Term
|
Definition
liver
cystic duct
common hepatic duct |
|
|
Term
| bs to hepatic and common bile duct? |
|
Definition
right hepatic (lateral) and retroduodenal br of GDA (medial)
-aka 9 and 3 o'clock on ERCP |
|
|
Term
| what liver segments is GB under? |
|
Definition
|
|
Term
| where does cystic vein drain? |
|
Definition
|
|
Term
| where are bile duct lymphatics located? |
|
Definition
|
|
Term
| origin of biliary innervations? |
|
Definition
parasymp: left vagus (anterior vagus)
symp: T7-10 splanchnic and celiac ganglion |
|
|
Term
| what histo layer does GB lack? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| contraction of S of Oddi @ ampulla of vater |
|
|
Term
| what agents relax vs contract s of oddi? |
|
Definition
morphine = contract
glucagon = relax |
|
|
Term
| essential bile functions? |
|
Definition
FAT soluble vitamin absorption
FAT absorption
bili and cholesterol excretion |
|
|
Term
| how does GB concentrate bile? |
|
Definition
-active Na resorption (NaH exchanger)
-active Cl resorption (ClBicarb exchanger)
==>draws water out of bile and into gb epithelium. |
|
|
Term
| normal sizes of CBD vs PD vs GB wall |
|
Definition
-CBD <8mm (<10mm s/p chole)
-PD/GB wall < 4 mm |
|
|
Term
Concentration of Na, Cl, bile salts, cholesterol
-@ hepatic vs GB |
|
Definition
hepatic vs GB
-Na: 150 vs 250-300
-Cl: 50-100 vs 1-10
-bile salt: 1-50 vs 250-350
-chol: 50-100 vs 300-700
Q: why chloride goes down?? |
|
|
Term
Ducts of Luschka
-def
-origin/drainage |
|
Definition
-accessory bile ducts, course along but not into the GB
-from right lobe liver, drain into extra-hepatic bile ducts |
|
|
Term
| Dx of duct of luschka injury>? |
|
Definition
|
|
Term
| what causes inc vs dec bile excretion? |
|
Definition
inc = CCK, secretin, vagus
dec = VIP, SStatin, sympathetics |
|
|
Term
| Where does abberant posterior right hepatic duct originate? |
|
Definition
segments 6 or 7
-lies on GB bed fossa = injury risk |
|
|
Term
| what is ischemic with injury of abberant posterior right hepatic artery? |
|
Definition
|
|
Term
| where is energy derived from for GB bile concentration? |
|
Definition
| NaK ATPase at basolateral membrane |
|
|
Term
| where are bile salts reabsorbed? |
|
Definition
-conj bile: active resorption @ TI (50%)
-non conj: 45% at SB, 5% colon |
|
|
Term
| when does max GB emptying occur? |
|
Definition
|
|
Term
|
Definition
80% from hepatocytes
20% from bile canalicular cells |
|
|
Term
| what gives bile its color? |
|
Definition
|
|
Term
|
Definition
stercobilin
-conj bili breakdown product |
|
|
Term
|
Definition
urobilinogen-->urobilin
-formed from conversion of reabsorbed conj bilirubin |
|
|
Term
|
Definition
-HMG CoA (+HMG COA REDUCTASE) = cholesterol
-Chol (+1-a-OHylase) = bile acids |
|
|
Term
|
Definition
|
|
Term
| causes of non-pigmented stones? |
|
Definition
| -stasis, Ca nucleation, inc water resorption -dec licithin and bile salts |
|
|
Term
|
Definition
|
|
Term
| Cause of Ca pigmented stones? |
|
Definition
| solubilization of UNconj bili with precipitation =CaBili stones |
|
|
Term
|
Definition
-2/2 hemolytic dz, cirrhosis, chronic TPN
-pathogenesis = inc bili, dec hepatic funct, bile stasis ==> CaBili stones |
|
|
Term
|
Definition
infxn = primary CBD stones
-MC asians,
- |
|
|
Term
| Pathogenesis of brown stones |
|
Definition
| E coli infxn -> production of B glucuronidase, which deonjigates bili ==> Ca Bilirubinate stones |
|
|
Term
| tx of primary duct stones? |
|
Definition
all need drainage procedure
-sphincteroplasty = 90% successful |
|
|
Term
| sensitivity of US for Gstones? |
|
Definition
|
|
Term
Most sensitive test for cholecystitis?
-interp? |
|
Definition
CCK-CS test Cholecystokinin Cholescintigraphy
-no GB visualization = chronic chole
- >60 min to empty? biliary dyskin
- EF<40? = dyskinesia |
|
|
Term
| indications for pre-chole ERCP? |
|
Definition
-AST/LT > 200 without gstone panc
-bili > 5 |
|
|
Term
| % pts undergoing chole that have retained CBD stone? |
|
Definition
| 1-2% (99% of these cleared with ERCP) |
|
|
Term
| MCC source of infected bile? |
|
Definition
dissemination from portal system
(NOT retrograde from oddi) |
|
|
Term
| MC pop for emphysematous chole? |
|
Definition
|
|
Term
| imaging for Gstone ileus? |
|
Definition
| plain film air in biliary system 2/2 duodL:GB fistula |
|
|
Term
| MC site of obstruction g-stone ileus? |
|
Definition
|
|
Term
| MC cause late post op CBD stricture? |
|
Definition
ischemia from lap chole
-others: chronic panc, GB CA, bile duct CA` |
|
|
Term
| Bile duct stricture w./out hx of iliary manipulation or pancreatitis? |
|
Definition
CA until proven otherwise
-get MRCP.. if no dx need ERCP |
|
|
Term
|
Definition
| if 2/2 ischemia/chronic panc--> choledocho-J |
|
|
Term
|
Definition
bile duct::Hepatic art fistula
MC 2/2 instrumentation > trauma |
|
|
Term
|
Definition
| UGI bleed, jaundice, RUQ pain |
|
|
Term
|
Definition
angiogram-->embolize
EGD with blood @ vater |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| liver(segments 4 and 5) and cystic duct nodes (right side) |
|
|
Term
|
Definition
|
|
Term
|
Definition
Porcelain GB
PSC
GB adenomas (esp w/PSC) |
|
|
Term
| surgical approach for GB CA? |
|
Definition
lap chole CONTRAINDICATED
-tumor seeding at port sites |
|
|
Term
| MC stage at presentation for GB CA? |
|
Definition
80% p/w stage 4
-20% resectable |
|
|
Term
|
Definition
|
|
Term
|
Definition
T1 = confined to mucosa, Lamina prop.
-->chole is sufficient |
|
|
Term
|
Definition
T2 = muscularis propria invasion
-tx = wedge seg 4 and 5 w/ 2-3 cm margin
AND lymphadenectomy @ portal triad nodes |
|
|
Term
|
Definition
T3 or T4 = beyond muscularis prop
-needs formal resection 4b, 5 (possible right hepatectomy) AND strip portal triads
-possible CBD rsnx with hepatico-J |
|
|
Term
| criteria for non-resectable GB CA? |
|
Definition
-LN spread beyond hepatoduod lig (celiac, SMA, para-aortic, IVC)
-main PV or PHA invasion/encasement
-direct invasion >2 extrahepatic organs/structures
-mets (including liver) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 5% (30% after resection with cure) |
|
|
Term
| malignant vs benign CBD stricture appearance? |
|
Definition
|
|
Term
| CBD stone removal options |
|
Definition
1. ERCP
2. PTC with stone forceps
3. Open choledocotomy
4. transduodenal incision, open sphincterotomy
5. choledocho-J or hepatico-J as last resort, oversew distal CBD |
|
|
Term
|
Definition
C sinensis infxn,
UC
Choledochal cysts
PSC
bile duct infection |
|
|
Term
|
Definition
early painlesss Jaundice
late weight loss, pruritis
-persistently elevated bili/alk Phos |
|
|
Term
|
Definition
upper 1/3 CholangioCA
= MC type, = worst prog |
|
|
Term
| tx of cholangio CA based on location? |
|
Definition
upper = klatskin = usually non-resectable
middle = hepatico J
lower = whipple |
|
|
Term
|
Definition
female, asian,
90% extrahepatic , 15% CA risk |
|
|
Term
| MC choledochal cyst type? |
|
Definition
| type 1 = fusiform/saccular dilation of extrahepatic ducts |
|
|
Term
| pathophys of choledochal cysts? |
|
Definition
| abn reflux of panc enzymes during uterine development |
|
|
Term
|
Definition
| cyst excision w/hepatico-J and cholecystectomy |
|
|
Term
| TYpe 4 vs 5 choledochal cyst definition? |
|
Definition
-partially intrahepatic
-totally intrahepatic (Caroli's disease)
==>tx with partial rsxn or liver txp |
|
|
Term
|
Definition
|
|
Term
|
Definition
| jaundice, pruitis, RUQ pain, weight loss |
|
|
Term
|
Definition
|
|
Term
|
Definition
portal HTN
hepatic failure 2/2 fibrosis of intra and extrahepatic ducts
--NOT improved with colonic rsxn for UC |
|
|
Term
|
Definition
long term...liver txp
cholestyramine vs pruritis
urso vs sxs |
|
|
Term
|
Definition
females,
medium sized hepatic ducts |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| charcot triad? Reynold pentad? |
|
Definition
RUQ pain, fever, jaundice
+ AMS and shock |
|
|
Term
| MCC Cholangitis organsim? |
|
Definition
|
|
Term
| MCC serious complication cholangitis? |
|
Definition
|
|
Term
|
Definition
emergent ERCP
PTC if fails |
|
|
Term
Shock after lap chole?
-early
-late |
|
Definition
-early (24 hrs)= hemorrhagic from clip fail
-late = septic shock 2/2 clip on CBD (average 7 day presentation) |
|
|
Term
|
Definition
cholecystectomy
= thick nodule of mucosa and muscle a/w rokitansky -Aschoff sinuses |
|
|
Term
| granular cell myoblastoma = |
|
Definition
benign neuroendocrine tumor of GB
-chole = tx |
|
|
Term
|
Definition
| speckled chol deposits on GB wall |
|
|
Term
|
Definition
if > 1 cm..w/u malignancy
-inc malig if pt > 60 yo, sessile, a/w PSC |
|
|
Term
|
Definition
bili bound to albumin
-18 day half life, takes longer to clear |
|
|
Term
|
Definition
CHD compression by ..
1. GB stone
2. GB inflammation that leads into cystic duct and then to CHD = stricture |
|
|
Term
|
Definition
|
|
Term
| indications for asymptomatic chole? |
|
Definition
liver txp
gastric bypass if pt has stones |
|
|
