ABSITE ch 32 biliary system.txt

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ABSITE ch 32 biliary system.txt
2010-01-02 12:52:39
biliary system

ABSITE ch 32 biliary
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  1. What artery does the cystic artery come off of?
    Right hepatic a.
  2. Triangle of Calot
    Cystic duct, CBD, liver edge
  3. Blood supply to CBD
    Right hepatic artery, GDA
  4. Parasympathetic innervation of gallbladder
    Vagus (anterior/left trunk)
  5. Sympathetic innervation of gallbladder
  6. Drug that contracts the sphincter of Oddi
  7. Drug that relaxes the sphincter of Oddi
  8. Normal CBD size
  9. Normal GB wall size
  10. Normal pancreatic duct size
  11. Invagination of epithelium of the wall of the GB formed from increased GB pressure
    Rokitansky-Aschoff sinuses
  12. Biliary ducts that go directly into the GB from the liver
    Ducts of Luschka
  13. Factors that increase bile excretion (3)
    CCK, secretin, vagal input
  14. Factors that decrease bile excretion (3)
    Somatostatin, VIP, sympathetic stimulation
  15. Essential functions of bile (3)
    Fat soluble vitamin absorption, bilirubin excretion, cholesterol excretion
  16. % of bile salts lost in stool
  17. Location of active resorption of conjugated bile salts (and proportion absorbed by this method)
    Terminal ileum (50%)
  18. Location of passive resorption of nonconjugated bile salts (and proportion absorbed by this method)
    Small intestine (45%) and colon (5%)
  19. Breakdown product of conjugated bilirubin in the gut; gives stool brown color
  20. Breakdown product of conjugated bilirubin in gut; yellow
  21. Enzyme that synthesizes cholesterol
    HMG coA reductase
  22. Cause of gallstones in obese people
    Overactive HMG coA reductase
  23. Cause of gallstones in thin people
    Underactive 7-alpha-hydroxylase
  24. Most common type of gallstone found on ultrasound
    Nonpigmented stones
  25. Gallstones caused by stasis, calcium nucleation by mucin glycoproteins, and increased water absorption from GB
    nonpigmented stones
  26. Most common type of gallstone worldwide (ex: US)
    Pigmented stones
  27. Gallstones caused by solubilization of unconj bili with precipitation of calcium
    Pigmented stones
  28. Gallstones caused by hemolytic disorders or cirrhosis, chronic TPN or ileal resection
    Black stones
  29. Type of stone primarily found in CBD
    Brown stones
  30. GB wall distension and inflammation caused by obstruction of cystic duct by stones
  31. Most common organisms in suppurative cholecystitis (3)
    E. coli, klebsiella, enterococcus
  32. Findings of acute cholecystitis (3)
    Gallstones, GB wall thickening, pericholecystic fluid
  33. If GB cannot be seen on HIDA, then . . .
    Cystic duct is probably obstructed; need cholecystectomy
  34. Impaired GB excretion despite adequate stimulation by CCK
    Biliary dyskinesia
  35. Indications for preop ERCP (6)
    Jaundice, cholangitis, pancreatitis, inc bilirubin, inc AST/ALT, CBD stone
  36. % of patients who have a retained stone after cholecystectomy
  37. Transient cystic duct obstruction caused by gallstone passage
    Biliary colic
  38. Causes of pneumobilia (3)
    Previous ERCP, cholangitis, erosion of biliary system into duodenum (gallstone ileus)
  39. Causes of acalculous cholecystitis (4)
    Severe burns, prolonged TPN, trauma, major surgery
  40. Gas in GB wall secondary to C. perfringens
    Emphasematous gallbladder disease
  41. Fistula between GB and duodenum causing SBO
    Gallstone ileus
  42. Treatment of CBD injury after lap chole
    Hepaticojejunostomy (if >50% circumference injury); primary repair (if <50% circumference)
  43. Treatment of bile leak
    ERCP/stent if small injury, hepaticojejunostomy if large injury
  44. Most important cause of late postoperative biliary strictures
  45. UGI bleed, jaundice, RUQ pain + Fistula between biliary system and hepatic artery
  46. Most common cancer of biliary tract
    GB adenocarcinoma
  47. Gallbladder type that increases risk of GB cancer
    Porcelain gallbladder
  48. Treatment of porcelain GB
  49. Treatment of stage I GB cancer
  50. Treatment of stage II GB cancer
    Cholecystectomy + segment IV and V resection + regional lymphadenectomy
  51. Risk factors for cholangiocarcinoma (7)
    C. sinesis infection, typhoid, PSC, UC, choledochal cyst, chronic bile duct infection, congenital hepatic fibrosis
  52. Cholangiocarcinoma in upper 1/3 of bile duct; usually unresectable
    Klatskin tumor
  53. Fusiform or saccular dilation of extrahepatic ducts
    Type I choledochal cyst
  54. Totally intrahepatic cystic disease of bile ducts
    Type V choledochal cyst (Karoli?s disease)
  55. Autoimmune disease with beading of bile ducts on ERCP; can lead to portal HTN and hepatic failure
  56. Drug to decrease pruritic symptoms in liver disease (2)
    Cholestyramine, urodeoxycholic acid (UDCA)
  57. Autoimmune disease caused by anti-mitochondrial antibodies that can lead to liver failure
  58. Charcots triad
    RUQ pain, fever, jaundice
  59. Reynold?s pentad
    Charcot?s triad + mental status changes and shock
  60. Most common organisms causing cholangitis
    E. coli, Klebsiella
  61. Late complications of cholangitis (2)
    Abscess, stricture
  62. Most common cause of shock after lap chole (2: early AND late)
    Hemorrhagic (from clip falling off) and septic (from CBD clip/cholangitis)
  63. Thickened nodule of mucosa and muscle associated with Rokitansky-Aschoff sinus
  64. Benign neuroectoderm tumor of GB
    Granular cell myoblastoma
  65. Speckled cholesterol deposits on GB wall
  66. Treatment of GB polyp
  67. Compression of common hepatic duct by a stone in the infundibulum of GB
    Mirizzi syndrome