Gallbladder diseases Flashcards
(45 cards)
Which artery supplies the gallbladder? and what is the gallbladder’s capacity?
CYSTIC ARTERY branch of right hepatic artery
30-45cc
How long is the common bile duct?
10-15cm
should not be more than 6mm in diameter
Where does the common bile duct join the major pancreatic duct?
the wall of the second part of the duodenum -> AMPULLA OF VATER
intraduodenal part of CBD has sphincter of ODDI to regulate bile flow
Where does the spiral valve of Heister exist?
in the neck of the gallbladder continuous with the cystic duct -> makes catheterization difficult
What is the lymphatic drainage of the gallbladder?
- cystic lymph node of LUND by the junction of the cystic & common hepatic ducts ——> CELIAC NODES -> porta hepatis
Which hormone is responsible for stimulation of gallbladder contraction?
CHOLECYSTOKININ (CCK)
- fatty food stimulates the duodenal mucosa to secrete it
What are the benefits of x-ray use in case gallbladder disease?
- could detect only radio-opaque stones (10-15%) —> mercedes benz
- porcelain gallbladder -> calcified wall -> premalignant
- emphysematous cholecystitis -> gas within wall
- biliary fistula -> gas within biliary system after sphincterotomy or anastomosis
how can we differentiate between a renal & gallbladder stone in an x-ray?
LATERAL X-RAY
- renal -> in spine
- gallbladder -> anterior to spine
What are the functions of the gallbladder?
- storage of bile until CCK is secreted -> contracts
- concentration of bile -> absorption of water, sodium chloride, & bicarbonate by mucous membrane
- secretion of mucus -> in complete obstruction of cystic duct could lead to mucocele
What is the first-line of radiological investigations used in biliary disease?
ultrasound abdomen shows
- > visualizes mobile, hyperechoic, intraluminal mass with acoustic shadow
- > cholelithiasis
- > gallbladder wall thickening
- > pericholecystic fluid
- Murphy’s sign
What was used in adjunction with ultrasound when a patient had symptoms of cholelithiasis with a negative ultrasound?
ORAL CHOLECYSTOGRAM (OCG)
- more useful in smaller stones & counting the number of stones present
- patient should be on a fat free diet for 3 days -> take 6 tablets of TELEPAQUE the previous night -> x-ray abdomen in erect position -> fatty meal is given -> another x-ray taken to see change in size of gallbladder
What are the contraindications of oral cholecystogram (OCG)?
- patient with serum bilirubin >3mg
- acute cholecystitis (because cystic duct is contracted)
- vomiting —-> use IV CHOLANGIOGRAM instead (inject biligram)
What are the advantages of sonography?
- no ionizing radiation
- detection of small calculi
- no contrast medium
- less patient preparation
When is CT used in case of gallbladder disease?
- extent of primary tumor
- relationship to other organs & blood vessels
- in obese patients
- if ultrasound is not definitive
What is the benefit of Magnetic Resonance CholangioPancreatography (MRCP)?
- non-invasive & as diagnostic as PTC & ERCP
- demonstrates ductal obstruction, strictures, & intraductal abnormalities
What is the benefit of Tc99-labelled iminodiacetic acid (HIDA)?
diagnoses ACUTE CHOLECYSTITIS & other biliary disorders (biliary atresia)
- non-visualization of gallbladder -> acute cholecystitis
- delayed or reduced visualization -> chronic cholecystitis
- biliary scintigraphy diagnoses bile leaks & iatrogenic biliary obstruction
- evaluation of biliary dyskynesia or sphincter of Oddi dysfunction -> post-cholecystectomy syndrome
When is peroperative cholangiography used?
- during a cholecystectomy -> catheter is placed in the cystic duct & contrast is injected directly into the biliary tree
- defines the anatomy of the biliary tree
- excludes the presence of stones within the bile ducts
- when cystic duct feels dilated more than normal
- if u feel a stone slipping into ducts after clipping the gallbladder
- make sure the OR table is fit for x-ray or not
What method of investigation is used to cannulate the sphincter of Oddi, and inject dye to visualize the biliary & pancreatic tree?
Endoscopic Retrograde Cholangio-pancreatography (ERCP)
What are the diagnostic indications for ERCP?
- congenital anomalies
- stones
- stricture in biliary tree
- choledochal cyst
- chronic pancreatitis -> chain of lakes
- malignancy -> irregular filling defect
- biopsy from tumors
- sampling or biliary & pancreatic juices for cytology
What are the therapeutic uses of ERCP?
- extraction of stone
- stenting of tumor in CBD or pancreas
- dilatation of biliary strictures
- endoscopic sphincterotomy
What are the complications of ERCP?
- pancreatitis
- duodenal injury
- cholangitis
- bleeding
What are the rules of use of Percutaneous Transhepatic Cholangiography (PTC)?
- normal coagulation
- dilated biliary radicles (in long standing obstruction)
What are the indications for PTC?
- in severe obstructive jaundice -> under antibiotics & control of bleeding tendencies
- if ERCP is inappropriate of failed
- to drain biliary obstruction
- used for stenting through obstruction in hepatic ducts or CBD
Where is the Chiba or Okuda needle inserted while preforming PTC?
right 8th intercostal space in mid-axillary line -> aspirate bile -> inject water-soluble iodine to visualize biliary radicles
