion)

A

bile ducr curves behind the first portion of the duodenum and diverges laterallt from the porral vein and hepatic arteries

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23
Q

lower third (pancreatic portion)

A

curve behind the head of the pancreas

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24
Q

sphincter of oddi

A

thick coat of circular smooth muscle, surroubds the common bile duct. Controls the flow of bile, and pancreatic juice and into duodenum.

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25
Q

The arterial supply to the bile ducts derived from

A

GASTRODUODENAL AND RIGHT HEPATIC ARTERIES, MAJOR TRUNKS LATERAL WALLS OF THE COMMON DUCT

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26
Q

Normal adult consuming an average diet

A

500-1000ml of bile a day

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27
Q

rudimentary

A

small, nonfunctional hypoplastic remnat

28
Q

lIver produces bile continously and excetes it into the

A

BILE CANALICULI

29
Q

BIle is composed of

A

water, mixed with bile salts, and acids, cholesterol. phospholipids (lecithin), proteins, and bilirubin.

30
Q

80% of the secrered conjugated bile acids are reabsorbed in the

A

terminal ileum

31
Q

GB, Bile ducts, sphicter of oddi

A

act together to store and regulate flow of bile.

32
Q

Main fx of hepatic bille

A

store hepatic bile in order to deliver it in a coordinated fashion to the duodenum in response to meal.

33
Q

MUCOSAL CELLS OF GB SECRETE AT LEAST 2 IMORTATNR PRODUCT

A

GLYCOPROTEIN AND HYDROGEN IONS

34
Q

GLYCOPROTEINS SECRETES

A

Protect the mucosa from the corrosive action and facilitate passage of bile via cystic duct.

35
Q

HYDROGEN IONS

A

decreasing the ph of stored bile. This acidification helps prevent the precipitation of ca salts, which can act as a nidus for STONE FORMATION

36
Q

main stimuli to this coordinated effort of gb emptying

A

cholecystokinin cck#

37
Q

CCK released

A

endogenouslt from enteroendocrine cells in the duodenum in response to meal

38
Q

defects in the motor activity of the gb inhibit correct emotying are thought to play a role

A

Cholesterol nucleation and gallstone formation

39
Q

Parasympathomimetic or cholinergic drugs contract the GB

A

nicotine and caffeine

40
Q

Anticholinergic drugs for gallbladder relaxation

A

Atropine

41
Q

Antral distenton of the stomach causes both

A

Gallbladder contraction and relaxation of the spinchter of oddi.

42
Q

Initial test of choice in evaluating pt with suspected malignancy of the GB

A

ct scan

43
Q

Preferred imaging modality for precise evaluation of biliary and pancreatic duct pathology

A

MRCP

44
Q

another option for noninvasive evaluation of the liver, gallbladder, bile ducts, and duodenum that provides both ana and fx information. Technetium-labeled derivatives of imnodiacetIc acid are injected iV, taken up by the Kupffer cells in the liver, excreted in the bile.

A

HEPATOBILIARY SCINTIGRAPHY OR HIDA SCANNING

45
Q

Advantage of ECRP

A

Direct visualization of the ampullary region, direct access to the distal common bile duct for cholangiography or cholescopy

46
Q

can be used to identify choledocholithiasis. useful for eval of retroduodenall portion of bile ducr, which is difficukt to resr in transabdominal ulratsonography

A

ENDOSCOPIC US

47
Q

biliary tree cant be assessed endoscopically, anterograde cholangiography can be performed by acessing i ntrahepatic bile ducr percistaneously with needle under fluroscopic guidance

A

Percutaneous transheparuc cholangiography

48
Q

Ptc potental rrisks

A

mainly bleeding, cholangitis, leak an dother catheter related probs

49
Q

Conditions predispose to the dev of gallstones

A

PREGNANCY
NON HDL HYPERLIPIDEMIA
CHROH’S DISEASE
CERTAIN BLOOD D/O HEREIDTARY SPHEROCYTOSIS, SC, THALASSEMIA

50
Q

PORCELAIN GB

A

significant calcifcation
pre malignant condition
absolute indication for cholecystectom, even when asymp

51
Q

Primary event in the formation of cholesterol stones

A

Supersaturation of bile with cholesterol
- non polar and soluble in water and bile

52
Q

What is formed when cholesterol is secrered into bile and sourrounded by bile salts and phospholipids

A

VESICLE COMPLEX

53
Q

Contains <20% cholestererol and are dark because of the presence of CA bilirubinare.

A

PIGMENTED STONES - usually brittle, small, dark and sometimes spiculared

  • formed by supersat of Uncojugated bilirubin within the bile.
54
Q

usually <1cm in diameter, brownish-yellowish, soft, and often mushy. form either in the gb or in the bile ducts secondary to bacterial infection and bile statsis. bacteria such as E.coli secrete b-ucoronidase that enzymaticallt cleaves conjugated bilirubin to produce insoluble uncojugated bilirubin. assoc with stasis secondary to parasite infection with Ascaris lumbricoides (roundworm) or Chlonorchis sinensis (liver in fluke)

A

BROWN STONES

55
Q

chief symp associated with symptomatic cholelithiasis

A

PAIN Biliary colic - constant and increases in severity. firts half of hour last up to 1 hr - 5hr

56
Q

Atypical presentations

A

in the back or left upper or right lower quadrant.
bloating and bleching may be present associated with attacks of paib,

57
Q

when pain lasts greater than 24 hours without resolving

A

impacted stone in the cystic duct or acute cholecystitis

58
Q

Impacted stone without cholecystitis

A

HYDROPS OF THE GB

59
Q

diagnosis of syptomatic chole or chronic chole depends on the presence of

A

typical symptoms and demonstration of stones on DIAGNOSTIC IMAGING

60
Q

Standard diagnistic test for gallstones as it is noninavsive and highly sensitive

A

abdominal ultrasound

61
Q

best long term results for patient with symptomatic gallstones

A

SURGICAL CHOLECYSTECOTOMY

62
Q

Impactiob of a larfe stone in rge neck og the gallbladder causing obstruction at the level of confluece of the cystic duct and common hepatic duct

A

MIRIZZI’S SYNDROME

63
Q

acute chole is mediated initially by mucosal toxin ___ a product of lecithin, as well as bile salts and platelet activating factors

A

lysolecithin

64
Q

CM of acute chole:

A

Begins as an attack of biliary colic with relapsing and remitting pain in the right upper quadrant or epigastrium that may radiate to the right back or interscapular area.
-febrile
, anorexia, nausea, vomiting.
creates focal peritinitis.

65
Q

PE of acute chole

A

tenderness and guarding are usualyy present in right upper quadrant.

66
Q

INspiratory arresr with deep palapatio in thw right subcostal area.

A

Murphy’s sign

SURGERY (6 decks)

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