biliary.txt

The flashcards below were created by user nsmallwood on FreezingBlue Flashcards.

boundaries of triangle of calot
- cystic duct
- CBD
- Liver
injury during lap chole can result in ischemia to segment VI and VII

aberrant post right hepatic
lymphatics are found where in relation to the cbd

right side
layers not present in gallbladder

submucosas and muscularis mucosa
what are Rokitansky-aschoff sinuses

invagination of epithelium in to muscle layer secondary to increase intraluminal pressure
bile concentrated in gallbladder by

active Na and water reabsorption
ion not increased in bile concentration

chloride
bile salt pool

6 gm and 6 cycles per day
post prandial emptying of GB is maximal when

2 hours
promote calcium nucleation

mucin glycoproteins
black stones seen in
- hemolytic d/o
- liver disease -cirrhosis/tpn
- terminal ileum resection
what is important for the development of black stones
- increased bilirubin load
- decreased hepatic function
- bile stasis
parameters for chronic cholecystitis on HIDA

if the GB takes greater than 60 minutes to empty after a meal
EF needed to diagnose biliary dyskinesia

<40%
highest incidence of positive bile cultures seen with

post op strictures
risk factors for malignacy in gallbladder polyps
- size >1cm
- age >60
- sessile polyps
- PSC
charcots triad
- ruq pain
- fever
- jaundice
cholo venous reflux occurs at what pressure

>20mmhg
organisms seen in primary CBD
- E coli
- Clonorchis sinensis
- A lumbricoides
- T trichiura
treatment of recurrent pyogenic cholangitis (oriental kind)
- ERCP with sphincterotomy and dilation but do not stent
- Eventually will need hepaticoJ
which ducts can you ligate

any duct less than 2mm
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
treatment for biliary leak post cholecystectomy

ercp sphincterotomy stent
likely clip on CBD

if greater than 7 days decompress and wait 6-8 weeks
ddx for jaundice
- cbd stones or stricture
- primary liver disease
- hemolysis
tx of hemobilia

angioembolization
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
what pts with cholangiocarcinoma are elligible for a transplant

unresectable <3cm and hilar
surgery for IIa and great gallbladder cancer
- cholecystectomy
- formal resection of IVb and V
- stripping of portal triad

Author

nsmallwood

124199

Card Set

biliary.txt

Description

biliary

Updated

2011-12-17T19:45:55Z

Show Answers