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Flashcards in Gallbladder Deck (76)
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1

the capacity of the gallbladder is ____

30 to 50 mL

2

The GB lacks the following smooth muscle layer

muscularis mucosa
submucosa

3

What is the main blood supply of the gallbladder?

Cystic artery

4

The cystic artery is a branch of?

right hepatic artery

5

What passes through the triangle of callot?

Cystic artery

6

That are the borders of the traingle of callot?

Cystic duct
common hepatic duct
cystic artery

7

The budd triangle is bordered by

R: cystic duct
L: common hepatic
Superior: margin of the right lobe of liver

8

This refers to a circular area that fits into the hepatocystic duct angle

moosman area

9

The opening of the pancreatic duct is called ___

ampulla of Vater

10

The ampulla of vater is surrounded by ____

sphincter of oddi

11

The ampulla of vater is ___ cm distal to pylorus

10cm

12

The primary bile salt is composed of _____

chenodeoxycholate/cholate

13

The secondary bile salt is composed of ____

deoxycholate/lithocholate

14

What is the rate of feed forward secretion of per day of bile?

30g/day

15

How many grams of bile sals is secreted in the feces per day?

0.2-0.6g/day

16

The liver produces how many grams of liver per day?

0.2 to 0.6g

17

The primary bile salts are conjugated with these:

glycine and taurine

18

[Neurohormonal Regulation]

Nerve that stimulates GB contraction

vagus

19

[Neurohormonal Regulation]

inhibits GB contraction

VIP, somatostatin

20

[Neurohormonal Regulation]

GB contraction

CCK

21

[Neurohormonal Regulation]

This stimulates the relaxation of the sphincter of oddi

CCK

22

[Neurohormonal Regulation]

stimulates liver ductal secretion

Secretin

23

What are the UTZ characteristics of gallstone?

Acoustically dense
Produce posterior shadow
Move with changes in position

24

[diagnose]

Stone
GB thickening
Pericholecystic fluid
sonographic murphy sign

acute cholecystitis

25

[Color of Gallstone ]

hemolytic disorders, cirrhosis can have this type of stone

pigment stone

26

[Type of Gallstone ]

radiolucent stone in UT

cholesterol

27

[Type of Gallstone ]

mulberry-shaped stone is composed of___

cholesterol + pigment

28

[Type of Gallstone ]

small, brittle, spiculated

supersaturation of Ca bilirubinated, carbonate and phosphate

due to hemolytic disorders and cirrhosis

black pigment stones

29

[Type of Gallstone ]

soft, mushy

usually secondary to bacterial infection or bile stasis

brown pigment stones

30

What are the indications for Prophylactic Cholecystectomy?

1. Hemoglobinopathies (sickle cell)
2. Hereditary spherocytosis and thalassemia at the time of splenectomy
3. Transplant recipients (Cardiac and Lung)

31

Porcelain bladder leading to GB CA has an incidence rate of ___

0

32

What are the absolute contraindications of laparoscopic cholecystectomy?

1. Refractory coagulopathy
2. Inability to tolerate general anesthesia
3. Diffuse peritonitis with hemodynamic compromise
4. Cholangitis
5. Potentially curable GB CA

33

What are the relative contraindications of cholecystectomy?

1. Previous upper abdominal surgery with extensive adhesions
2. Cirrhosis
3. Portal hypertension
4. Severe cardiopulmonary disease
5. Pregnancy

34

[diagnosus]

RUQ pain, unremitting
fever, anorexia, nausea, vomiting

(+) murphy

Acute cholecystitis

35

[PE in Acute cholecystitis]

examiner hooks fingers under right costal margin and asks patient to deeply inhale. patient stops inhaling due to sudden pain

Murphy sign

36

[PE in Acute cholecystitis]

hyperesthesia in the RUQ or R infrascapular region

Boas sign

37

[PE in Acute cholecystitis]

Present when the patient points to the right scapular tip with a fist and thumb pointing upwards to describe the pain

Collins Sign

38

[PE in Acute cholecystitis]

the most typical clincal sign of acute cholecystitis is

abdominal paon

39

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, what are the local signs?

1. Murphy
2. RUQ mass or pain or tenderness

40

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, what are the systemic signs?

1. Fever
2. Elevated CRP
3. Elevated WBC

41

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, how will you say that it is a suspected case of Acute Cholecystitis?

One Item in A + One item in B

42

[Diagnosis of Acute cholecystitis]

In Tokyo Guidelines, how will you say that it is a definite case of Acute Cholecystitis?

One item in A
One item in B
One Imaging findings of Acute cholecystitis

43

What are the UTZ findings in Acute cholecystitis?

1. Enlarged GB
2. >5 mm thich GB wall
3. GB stones
4. Debri echo
5. Ultrasonographic Murphy sign positive

44

[Imaging in Acute Cholecystitis]

In HIDA Scan
___ refers to the blush of increased pericholecystic radioactivity in cholecystitis

Rim Sign

45

[Imaging in Acute Cholecystitis]

In HIDA Scan

Failure of the tracer to fill within ___ minutes means that the cystic duct is obstructed

60 mins

46

[Severity grading for acute cholecystitis]

Cholecystitis + organ dysfunction

Grade III

47

[Severity grading for acute cholecystitis]

Cholecystitis without organ dysfunction

Grade II

48

Severe Acute cholecystitis is associated with what organ dysfunctions?

1; Hypotension requiring dopamine >5ug/kg/min
2. Decreased consciousness
3. PaO2/FiO2 ration <300
4. Oliguria, Crea >2.0
5. PT-INR > 1.5
6. PC <100,000

49

Moderate Acute cholecystitis is associated with what?

1. Palpable tender mass in RUQ
2. Duration of complaints >72 hours
3. Marked local inflammation
4. Elevated WBC >18,000

50

What are the analgesic of choice in patients with acute cholecystitis?

1. Meperidine
2. NSAIDS

51

What is the definitive management for acute cholecystitis?

Early cholecystectomy - 2-3 days

52

What is the best initial management for acute cholecystitis?

NPO, IV fluids

53

What is the definitive management for Grade I Acute Cholecystitis?

Early laparoscopic cholecystectomy (within 72 hours)

54

What is the definitive management for Grade II Acute Cholecystitis?

Early cholecystectomy (lap or open)

55

What is the definitive management for Grade III Acute Cholecystitis?

Urgent management of organ dysfunction and GB drainage

Delayed cholecystectomy (2-3 months after)

56

[Choledocholithiasis]

This type is formed primarily in the CBD

primary

57

[Choledocholithiasis]

This type is formed in the GB then migrate to CBD

secondary (most common)

58

[Type of Choledocholithiasis based on the timing]

Identified by cholangiography shortly after cholecystectomy

retained

59

[Type of Choledocholithiasis based on the timing]

found <2 years after cholecystectomy

residual

60

[Type of Choledocholithiasis based on the timing]

> 2 years after cholecystectomy

recurrent

61

[Diagnosis of Choledocholithiasis]

gold standard for diagnosis

ERCP

62

[Diagnosis of Choledocholithiasis]

initial test

abdominal UTZ

63

[Diagnosis of Choledocholithiasis]

UTZ characteristics suggestive of choledocholithiasis

1. GB stones
2. Dilated CBD > 8mm

64

What are the indications for IOC during laparoscopy during cholecystectomy

1. Jaundice
2. Elevated LFTs
3. CBD larger than 5-7mm
4. cystic duct larger than 3mm
5. Multiple GB stones
6. CBD visualized on preoperative UTZ
7. Palpable CBD intraop
8. Short cystic duct

65

[Treatment of choledocholithiasis]

If diagnosis is known pre-operatively, the treatment options are as follows:

1. ERCP plus sphincterotomy
2. Ductal clearance of stones
3. Lap cholecystectomy

66

[Treatment of choledocholithiasis]

If diagnosis is known pre-operatively, the treatment options are as follows:

1. Lap cholecystectomy
2. Intraoperative cholangiography
3. Lap CBDE or sphincterotomy (next day)

67

[Treatment of choledocholithiasis]

If the endoscopic management fails,

OPEN CBDE

68

[Treatment of choledocholithiasis]

if with impacted stones at the ampulla

Choledochoduodenostomy
Roux-en-Y choledochojejunostomy

69

[Treatment of choledocholithiasis]

Surgical management of retained stones

Extract stone through the T Tube tract at 2-4 weeks

OR

ERCP + sphincterotomy

70

___ syndrome is caused by an extrinsic compression from an impacted stone in the cystic duct or hartmann's pouch of the GB

Mirrizi Syndrome

71

____ syndrome

Gallstone ileus of the duodenum

Bouveret syndrome

72

___ triad

pneumobilia, small bowl obstruction, ectopic gallstone

Rigler triad

73

[diagnosis]

ascending bacterial infection of the biliary in association with partial or complete blockage of the bile duct

cholangitis

74

the most common cause of cholangitis

gallstone

75

[Tokyo Guideline for Acute Cholangitis]

clinical context for acute cholangitis

1. History of biliary disease
2. Fever or chills
3. Jaundice
4. Abdominal pain (RUQ or upper abdomen)

76

[Tokyo Guideline for Acute Cholangitis]

laboratory data for acute cholangitis

1. leukocytosis
2. High CRP
3. Abnormal liver function test