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SB82 Biliary System

SB82 Biliary System - Loosely taken from Fiser's ABSITE review

QuestionAnswer
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
Created by: StudyBug82