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13 Cards in this Set

  • Front
  • Back
Gallstones 70% are _______ (mc), bilirubin and calcium
cholesterol
Cholesterol stones: hypercholesterolemia
Bilirubin stones: hemolytic disorders
Calcium stones: ________
infection
Asymptomatic Calcified or ________ Gallbladder assoc. 25% malignancy
Asymptomatic Calcified or Porcelain Gallbladder assoc. 25% malignancy
Diag of gall bladder probs
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
Inflammation of GB
85% due to ____
stones
Ascending Cholangitis: ________ triad > Fever, RUQ pain, Jaundice. _______ Pentad> + mental status change and hypotension
Ascending Cholangitis: Charcot’s triad > Fever, RUQ pain, Jaundice. Reynolds Pentad> + mental status change and hypotension
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.
Procedure to remove GB
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
Benign tumors of biliary tract
Papilloma
Adenomyosis/Polyps
Carcinoid
Myxoma
Fibrolipoma
Malignant Tumors Gallbladder
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
Treatment of malig tumor of GB
Cholecystectomy
Wedge Resection
Lymphadenectomy
Types of Choledochal Cysts
1: Fusiform
2: Diverticulum
3: Choledochocele involving duodenum
4: Cysts of intrahepatic bile ducts (Caroli’s dz)
Treatment for Choledochal Cysts
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