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29 Cards in this Set
- Front
- Back
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What are spiral valves of Heister?
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Valves in Cystic Duct
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What is Triangle of Calot?
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Inferior Margin of Liver
-Common Hepatic Duct Medially Cystic Duct Laterally |
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Gallstones one X ray?
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Most are radiolucent
--wont see due to HIIGH cholesterol content |
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Who are at increased risk of gallstones, though may be ASx?
What is Hallmark Hx for Them |
women > men
Native Americans -Biliary Colic pain --severe RUQ to Back, 1-4 hours |
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Is biliary colic related to infection? What is?
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NO
Acute Cholecystitis --Fever, Chills, Anorexia - + Murphey Sign |
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What is Courvoisier's Law?
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Non tender palpable GB with Jaundice
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Why might Pancreatic Enzymes be involved in GB Stones
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Common Bile duct passes through the head of Pancreas
Look for Amylase and Lipase |
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What will be early yellow parts in hyperbilirubinemia and what levels do they need?
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Scleral Icterus - bil>3
Frenulum of tongue >1.5 (which is JUST above top value) |
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What is a HIDA Scan
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99m technetium labelled derivative of iminodiacetic acid.
sensitivity and specificity 90-97% Excreted by liver in bile GB fills = normal NOn filling support Cholecystitis Every GB should FILL uP when NOT Eating |
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What is a Direct injection of contrast agent into the ducts
What is an ERCP |
Percutaneous Transhepatic Cholangiogram (PTC)
Cannulate Sphincter of Oddi Cannot get past Vlaves of Heister -Can do Sphincterotomy, extract stones |
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What are the 4 Fs for?
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Acute Cholecystitis
-Cholesterol stones most frequent -IF Sx, preceded with Biliary Colic in 60% |
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What is term for Stones in Common Hepatic Duct
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Choledocholithiasis
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What is Charcot't triad ?
What does it indicate |
Acute Cholangitis
= Jaundice, RUQ Pain, Fever w/ Chills |
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What is diff btw Acute Cholangitis and Acute Supparative Cholangitis
IMPORTANT |
Acute has Charcot's triad- jaundice, RUQ pain, fever w/chills
Suppartive Cholangitis has Pus and Reynolds pentad-->hypotension, confusion + Charcot's triad |
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When One Large Gallstone erodes through the GB wall and goes into the Small Bowel?
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Gallstone Ileus
--size of Jawbreaker ---Rolles through the small bowel till it plugs Ileocecal valve = SBO |
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With Gallbladdar cancer, what is 5 year survival
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REally bad
-5 year survival is <5% Adenocarcinomas predominate |
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About location of Bile duct cancers
Presentation? |
2/3rds above junction of cystic and common hepatic duct
Will have jaundice |
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How are Proximal & Middle 1/3rd Tumors in Bile Duct treated?
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Roux-en-Y Hepatico- Jejunostomy
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How are Distal 1/3rd of Tumors in Bile Duct Treated?
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Whipples
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Dilations of Biliary Duct work
-usually congenital? |
Choledochal cysts
--presents in Late Teens, usually with Jaundice |
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What iare choledochal cysts?
Male vs. Female? Presents when? How? Treatment? Risks? |
Congenital enlargement
– Not really cysts • Females 4:1 ratio • Presents late teens – Usually with jaundice • Resection with Roux‐en‐Y hepaticojejunostomy • High rate of stricture and risk of cancer |
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What retroperitoneal organ has the Duct of Wirsung/ What is duct
WHat is Pancreatic Divisum? |
1. Main Duct of Pancreas is the Duct of Wirsung
2. State of Non fusion of dorsal ventral buds --No Main duct - So Duct of Santorini to minor ampulla into Duodenum |
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Causes of Acute Pancreatitis
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ETOH and Biliary Calculi
--85% of cases in USA |
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Signs of Acute Pancreatitis
MISSED SLIDE |
Non crampy epigastric pain
N&V Fever Tachy Like an internal BURN!! Hemorrahgic Pancreatis |
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A person with elevated Amylase what do you think about
(Hyperamylasemia) |
Perforated Bowel
Ischemic bowel Renal Failure Tumors Ectopic Pregger Ovarian Tumor |
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What is infundibulum in GB
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neck basically
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What is in this Triangle of Calot space that you may want to avoid cutting?
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Right Hepatic A. courses through
--you DON"T want to ligate this |
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What do pigment stones indicate?
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Hemolytic Dz or Cirrhosis
--brown or black |
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When do you operate on Acute Cholecystitis is ASx?
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IF Acute Cholecystitis AND Diabetic
(not sure if Acute Cholecystis can be ASx or if its Just GB Stones if ASx) |
