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nsmallwood
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boundaries of triangle of calot
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injury during lap chole can result in ischemia to segment VI and VII
aberrant post right hepatic
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lymphatics are found where in relation to the cbd
right side
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layers not present in gallbladder
submucosas and muscularis mucosa
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what are Rokitansky-aschoff sinuses
invagination of epithelium in to muscle layer secondary to increase intraluminal pressure
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bile concentrated in gallbladder by
active Na and water reabsorption
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ion not increased in bile concentration
chloride
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bile salt pool
6 gm and 6 cycles per day
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post prandial emptying of GB is maximal when
2 hours
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promote calcium nucleation
mucin glycoproteins
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black stones seen in
- hemolytic d/o
- liver disease -cirrhosis/tpn
- terminal ileum resection
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what is important for the development of black stones
- increased bilirubin load
- decreased hepatic function
- bile stasis
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parameters for chronic cholecystitis on HIDA
if the GB takes greater than 60 minutes to empty after a meal
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EF needed to diagnose biliary dyskinesia
<40%
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highest incidence of positive bile cultures seen with
post op strictures
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risk factors for malignacy in gallbladder polyps
- size >1cm
- age >60
- sessile polyps
- PSC
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cholo venous reflux occurs at what pressure
>20mmhg
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organisms seen in primary CBD
- E coli
- Clonorchis sinensis
- A lumbricoides
- T trichiura
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treatment of recurrent pyogenic cholangitis (oriental kind)
- ERCP with sphincterotomy and dilation but do not stent
- Eventually will need hepaticoJ
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which ducts can you ligate
any duct less than 2mm
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order of tests for post op N/V, sepsis, jaundice
- u/s
- drain fluid if present
- ERCP if bilious
- PTC if this doesnt work
- HIDA if small duct
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treatment for biliary leak post cholecystectomy
ercp sphincterotomy stent
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likely clip on CBD
if greater than 7 days decompress and wait 6-8 weeks
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ddx for jaundice
- cbd stones or stricture
- primary liver disease
- hemolysis
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tx of hemobilia
angioembolization
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what distinguishes a nonresectable biliary CA
- LN spread beyond hepatoduodenal ligament
- main portal vein or proper hepatic artery invasion
- direct invasion of stomach, colon, duodenum, abdominal wall
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what pts with cholangiocarcinoma are elligible for a transplant
unresectable <3cm and hilar
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surgery for IIa and great gallbladder cancer
- cholecystectomy
- formal resection of IVb and V
- stripping of portal triad
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