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SB82 Biliary System
SB82 Biliary System - Loosely taken from Fiser's ABSITE review
| Question | Answer |
|---|---|
| What substance contracts the sphincter of Oddi? ________ | Morphine |
| What substance relaxes the sphincter of Oddi? ________ | Glucagon |
| What is the normal diameter of the CBD? | < 4 mm |
| What happens to the total bile acid pools after cholecystectomy? | Decreases |
| This phenomenon is caused by increased gallbladder pressure, and is manifested by invagination of the gallbladder epithelium into the muscle layer _________________ | Rokitansky-Aschoff sinuses |
| These ducts can leak after cholecystectomy ____________ | Ducts of Luschka |
| Which substances increase bile excretion? (5) | CCK, amino acids, HCl, fatty acids, secretin |
| Which substances decrease bile excretion? (2) | VIP, somatostatin |
| Is bile acidic, neutral or alkaline? __________ | Alkaline |
| How does increased protein in the diet affect bile? | It increases intraluminal acidity, which helps keep calcium in the bile soluble and less likely to form stones |
| What hormone is involved in tonic gallbladder contraction? ___________ | CCK |
| What hormone is involved in the Phase II migrating motor complex that assists gallbladder contraction? ___________ | Motilin |
| The gallbladder forms concentrated bile by active absorption of what two substances? ____________ | Sodium and water |
| Where does active resorption of conjugated bile acids occur? __________ | Terminal ileum |
| Where does passive resorption of unconjugated bile acids occur? _________ | Small intestine (45%) and colon (5%) |
| What is the rate-limiting enzyme in cholesterol synthesis? _____________ | HMG Co-A reductase |
| E. coli produces the ______________ enzyme, which deconjugates bilirubin, forming calcium bilirubinate and ultimately the formation of brown gallstones. | beta-glucuronidase |
| An impacted gallstone without cholecystitis causes gallbladder distension and formation of white mucus. This condition is called ________________ | Hydrops of the gallbladder |
| What substances mediate the inflammation in cholecystitis? (3) | Lysolecithin, PAF, bile salts |
| What is the treatment for cystic duct stump leak? | Percutaneous drainage, followed by ERCP with stent |
| What bacterium is the most common culprit in emphysematous gallbladder disease? _________________ | Clostridium perfringens |
| If the damage to the CBD is < ________ % of the diameter, it can be primarily repaired. | Fifty |
| What is the most common site of obstruction in gallstone ileus? _______________ | Terminal ileum |
| What is the treatment for gallstone ileus? | Proximal enterotomy with stone removal, then cholecystectomy if tolerated |
| What radiographic finding do you see with gallstone ileus? ___________ | Pneumobilia |
| What is the most common cause of late post-op biliary strictures? __________ | Ischemia |
| What is the treatment of biliary strictures? If that fails? | ERCP with stent, then PTC if needed |
| Late CBD or hepatic duct strictures need brushings to test for ______________ | Cancer |
| Cholecystectomy is sufficient to treat gallbladder cancer stage ____________ | One |
| Stage II gallbladder cancer needs wide liver resection with margins of _________ cm | 2-3 |
| Klatskin tumors are usually _______________ (resectable / unresectable) | Unresectable |
| Bile duct cancers in the middle 1/3 require this operation: ___________ | Hepaticojejunostomy |
| Bile duct cancers in the inferior 1/3 require this operation: ___________ | Pancreaticoduodenectomy |
| Which type of choledochal cyst is fusiform and is the most common? _________ | Type I |
| Which type of choledochal cyst manifests as a CBD diverticulum? _______ | Type II |
| Which type of choledochal cyst manifests as a CBD dilation within the duodenum? _________ | Type III |
| Which type of choledochal cyst has intrahepatic and extrahepatic components? ___________ | Type IV |
| Which type of choledochal cyst is entirely intrahepatic? _____________ | Type V (Caroli’s disease) |
| Treatment for choledochal cysts types I and II | Excision and roux-en-Y hepaticojejunostomy |
| Treatment for choledochal cyst Type III | Transduodenal marsupialization and excision |
| Treatment for choledochal cyst Type IV and V | Segmental liver resection |
| This bile duct disease shows antimitochondrial antibodies and has no uncreased risk of cancer ___________ | Primary biliary cirrhosis |
| This biliary pathology is associated with ulcerative colitis and has beading on ERCP __________ | Primary sclerosing cholangitis |
| PSC improves after colectomy for ulcerative colitis: True or false | False |
| This is a term for a thickened nodule of mucosa and muscle associated with Rokitansky-Aschoff sinuses, and is often due to chronic cholecystitis __________ | Adenomyomatosis |
| This benign neuroectodermal tumor of the gallbladder can occur in the biliary tract and show symptoms of cholecystitis _________ | Granular cell myoblastoma |
| Speckled deposits of cholesterol on the gallbladder wall ______________ | Cholesterolosis |
| Gallbladder polyps > ________ cm in size are concerning for malignancy | One |
| This cephalosporin can cause gallbladder sludging and cholestatic jaundice __________ | Ceftriaxone |
| What trimester should a pregnant patient with symptomatic cholelithiasis have a cholecystectomy? ____________ | Second |
| This syndrome is caused by compression of the common hepatic duct by a stone in the gallbladder infundibulum ______________ | Mirizzi syndrome |
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StudyBug82
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