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Flashcards in Gallbladder Deck (43):
1

Anatomy of the GB

RUQ of abd under liver
Cystic duct exits and joins common hepatic duct to form common bile duct
CBD empties into the duodenum at ampulla of Vader, which is surrounded by the sphincter of Oddi

2

What stimulates bile rls from the GB

CCK (cholecystokinin) causes the GB to contract, which rls's bile into the duod.

3

Why isn't there bile reflux back into the GB?

spiral valves of Heister

4

Arterial supply to the GB

cystic artery, which usu comes from the R hepatic artery

5

What is the triangle of calot?

cystic duct
common hepatic duct
cystic artery (some say edge of liver and the cystic artery goes through the triangle)

6

What is cholelithiasis

Gallstones

7

What is biliary colic

Pain produced when the GB contracts against a stone in the neck of the GB or as a stone passes through the bile duct

8

What is acute cholecystitis

inflammation and infection of the GB
usu w total or partial obstruction of the cystic duct

9

What are the most common organisms cultured during an episode of acute cholecystis?

E. coli
Klebsiella
enterococci
Bacteroidies fragilis
Pseudomonas

10

What is cholodocholithiasis

Stone in the CBD

11

What are stones made of?

Cholesterol (80%)
Calcium carbonate
or both

12

How do stones form?

Bile becomes supersaturated with cholesterol, stones precipitate out of soln.
High cholesterol diet can be a cause of cholesterol stones.

13

Calcium bilirubinate stones are found in a/w which diseases?

chronic biliary infection
cirrhosis
hemolytic processes- sickle cell anemia, thalassemia, spherocytosis

14

T/F Spinal cord injury predisposes to pigment stones (calcium bilirubinate)

False- predisposes to cholesterol stones

15

Px of gallstones

most pts are asx

16

Px of biliary colic

RUQ or epigastric pain, often radiates to right side or back
Usu postprandial, precipitated by fatty food intake
Lasts several hours before resolving
Also nausea/vom with it
But NO fever

17

Px of cholecystitis

Constant pain w progressive worsening. Fever chills sweats. It's inflam/infection, so it's signs of that- signs of peritoneal irritation, including RUQ rebound and guarding.
Murphy's sign- arrest of inspiration on deep palpation of RUQ

18

Px of choledocholithiasis

Dark urine or light colored stools- since the CBD is blocked, bile pigments can't get to the GI tract- so it's not cleared in stool, and instead it's cleared renally.
Also a/w jaundice and signs of biliary colic

19

Ascending cholangitis px

RUQ pain plus fever and chills. It's infection of bile duct from ascending bacteria.

20

Gallstone pancreatitis px

epigastric tenderness/pain radiating to the back
pancreatitis is dt choledocholithiasis- stone in the CBD

21

WHat is the Charcot triad?

For cholangitis
1. Fever
2. RUQ pain
3. Jaundice

22

What is the Reynolds pentad

For cholangitis that progressed to sepsis- charcot plus hypotension and mental status chgs
(charcot - fever, RUQ, jaundice)

23

Dx eval for cholecystitis

increased WBC
US- fluid around GB, thickened GB wall, GB distention
if it's acalculus cholecystitis, use HIDA (cholescintigraphy)- inject radioactive nucelotide into liver, it's excreted into biliary tree- if it's acute cholecystitis, then the cystic duct is obstructed so the GB will not fill- all radionucelotide will go out to the duodenum

24

Dx eval for cholodocholithiasis

Increased serum bilirubin and alk phos
US- detects stones
Best for CBD stones is ERCP- use endoscope to visualize ampulla, put contrast in retrograde. Can also extract stones.
MRCP good for detecting CBD stones but not therapeutic like ERCP

25

Dx eval for Cholangitis

Elevated serum bilirubin and transaminase levels

26

Dx eval for Gallstone pancreatitis

Elevations in serum amylase and lipase
US-detects stones

27

What happens if the dx of cholecystitis is delayed?

GB necrosis

28

What kind of cholecystitis is seen in diabetic pts?

Emphysematous cholecystitis d/t Clostridium perfringens

29

What is gallstone illeus?

Large gallstone erodes wall bt GB and bowel, making a fistula. The stone goes into the bowel and then down to the ileo-cecal junction, where it gets caught and causes distal bowel obstruction.

30

Rx for pts w asx stones

Usu not surgery. Incidence of complications only 2% per year.

31

Rx for biliary colic

Lap chole- elective

32

Rx for common duct stones

ERCP or intraop cholangiography (+ lap chole if colic)

33

Rx for acute cholecystitis

Fluids (vom/d cause dehydration)
IV abx
Lap chole
If pts too sick for surg, place a cholecystostomy tube for decompression/drainage, do surg when they are stable

34

Rx for gallstone pancreatitis

Fluids and observation
80% of cases are mild
Severe cases (necrosis, infection complications) get abx
Do early ERCP if signs of CBD obstruction.
After pancr is less inflamed, do cholecystectomy w intraop cholangiography.
Recurs a lot.

35

Rx for cholangitis d/t choledocholithiasis

Rapid dx and Rx!
IV abx and urgent biliary decompression and drainage.
ERCP with sphincterotomy is main Rx.
Can also do percutaneous or open surgical drainage.

36

Risk factors for cancer of GB

gallstones, porcelain GB, adenoma
females have 3x risk

37

What kind of ca is GB ca?

80% adenocarcinoma
10% anaplastic
5% sq cell

38

HPE for GB ca

vague RUQ pain
weight loss, anorexia
RUQ mass may be palpated
If jaundice- means invasion/compression of biliary system

39

Rx for GB ca

Radical resection of GB
+ partial hepatic resection
other palliative op- pgx is really bad. 4% 5yrs.

40

Risk factors for bile duct cancer

UC, sclerosing cholangitis, infection w Clonorchis sinensis (liver fluke)

41

HPE for bile duct ca

RUQ pain in advanced dz
Distended GB or jaundice (tumor obstructs biliary tree)

42

Dx eval for bile duct ca

US or CT can show obstruction, but need PTC or ERCP usu necessary to see lesion

43

Rx and pgx for bile duct ca

Rx surgical resection
Pgx really bad. 90% mortality at 5 years.