Notes in Chapter_32:_Biliary_System

To Subscribe, use this Key

Status	Last Update	Fields
Published	07/07/2024	The gallbladder lies beneath liver segments {{c1::4}} and {{c1::5}}
Published	07/07/2024	The cystic artery is a branch of the {{c1::right hepatic}} artery
Published	07/07/2024	The {{c2::lateral}} border of the triangle of Calot is the {{c1::cystic duct}}
Published	07/07/2024	The {{c2::medial}} border of the triangle of Calot is the {{c1::common hepatic duct}}
Published	07/07/2024	The {{c2::superior}} border of the triangle of Calot is the {{c1::inferior liver surface}}
Published	07/07/2024	The hepatic and common bile ducts receive their blood supply from the {{c1::right hepatic}} artery (lateral) and the {{c1::gastroduodenal}} arter…
Published	07/07/2024	The cystic veins drain into the right branch of the {{c1::portal vein}}
Published	07/07/2024	Gallbladder lymphatics are located on the {{c1::right::right or left}} side of the common bile duct
Published	07/07/2024	The parasympathetic nerve supply to the gallbladder comes from the {{c1::left (anterior) trunk of the vagus nerve}}
Published	07/07/2024	The sympathetic nerve supply to the gallbladder comes from the {{c1::splanchnic}} and {{c1::celiac}} ganglions
Published	07/07/2024	The gallbladder does NOT have {{c2::submucosa}}; its mucosa is {{c1::columnar epithelium}}
Published	07/07/2024	Do the common bile duct or common hepatic duct undergo peristalsis?{{c1::No}}
Published	07/07/2024	The gallbladder is able to fill with bile due to contraction of {{c1::the sphincter of Oddi}}
Published	07/07/2024	Morphine causes the sphincter of Oddi to {{c1::contract}}
Published	07/07/2024	Glucagon causes the sphincter of Oddi to {{c1::relax}}
Published	07/07/2024	The common bile duct is normally less than {{c1::8}} mm wide
Published	07/07/2024	The common bile duct becomes {{c1::bigger}} after cholecystectomy(bigger or smaller)
Published	07/07/2024	The gallbladder wall is normally less than {{c1::4}} mm thick
Published	07/07/2024	The pancreatic duct is normally less than {{c1::4}} mm wide
Published	07/07/2024	Total bile salt pools {{c1::de}}crease after cholecystectomy
Published	07/07/2024	The highest concentration of CCK and secretin cells are located in the {{c1::duodenum}}
Published	07/07/2024	Epithelial invaginations in the gallbladder wall formed from increased gallbladder pressure are called {{c1::Rokitansky-Aschoff}} sinuses
Published	07/07/2024	Biliary ducts that lie in the gallbladder fossa are called {{c1::ducts of Luschka}}
Published	07/07/2024	CCK, secretin, and vagal input all cause {{c1::in}}creased bile excretion
Published	07/07/2024	Somatostatin and sympathetic stimulation cause {{c1::de}}creased bile excretion
Published	07/07/2024	The essential functions of bile are: - {{c1::Fat-soluble vitamin}} absorption - {{c2::Essential fat}} absorption - {{c3::Bilirubin}} an…
Published	07/07/2024	The gallbladder concentrates bile by {{c1::active}} resorption of NaCl and {{c1::passive}} resorption of water(active or passive)
Published	07/07/2024	Gallbladder emptying is at the maximum {{c1::2 hours::time}} after eating
Published	07/07/2024	Cholesterol is converted to bile salts via the enzyme {{c1::7-alpha-hydroxylase}}
Published	07/07/2024	Gallstones occur in {{c1::10}}% of the population
Published	07/07/2024	Most gallstones are radio-{{c1::lucent}}
Published	07/07/2024	Do dissolution agents (like monooctanoin) work on pigmented gallstones?{{c1::No}}
Published	07/07/2024	The three types of gallstones are:1) Nonpigmented (cholesterol) stones2) Pigmented stones3) {{c1::Brown}} stones
Published	07/07/2024	{{c1::Nonpigmented (cholesterol)}} and {{c1::black pigmented}} stones almost always form in the gallbladder
Published	07/07/2024	{{c1::Brown}} stones most commonly form in the bile ducts(cholesterol, pigmented, or brown)
Published	07/07/2024	Stones that form in the common bile duct are called {{c1::primary}} common bile duct stones
Published	07/07/2024	Stones that form in the gallbladder and then get stuck in the common bile duct are {{c1::secondary}} common bile duct stones
Published	07/07/2024	The treatment for primary common bile duct stones is {{c1::sphincteroplasty}}
Published	07/07/2024	Frank purulence in the gallbladder is known as {{c1::suppurative cholecystitis}}
Published	07/07/2024	The most common organisms in acute cholecystitis are:1) E. coli2) {{c1::Klebsiella}}3) {{c2::Enterococcus}}
Published	07/07/2024	Biliary dyskinesia is when the gallbladder's ejection fraction is less than {{c1::40}}%
Published	07/07/2024	Indications for an emergent ERCP are when there is concern for a(n) {{c1::common bile duct stone}}
Published	07/07/2024	Indications for a pre-op ERCP are persistently elevated {{c1::AST/ALT}} or {{c1::bilirubin}}
Published	07/07/2024	Cholecystitis in very ill patients can be treated with {{c1::cholecystostomy tube}}
Published	07/07/2024	The most common cause of air in the biliary system is {{c1::previous ERCP and sphincterotomy}}
Published	07/07/2024	Bacteria that infect the bile normally come from the {{c1::portal system}}
Published	07/07/2024	The highest incidence of positive bile cultures occurs with postoperative {{c1::strictures}}
Published	07/07/2024	Cholecystitis in pregnancy is treated with {{c1::NPO}} and {{c1::antibiotics (cefoxitin)}}
Published	07/07/2024	The primary pathology in acalculous cholecystitis is bile {{c1::stasis}} and increased {{c1::viscosity}}
Published	07/07/2024	Acalculous cholecystitis is treated with cholecystectomy or {{c1::percutaneous drainage}} if patient is too unstable
Published	07/07/2024	Emphysematous gallbladder is defined when there is gas in the {{c1::gallbladder wall}}
Published	07/07/2024	Emphysematous gallbladder disease has an increased incidence in diabetics and is usually caused by the bacteria {{c1::Clostridium perfringens}}
Published	07/07/2024	Emphysematous gallbladder disease is treated with emergent {{c1::cholecystectomy}}
Published	07/07/2024	Pneumobilia (air in the biliary system) is commonly seen in {{c1::gallstone}} ileus
Published	07/07/2024	Removal of the stone in gallstone ileus should be performed through an enterotomy {{c1::proximal}} to the site of obstruction(distal or proximal)
Published	07/07/2024	The most common cause for laparoscopic common bile duct injury is excess {{c1::cephalad}} retraction
Published	07/07/2024	If a CBD injury is detected intraoperatively, primary repair can be performed if < {{c1::50}}% of the circumference of the CBD is involved
Published	07/07/2024	In a CBD injury, do not try to attach the duct remnant to the {{c1::duodenum}} because it won't reach
Published	07/07/2024	The preferred imaging test for suspected CBD injury (nausea, vomiting, and jaundice post-op) is {{c1::ultrasound}}
Published	07/07/2024	If ultrasound confirms fluid collection in concern for CBD injury, the next best step is {{c1::percutaneous drain}}
Published	07/07/2024	If there is confirmed bilious fluid collecting in the abdomen from CBD injury, perform {{c1::ERCP}} with {{c1::sphincterotomy}} and {{c1::stenting}} i…
Published	07/07/2024	A completely transected common bile duct will show {{c1::dilated}} hepatic ducts on ultrasound {{c1::without::with or without}} fluid collection
Published	07/07/2024	The first step for a confirmed completely transected common bile duct is {{c1::percutaneous transhepatic cholangiography (PTC) tube}}
Published	07/07/2024	Sepsis after laparoscopic cholecystectomy is treated with {{c1::fluid resuscitation}}
Published	07/07/2024	Iatrogenic bile duct injuries are named based off the {{c1::Strasberg}} classification (A-E)
Published	07/07/2024	Strasberg type E classification of bile duct injuries is further stratified into 5 {{c1::Bismuth}} types
Published	07/07/2024	Injury to the cystic duct or from minor hepatic ducts draining the liver bed is Strasberg type {{c1::A}}
Published	07/07/2024	Occlusion of the biliary tree from injury to an aberrant right hepatic duct is Strasberg type {{c1::B}}
Published	07/07/2024	Transection with a leaking aberrant right hepatic duct is Strasberg type {{c1::C}}
Published	07/07/2024	Lateral injury to a major duct (like the CBD) is Strasberg type {{c1::D}}
Published	07/07/2024	Injury to the main hepatic duct is Strasberg type {{c1::E}}
Published	07/07/2024	Major hepatic duct injury more than 2 cm from the biliary confluence is Bismuth type {{c1::1 (E1)}}
Published	07/07/2024	Major hepatic duct injury less than 2 cm from the biliary confluence is Bismuth type {{c1::2 (E2)}}
Published	07/07/2024	Major hepatic duct injury at the intact biliary confluence is Bismuth type {{c1::3 (E3)}}
Published	07/07/2024	Major hepatic duct injury with destruction of the biliary confluence is Bismuth type {{c1::4 (E4)}}
Published	07/07/2024	Major hepatic duct injury with concomitant right aberrant hepatic duct injury is Bismuth type {{c1::5 (E5)}}
Published	07/07/2024	Bile duct strictures after laparoscopic cholecystectomy are most commonly caused by {{c1::ischemia}}
Published	07/07/2024	Bile duct strictures without history of surgery or pancreatitis is highly concerning for {{c1::cancer}}
Published	07/07/2024	Bile duct strictures are diagnosed with {{c1::MRCP}}
Published	07/07/2024	Bile duct strictures not due to cancer are treated with {{c1::choledochojejunostomy::procedure}}
Published	07/07/2024	Hemobilia (blood in the bile) is most commonly caused by a fistula between the bile duct and {{c1::hepatic arteries}}
Published	07/07/2024	Upper GI bleeding, jaundice, and RUQ pain is the classic presentation for {{c1::hemobilia}}
Published	07/07/2024	Hemobilia most commonly occurs after {{c2::percutaneous instrumentation}} or {{c1::trauma to the liver}}
Published	07/07/2024	Hemobilia is diagnosed with {{c2::angiogram}} or {{c1::EGD}}
Published	07/07/2024	Firstline treatment for hemobilia is {{c1::angioembolization}}
Published	07/07/2024	The most common cancer of the biliary tract is {{c1::gallbladder adenocarcinoma}}
Published	07/07/2024	The most common site of metastasis for gallbladder adenocarcinoma is the {{c1::liver}}
Published	07/07/2024	If no muscle is involved in gallbladder adenocarcinoma, treat with {{c1::cholecystectomy}}
Published	07/07/2024	If in muscle, but not beyond, gallbladder adenocarcinoma can be treated with {{c1::wedge}} resection of segments 4b and 5
Published	07/07/2024	If there is beyond muscle involvement in gallbladder adenocarcinoma, treat with {{c1::formal}} resection of segments 4b and 5
Published	07/07/2024	Can gallbladder cancer be approached laparoscopically?{{c1::No}}
Published	07/07/2024	The diagnostic imaging of choice for cholangiocarcinoma is {{c1::MRCP}}
Published	07/07/2024	A cholangiocarcinoma occuring at the biliary confluence is known as a {{c1::Klatskin}} tumor
Published	07/07/2024	Klatskin tumors are further stratified into the {{c1::Bismuth-Corlette}} classification of 1-4
Published	07/07/2024	Klatskin tumor below the confluence of the hepatic ducts is Bismuth-Corlette type {{c1::1}}
Published	07/07/2024	Klatskin tumor reaching the confluence of the hepatic ducts is Bismuth-Corlette type {{c1::2}}
Published	07/07/2024	Klatskin tumor occluding the common hepatic and right hepatic ducts is Bismuth-Corlette type {{c1::3a}}
Published	07/07/2024	Klatskin tumor occluding the common hepatic and left hepatic ducts is Bismuth-Corlette type {{c1::3b}}
Published	07/07/2024	Klatskin tumor that involves the confluence and both the right and left hepatic ducts is Bismuth-Corlette type {{c1::4}}
Published	07/07/2024	Klatskin tumor that has multiple foci of involvement is Bismuth-Corlette type {{c1::4}}
Published	07/07/2024	Klatskin tumors respond poorly to treatment, but {{c1::hepatic}} resection can be attempted
Published	07/07/2024	Cholangiocarcinoma involving the lower portion of the bile tract (near the pancreas) can be treated with {{c1::Whipple procedure}}
Published	07/07/2024	Unresectable cholangiocarcinoma is treated with palliative {{c1::stenting}}
Published	07/07/2024	Cholangiocarcinoma has a {{c1::higher}} 5-year survival rate than gallbladder adenocarcinoma(higher or lower)
Published	07/07/2024	Gallbladder adenocarcinoma first spreads to the cystic duct nodes, also known as {{c1::Calot's}} node
Published	07/07/2024	Choledochal cysts are caused by abnormal reflux of {{c1::pancreatic}} enzymes during uterine development
Published	07/07/2024	Biliary cysts characterized by cystic or fusiform dilation of the common bile duct is type {{c1::1}}
Published	07/07/2024	Biliary cysts characterized as true diverticula of the extrahepatic bile ducts are type {{c1::2}}
Published	07/07/2024	Biliary cysts chacterized by cystic dilations limited to the intraduodenal portion of the distal common bile duct are type {{c1::3}}
Published	07/07/2024	Biliary cysts characterized by the presence of multiple cysts that must include extrahepatic cysts are type {{c1::4}}
Published	07/07/2024	Biliary cysts that are characterized by one or more cystic dilations of the intrahepatic ducts, without extrahepatic duct disease are type {…
Published	07/07/2024	The presence of multiple type 5 (intrahepatic) biliary cysts is known as {{c1::Caroli}} disease
Published	07/07/2024	Biliary cysts characterized by isolated cystic dilations of the cystic duct are type {{c1::6}}
Published	07/07/2024	The long term treatment for PSC is {{c1::liver transplant}}
Published	07/07/2024	PSC is treated medically with {{c2::cholestyramine}} and {{c1::ursodeoxycholic acid}}
Published	07/07/2024	Long term treatment for PBC is {{c1::liver transplant}}
Published	07/07/2024	Cholangitis is usually caused by an obstructing gallstone, but can also be caused by iatrogenic {{c1::tubing}}
Published	07/07/2024	The most common organisms causing cholangitis are E. coli (#1) and {{c1::Klebsiella}}
Published	07/07/2024	The initial treatment of cholangitis is {{c1::fluids}} and {{c1::antibiotics}}
Published	07/07/2024	After resuscitation, cholangitis is treated with emergent {{c1::ERCP}}
Published	07/07/2024	{{c2::Early (first 24 hours)}} shock after laparoscopic cholecystectomy is likely due to {{c1::hemorrhage}}
Published	07/07/2024	{{c2::Late (after first 24 hours)}} shock after laparoscopic cholecystectomy is caused by {{c1::sepsis}}
Published	07/07/2024	A thickened nodule of mucosa and muscle associated with Rokitansky-Aschoff sinus is known as {{c1::adenomyomatosis}}
Published	07/07/2024	A benign neuroectoderm tumor of the gallbladder is a(n) {{c1::granular cell myoblastoma}}
Published	07/07/2024	Speckled cholesterol deposits on the gallbladder wall is known as {{c1::cholesterolosis}}
Published	07/07/2024	Gallbladder polyps greater than {{c1::1}} cm in size are concerning for malignancy
Published	07/07/2024	Bilirubin that becomes covalently and irreversibly bound to albumin is known as {{c1::delta bilirubin}}
Published	07/07/2024	Compression of the common hepatic duct by a stone in the gallbladder infundibulum is known as {{c1::Mirizzi}} syndrome and is treated with {{c2::…
Published	07/07/2024	An antibiotic that can cause gallbladder sludging and cholestatic jaundice is {{c1::ceftriaxone}}
Published	07/07/2024	Asymptomatic cholecystectomy may be indicated in patients undergoing {{c1::liver transplant}} or gastric bypass if stones are present
Published	07/07/2024	{{c1::Lemmel}} syndrome is characterized by obstructive jaundice caused by a peri{{c2::ampullary}} duodenal {{c3::diverticulum}}&n…
Published	07/07/2024	{{c2::Rigler's}} triad is seen in {{c1::gallstone ileus}}:1) {{c5::Small bowel obstruction}}2) {{c4::Gallstone outside gallbladder}}3) {{c3::Air in th…
Published	07/07/2024	Gallbladder cancer stage T{{c1::1a}} involves gallbladder {{c2::mucosal connective tissue}} only
Published	07/07/2024	Gallbladder cancer stage T{{c2::1b}} involves the gallbladder {{c1::muscularis}} layer
Published	07/07/2024	Gallbladder cancer stage T{{c1::2}} involves invasion of {{c2::connective tissue}} below the {{c2::muscularis}} layer
Published	07/07/2024	Gallbladder cancer stage T{{c2::3}} involves {{c1::invasion of local organs (e.g liver)}}
Published	07/07/2024	Gallbladder cancer stage T{{c2::1a}} is treated with {{c1::simple cholecystectomy}}
Published	07/07/2024	Gallbladder cancer stage T{{c2::1b}} is treated with {{c1::cholecystectomy and wedge resection of hepatic lobes 4 and 5}}
Published	07/07/2024	Gallbladder cancer stage T{{c2::3}} is treated with {{c1::cholecystectomy and formal resection of hepatic lobes 4 and 5}}
Published	07/07/2024	{{c1::Gastric gallstone ileus}} is called {{c2::Bouveret's}} syndrome
Published	07/07/2024	A type {{c2::1}} choledochal cyst is repaired with a {{c1::hepaticojejunostomy}}
Published	07/07/2024	A type {{c2::2}} coledochal cyst is repaired via {{c1::simple excision}}
Published	07/07/2024	A type {{c2::3}} choledochal cyst is repaired via {{c1::Whipple procedure}}
Published	07/07/2024	A type {{c2::4}} choledochal cyst is repaired via {{c1::hepaticojejunostomy and resection of affected liver lobes}}
Published	07/07/2024	A type {{c2::5}} choledochal cyst is repaired via {{c1::liver transplant}}
Published	07/07/2024	The management of a common bile duct injury that happened >{{c2::7}} days post-op involves {{c1::waiting 6-8 weeks and doing hepaticojejunostomy}}
Published	07/07/2024	The preferred antibiotic for 3rd trimester cholecystitis is {{c1::cefoxitin}}
Published	07/07/2024	{{c1::Portal venous air::pneumobilia or portal gas}}
Published	07/07/2024	{{c2::Portal venous air::portal air or pneumobilia}} is usually located {{c1::peripherally::centrally or peripherally}} in the liver
Published	07/07/2024	{{c2::Pneumobilia::portal air or pneumobilia}} is usually located {{c1::centrally::centrally or peripherally}} in the liver
Published	07/07/2024	{{c1::Pneumobilia::portal air or pneumobilia}}
Published	07/07/2024	The most common causes of portal venous air include ischemic bowel, {{c1::inflammatory bowel disease}}{{c2::perforated ulcer}}, and necrotic {{c3…
Published	07/07/2024	Bile duct injury associated with excessive {{c2::cephalad}} retraction is known as a(n) "{{c1::tenting}} injury"
Published	07/07/2024	Post-cholecystectomy x-ray showing {{c1::dropped gallstones}}
Published	07/07/2024	Right upper quadrant pain, fever, and jaundice is known as {{c1::Charcot's}} triad
Published	07/07/2024	Charcot's triad plus mental status changes and shock is known as {{c1::Reynolds'}} pentad
Status	Last Update	Fields