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2011-12-17 14:45:55

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  1. boundaries of triangle of calot
    • cystic duct
    • CBD
    • Liver
  2. injury during lap chole can result in ischemia to segment VI and VII
    aberrant post right hepatic
  3. lymphatics are found where in relation to the cbd
    right side
  4. layers not present in gallbladder
    submucosas and muscularis mucosa
  5. what are Rokitansky-aschoff sinuses
    invagination of epithelium in to muscle layer secondary to increase intraluminal pressure
  6. bile concentrated in gallbladder by
    active Na and water reabsorption
  7. ion not increased in bile concentration
  8. bile salt pool
    6 gm and 6 cycles per day
  9. post prandial emptying of GB is maximal when
    2 hours
  10. promote calcium nucleation
    mucin glycoproteins
  11. black stones seen in
    • hemolytic d/o
    • liver disease -cirrhosis/tpn
    • terminal ileum resection
  12. what is important for the development of black stones
    • increased bilirubin load
    • decreased hepatic function
    • bile stasis
  13. parameters for chronic cholecystitis on HIDA
    if the GB takes greater than 60 minutes to empty after a meal
  14. EF needed to diagnose biliary dyskinesia
  15. highest incidence of positive bile cultures seen with
    post op strictures
  16. risk factors for malignacy in gallbladder polyps
    • size >1cm
    • age >60
    • sessile polyps
    • PSC
  17. charcots triad
    • ruq pain
    • fever
    • jaundice
  18. cholo venous reflux occurs at what pressure
  19. organisms seen in primary CBD
    • E coli
    • Clonorchis sinensis
    • A lumbricoides
    • T trichiura
  20. treatment of recurrent pyogenic cholangitis (oriental kind)
    • ERCP with sphincterotomy and dilation but do not stent
    • Eventually will need hepaticoJ
  21. which ducts can you ligate
    any duct less than 2mm
  22. 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
  23. treatment for biliary leak post cholecystectomy
    ercp sphincterotomy stent
  24. likely clip on CBD
    if greater than 7 days decompress and wait 6-8 weeks
  25. ddx for jaundice
    • cbd stones or stricture
    • primary liver disease
    • hemolysis
  26. tx of hemobilia
  27. 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
  28. what pts with cholangiocarcinoma are elligible for a transplant
    unresectable <3cm and hilar
  29. surgery for IIa and great gallbladder cancer
    • cholecystectomy
    • formal resection of IVb and V
    • stripping of portal triad