17 - Gallbladder and Biliary Tree 2024 (Rush Surgery)

Deoxycholic acid

Cholic acid is converted by bacteria to what secondary bile acids?

Active transport in the ileum

Conjugated bile acids are primarily absorbed in the intestine by what mechanism?

Cholecystokinin (CCK)

_____ (hormone) stimulates gallbladder contraction

Brown pigment stones

What type of gallbladder stone is associated stasis and infection?

Black pigment stone

What type of gallbladder stone is associated with cirrhosis or hemolysis

1. Presence of hyperechoic intraluminal focus

2. Shadowing posterior to the focus

3. Movement of the focus changes in position to the patient

The 3 sonographic criteria for gallstones are:

1.

2.

3.

Observation

What is the appropriate treatment for asymptomatic gallstones?

1. clearance of tissue from the hepatocystic triangle

2. complete dissection of the bottom one-third of the cystic plate

3. two and only two structures are seen entering the gallbladder (cystic duct and artery)

What are the components of the critical view of safety? (3)

72 hours

According to the Tokyo Guidelines, cholecystectomy is recommended for mild (grade I) cholecystitis within ___ hours

3 months

In patients who have undergone emergent biliary draining and have gallstones, how long must the patient wait before they can undergo elective cholecystectomy?

Emergent cholecystectomy

Once gas is seen in gall bladder on imaging, do not perform any other unnecessary procedures as this can result in delays leading to adverse results

What is the treatment for emphysematous gallbladder disease?

Obstructive jaundice

What is the best indication to perform preoperative ERCP in a patient with gallstones?

E. coli and Klebsiella

What are the most common bacterial organisms found in bile? (2)

Hematogenous portal venous spread

Bacteria in this case comes from the liver

What is the most common mechanism by which bacteria end up in bile?

1. RUQ pain

2. Fever

3. Jaundice

Charcot's triad consists of:

1.

2.

3.

1. RUQ pain

2. Fever

3. Jaundice

4. Shock

4. Mental status changes

Reynold's pentad consists of:

1.

2.

3.

4.

5.

Cholecystoduodenal

Second most common is cholecystocolic

What is the most common type of biliary-enteric fistula?

Terminal ileum

Where is the most common site of obstruction in gallstone in gallstone ileus?

Liver transplant

What is the definitive treatment for sclerosing cholangitis?

None; cholecystectomy is sufficient

This is an early-stage T1a tumor that was found incidentally. The treatment is cholecystectomy alone because the tumor is limited to the lamina propria and the chance of lymph node disease is < 3%. Higher staging would require further surgery

After cholecystectomy, pathology report states there was a finding of carcinoma that invades but does not penetrate the lamina propria. What is the next best step in management?

10 mm

Symptomatic patients are also indicated to undergo surgery even if the polyp is < 10 mm

For polypoid lesions in the gallbladder measure ≥ __ mm, cholecystectomy is indicated due to the risk for malignancy