Term
|
Definition
| UGI bleeding (hematemesis), RUQ pain, and jaundice |
|
|
Term
| Underlying lesion of hemobilia |
|
Definition
| arterial psuedoaneurysm with connection to the biliary tree |
|
|
Term
| Proposed etiology of choledochal cysts |
|
Definition
| anamalous pacreaticobiliary duct jxn whereby there is a long course from the jxn to the ampula |
|
|
Term
| Most common type of choledochal cyst |
|
Definition
| Type I: fusiform dilation of the bile duct |
|
|
Term
| Main reason to treat and method of treatment of choledochal cysts |
|
Definition
| malignant degeneration and by a biliary enteric bypass |
|
|
Term
| Purpose of routine IOC and alternative |
|
Definition
| Prevent CBD transection and obtaining a clean critical view |
|
|
Term
| Management of small lateral CBD injury vs a transection |
|
Definition
Repair a small lateral injury by closing the dochotomy over a t-tube
Repair CBD transection with a biliary-enteric bypass either immediately (if recognized intra-op) or delayed; if delayed, must drain hepatic ducts. |
|
|
Term
|
Definition
1) actively absorbs Na and Cl; passively absorbs water
2) epithelial cells secrete mucus, glycoproteins and acidifies bile to make calcium salts more soluble
3) Stimulated to contract by vagal innervation |
|
|
Term
| 5 yr survival of gallbladder cancer |
|
Definition
|
|
Term
| Managment of gallbladder cancer |
|
Definition
# if in situ or T1 (not extending into perimuscular CT or invading the liver) and has negative margins: CCY alone
# if invades the peri-muscular CT or liver (T2-T4): radical CCY (IVb and V segmentectomies, hepatoduodenal lymphadenectomy |
|
|
Term
| Post-operative management of cholangiocarcinoma |
|
Definition
|
|
Term
| What is a Klatskin Tumor and various subtypes |
|
Definition
Perihilar cholangiocarcinomas
Type I: limited to the common hepatic duct
Type II: involve the bifurcation the R and L hepatic ducts
Type III: enter the secondary right (IIIa) or secondary left (IIIb) intrahepatic ducts |
|
|
Term
| Treatment for Klatskin Tumor |
|
Definition
Type I and II: resection of extrahepatic biliary tree, portal lympadenectomy and B/L hepatico-j's
Type III: lobectomy or hemi-hepatectomy to achieve negative margins
Distal CBD tumor: Whipple
Unresectable dz: 5FU +/- mitomycin C and doxorubicin |
|
|
Term
| Epidemiology of emphasemytous cholecystitis |
|
Definition
# Predominantly elderly diabetic men
# gangrene present in 75%
# perforation in 25% |
|
|
Term
| Bacteria involved in emphysematous cholecystitis |
|
Definition
Clostridia welchii
E. Coli
Enterococcus
Klebsiella |
|
|
Term
|
Definition
| Bile Salts- 80%; phospholipids-15%; and cholesterol- 5% |
|
|
Term
|
Definition
|
|
Term
| Management of fistula in gallstone ileus |
|
Definition
| takedown and repair in young and healthy; interval repair in elderly |
|
|
Term
| Aschoff-Rokitansky sinuses |
|
Definition
| THe sinuses created when, as a result of the atrophy of the mucosa in chronic cholecystitis, the mucosa potrude into the muscular coat creating the sinuses |
|
|
Term
| Pathophys of acalculus cholecystitis |
|
Definition
| Low flow state to the GB -> marked GB distension -> bile stasis 2/2 to lack of contraction (many pts on TPN); |
|
|
Term
| Signs of Acalculous Cholecystitis |
|
Definition
1. Fever
2. Leukocytosis
3. RUQ pain
4. elevated bili and alk phos
5. Thickened GB on US w/o stones
6. nonvisualization of the GB on HIDA |
|
|
Term
|
Definition
| Cholesterol or Pigment (Brown or Black) |
|
|
Term
| What are black gall stones and where do they form? |
|
Definition
| hemolytic disorder (hereditary spherocytosis and sickle cell) and in the GB |
|
|
Term
| What are brown gall stones and where to they form? |
|
Definition
| Associated with parasytic infections and bacteria in the bile; they are formed within the bile ducts |
|
|
Term
| Important risk factors for GB cancer |
|
Definition
1. Female gender (2-3x more common than males)
2. Native American
3. Large gall stones
4. Carcinogens: azotoluene, nitrosamines
5. Calcified GB: only in selective mucosal calcification |
|
|
Term
| Most common presentation of bile duct stricture |
|
Definition
|
|
Term
| Most common location of iatrogenic bile duct strictures |
|
Definition
| Common hepatic duct distal to the confluence of the R and L hepatic ducts |
|
|
Term
| Most common cause of benign bile duct strictures and mechanism of injury |
|
Definition
| Iatrogenic injury during CCY; aggressive dissection near CBD |
|
|
Term
| W/u for painless jaundice |
|
Definition
| LFTs, RUQ US (dilated ducts proximal to stricture), CT scan (for massses), ERCP with endoscopic ultrasound (brushings for cytology) |
|
|
Term
| Management of benign focal stricture of bile duct |
|
Definition
| Biliary-enteric bypass (more invasive) vs. stening (risk of obstructing) |
|
|
Term
| Types of choledochal cysts |
|
Definition
I: dilation of either the entire common hepatic duct and CBD or a segment
II: diverticula that project from the CBD wall
III: in the intraduodenal portion of the CBD
IVa: multiple dilations of intrahepatic and extrahepatic biliary tree
IVb: multiple dilations of only the extrahepatic duct
V: dilations of the intrahepatic biliary tree (Caroli Dz) |
|
|
Term
|
Definition
| Dilations of the intrahepatic biliary tree (type V choledochal cysts) |
|
|
Term
| Strawberry GB and management |
|
Definition
| Liver hypersecretion of cholesterol -> excessive accumulation of cholesterol esters with in the lamina propria of the GB -> phagocytosis by macrophages in the mucosa gives it strawberry-like appearance; no surgery necessary |
|
|
Term
| Adenomyomatosis and management |
|
Definition
| hypertrophic smooth muscle bundles and the in growth of the mucosal glands into the muscle layer; no surgery necessary |
|
|
Term
| Jaundice with absent urobilinogen in the urine |
|
Definition
|
|
Term
| Effect of biliary obstruction on stool |
|
Definition
| Less bilirubin enters urobilinogen is made, less stercobilin in made and stool appears pale |
|
|
Term
| Indications for pre-Whipple biliary drainage and stenting |
|
Definition
| Cholangitis or intractable pruritis |
|
|
Term
| Risks a/w pre-Whipple biliary drainage |
|
Definition
| Wound infection and pancreatic fistula |
|
|
Term
| Indications for CCY when polyp is found on US |
|
Definition
1. symtomatic polyp
2. polyp a/w gallstones
3. polyp > 10 mm
4. age older than 50 |
|
|
Term
| Types of polypoid lesions of the GB |
|
Definition
- pseudo polyps (cholesterol polyps, adenomyomatosic polyps, inflammatory) multiple, pedunculated and small (< 10mm) are benign
- Adenomas/adenocarcinomas (larger than 10 mm) |
|
|
Term
| Factors a/w with a higher conversion rate from lap to open |
|
Definition
| 1. ASA class 2. GB wall > 4mm 3. previous surgery 4.Advanced age 5. male gender |
|
|
Term
| Longer hepatic duct and one more likely to be dilated in presence of distal obstruction |
|
Definition
|
|
Term
| Percentage of people in which the CBD and pancreatic duct unite outside the duodenal wall and traverse the wall as one duct |
|
Definition
|
|
Term
| Source and location of CBD blood supply |
|
Definition
| Right hepatic and GDA; runs in the 3 and 9 o'clock positions |
|
|
Term
| Method of repair of a bile duct injury |
|
Definition
| If small and longitudinal injury in large CBD or hepatic duct -> primary repair over a t-tube; if transverse, RNY hepatico-jej; if distal CBD, can do choledochal duodenostomy |
|
|
Term
| Pathogenesis, natural hx and management of hydrops of the GB |
|
Definition
| a stone becomes impacted in cystic duct w/o acute chole, bile within GB is absorbed, but the GB epithelium continues to secrete mucus eventually leading to a GB distended with mucinous material (hydrops); possible GB wall edema and perforation; Cholecystectomy to avoid complications |
|
|
Term
| Percentage of gallstones that are pure cholesterol |
|
Definition
|
|
Term
| Percentage of gallstones that are radio-opaque |
|
Definition
|
|
Term
| Cause and source of pigment in pigment gallstones |
|
Definition
| Hemolysis which leads to a build up of calcium bilirubinate |
|
|
Term
| Difference b/w brown and black pigmented gallstones |
|
Definition
| Both are pigment stones but brown stones are a/w bacterial and parasytic infxs |
|
|
Term
Cholangiohepatitis AKA pyogenic cholangitis:
# presentation
# pathogenesis
# natural hx
# management |
|
Definition
# Fever + RUQ pain + jaundice + elevated WBC + ALP and tbili with dilated CBD, intrahepatic ducts, multiple strictures and stones on MRCP
# Bacteria deconjugate bilirubin in the biliary tree which precipitates as sludge which combines with dead bacteria to form brown stones; Stones usually harbor parasite egg (Clonorchis sinensis, Opisthorchis viverrini and Ascaris lumbricoides);
# Recurrent cholangitis, liver abscesses, structures, liver failure and increased risk of cancer
# ERCP + transhepatic cholangiography, eventually may need biliary-enteric bypass |
|
|
Term
| Benefit of early ( within 24 hrs of admission) vs. late lap chole |
|
Definition
Same conversion to open rates, same complication rate, bile duct injury rate, and mortality;
Early lap choles have shorter hospital stays |
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