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29 Cards in this Set

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What are spiral valves of Heister?
Valves in Cystic Duct
What is Triangle of Calot?
Inferior Margin of Liver
-Common Hepatic Duct Medially
Cystic Duct Laterally
Gallstones one X ray?
Most are radiolucent
--wont see
due to HIIGH cholesterol content
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
Is biliary colic related to infection? What is?
NO

Acute Cholecystitis
--Fever, Chills, Anorexia
- + Murphey Sign
What is Courvoisier's Law?
Non tender palpable GB with Jaundice
Why might Pancreatic Enzymes be involved in GB Stones
Common Bile duct passes through the head of Pancreas

Look for Amylase and Lipase
What will be early yellow parts in hyperbilirubinemia and what levels do they need?
Scleral Icterus - bil>3

Frenulum of tongue >1.5 (which is JUST above top value)
What is a HIDA Scan
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
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
What are the 4 Fs for?
Acute Cholecystitis
-Cholesterol stones most frequent
-IF Sx, preceded with Biliary Colic in 60%
What is term for Stones in Common Hepatic Duct
Choledocholithiasis
What is Charcot't triad ?
What does it indicate
Acute Cholangitis
= Jaundice, RUQ Pain, Fever w/ Chills
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
When One Large Gallstone erodes through the GB wall and goes into the Small Bowel?
Gallstone Ileus
--size of Jawbreaker
---Rolles through the small bowel till it plugs Ileocecal valve = SBO
With Gallbladdar cancer, what is 5 year survival
REally bad
-5 year survival is <5%

Adenocarcinomas predominate
About location of Bile duct cancers
Presentation?
2/3rds above junction of cystic and common hepatic duct

Will have jaundice
How are Proximal & Middle 1/3rd Tumors in Bile Duct treated?
Roux-en-Y Hepatico- Jejunostomy
How are Distal 1/3rd of Tumors in Bile Duct Treated?
Whipples
Dilations of Biliary Duct work
-usually congenital?
Choledochal cysts
--presents in Late Teens, usually with Jaundice
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
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
Causes of Acute Pancreatitis
ETOH and Biliary Calculi
--85% of cases in USA
Signs of Acute Pancreatitis

MISSED SLIDE
Non crampy epigastric pain
N&V
Fever Tachy
Like an internal BURN!!
Hemorrahgic Pancreatis
A person with elevated Amylase what do you think about
(Hyperamylasemia)
Perforated Bowel
Ischemic bowel
Renal Failure
Tumors
Ectopic Pregger
Ovarian Tumor
What is infundibulum in GB
neck basically
What is in this Triangle of Calot space that you may want to avoid cutting?
Right Hepatic A. courses through
--you DON"T want to ligate this
What do pigment stones indicate?
Hemolytic Dz or Cirrhosis
--brown or black
When do you operate on Acute Cholecystitis is ASx?
IF Acute Cholecystitis AND Diabetic

(not sure if Acute Cholecystis can be ASx or if its Just GB Stones if ASx)