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13 Cards in this Set
- Front
- Back
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Gallstones 70% are _______ (mc), bilirubin and calcium
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cholesterol
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Cholesterol stones: hypercholesterolemia
Bilirubin stones: hemolytic disorders Calcium stones: ________ |
infection
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Asymptomatic Calcified or ________ Gallbladder assoc. 25% malignancy
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Asymptomatic Calcified or Porcelain Gallbladder assoc. 25% malignancy
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Diag of gall bladder probs
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Ultrasound: 95% stones, assess wall thickness and bile duct size
HIDA scan +/- CCK: function (>35% normal) and anatomy ERCP: anatomy/bx/stone extraction CT/MRI/MRCP OCG (rare) Serum Liver Function tests Abdominal Radiographs |
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Inflammation of GB
85% due to ____ |
stones
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Ascending Cholangitis: ________ triad > Fever, RUQ pain, Jaundice. _______ Pentad> + mental status change and hypotension
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Ascending Cholangitis: Charcot’s triad > Fever, RUQ pain, Jaundice. Reynolds Pentad> + mental status change and hypotension
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Gangrenous: ______ art. thrombosis
Perforation: Abscess Emphysematous: Gas in GB wall due to ________ Choledocholithiasis: Jaundice Biliary-Enteric Fistula: may cause bowel obx. |
Gangrenous: cystic art. thrombosis
Perforation: Abscess Emphysematous: Gas in GB wall due to bacteria Choledocholithiasis: Jaundice Biliary-Enteric Fistula: may cause bowel obx. |
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Procedure to remove GB
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Abd. CO2 insufflation
4 Ports Dissection near GB Triangle of Calot: Common Hepatic Duct, Cystic duct, Inferior Liver Edge +/- cholangiogram Clip cystic duct and artery Cauterize GB fossa Remove Gallbladder |
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Benign tumors of biliary tract
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Papilloma
Adenomyosis/Polyps Carcinoid Myxoma Fibrolipoma |
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Malignant Tumors Gallbladder
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Adenocarcinoma 80%
MC cancer of biliary tract Found in 1% of all biliary tract surgery 90% have cholelithiasis Metastasis to pancreas, dudodenal and choledochal lymph nodes Can directly invade liver: Independent mass on US/CT |
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Treatment of malig tumor of GB
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Cholecystectomy
Wedge Resection Lymphadenectomy |
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Types of Choledochal Cysts
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1: Fusiform
2: Diverticulum 3: Choledochocele involving duodenum 4: Cysts of intrahepatic bile ducts (Caroli’s dz) |
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Treatment for Choledochal Cysts
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Treatment: Excision due to risk of malignancy
Type 1: cholecystectomy, cyst exc., roux-en-Y Type 2: Excision of cyst diverticulum Type 3: cyst excision, choledochoduodenostomy or transduo-sphincteroplasty Type 4: Liver transplant |
