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