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  1. cystic veins drain into what
    right branch of portal vein
  2. artery found in 1% of population that supplies seg VI and VII and found in triangle of calot
    aberrant post right hepatic aa
  3. blood suppy to the CBD
    branches of right hepatic aa. and gastroduodenal at the 3 and 9 oclock position
  4. layers of gallbladder
    columnar mucosa/lamina propria, fibrous/muscular layer, perimuscular layer containing nerves and lymphatics, serosa on areas not touching liver
  5. change in bile post cholecystectomy
    decrease in total bile acid pools
  6. highest concentration of secretin and cck found where
  7. aberrant post right hepatic duct drains what segments and joins what. Ligation causes what
    VI, VII; joins seperately from right hepatic duct; atrophy of involved segments
  8. decreased bile acid excretion is caused by
    vip, somatostatin, symphathetic input
  9. electrolyte not increased in the process of gallbladder bile concentration
  10. amount of bile salt pool
    6 grams
  11. bile acid secretion stimulated by
    secretin, cck, gastrin
  12. amount of bile produced daily
    600 to 750ml
  13. bile flow increased by increasing the active secretion of
  14. pathogenesis of gallstone formation
    cholesterol supersaturation, crystal nucleation, gallbladder dysmotility, gallbladder absorption
  15. promotes calcium nucleation
    mucin glycoproteins
  16. three factors in formation of black stones
    increase unconjugated bilirubin, decreased hepatic function, stasis
  17. black stones in cirrhotics caused by
    decrease conjugation
  18. enzyme found in e coli associated with brown stones
    beta glucoronidase
  19. all pts found to have brown stones need
    drainage procedure i.e ercp with sphincteroplasty
  20. radiolabeled agent used in imino-diacetic acid scan
  21. ejection fraction after 1 hour compatible with biliary dyskinesia
  22. highest incidence of positive bile cultures seen in
    post op strictures
  23. benign neuroectoderm tumor of gallbladder
    granular cell tumor- need cholecystectomy
  24. septic shock 7 days post cholecystectomy
    clip on cbd causing cholangitis
  25. initial test for ruq pain, fever, jaundice
  26. systemic bacteremia in cholangitis caused by
    cholo-venous reflux (>20mmHg)
  27. organisms causing primary stones
    e coli, clonorchis sinensis, ascaria lumbricoides, trichomonis trichiuria
  28. treatment of cbd stone
    antimicrobrials, ercp with sphincterotomy but no stent ultimately may need bypass
  29. injury to what size aberrant right posterior duct requires hepatico-j
  30. management of post cholecystectomy n/v, jaundice, sepsis
  31. differentiation of retained stone vs primary stone
    retained is less than 2 years
  32. treatment for hemobilia
  33. what makes a Klatskin tumor unresectable
    mets (to other parts of liver), involvement of main portal vein, proper hepatic artery, other viscera, lymph nodes other than those in hepatoduodenal ligament
  34. mid bile duct obstruction without stones
    gallbladder cancer
  35. surgery for Stage I-b gallbladder ca
    2-3cm excision of seg IV and V with lymphadenectomy of cbd; T3 and T4 require resection of IVb and V
  36. chemo found to be effective in gallbladder cancer
    5-FU, mitomycin, doxorubicin
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