外科：一般外（gallbladder）

25 flashcards · Other · by Wanying Koh

1. Calot's triangle borders 1) 2) 3) contains what structure

   Borders 1) liver bed 2) cystic duct 3) common hepatic duct within which contains cystic a.

2. asymptomatic GB stones - surgical indication 1) 2)

   1) GB wall calcification (porcelain GB) - due to chronic inflammation 2) children

3. acute cholecystitis treatment 1) based on what guidelines

   based on Tokyo guidelines

4. Chacot's triad

   1) fever 2) jaundice 3) 右上腹痛

5. reasons for conversion from LC to open

   anatomy in doubt cholangiogram doesn‘t clearly define anatomy operation not progressing （anatomy 不清楚，手術沒進展) gangrene GB 不需要改成 open. LC 依然可以切

6. CBD stone discovered months after LC Dx?

   recurrent CBD stone *不是原發性CBD stone 膽道構造異常 膽汁滯留

7. Dx?

   Acute cholecystitis w GB stone

8. intrahepatic CBD stone 1) treatment 2) recurrent or not?

   1) PTCD --> surgical / ERCP removal of stone 2) may be recurrent so patients may require second surgery

9. what causes pain from gallstones

   gallstones block the outflow of bile, which causes the gallbladder to spasm

10. acalculous cholecystitis 1) prognosis 2) mechanism 3) etiology 4) tx 5) 多少 % of cholecystitis patients 6) more common in what patients (young/old? many/few comorbidities?)

    1) poor prognosis 2) 膽囊缺血、 膽汁滯留 3) 造成 shock, heart failure, low BP：trauma, burns, infection, major surgery 4) ABx, cholecystectomy, PTC drainage if not for OP 5) 2-15% 6) older, many comorbidities

11. gallstones occur more often in which gender

    females

12. choledochal cyst 典型症狀 (x3)

    可摸到右上腹腫塊 jaundice 腹痛

13. asymptomatic choledochal cyst: requires surgery?

    surgical removal of GB required possible premalignant change

14. which choledochal cyst type require liver transplantation

    Type IV, V intrahepatic cysts 要換肝

15. Bismuth classification vs Todani classifcation 個別 for what

    Bismuth - cholangioCa at proximal hepatic duct close to hilar: Klatskin tumor Todani - choledochal cyst

16. cholangioCa 分佈 intra-hepatic: extra-hepatic:

    intra-hepatic: 20% extra-hepatic: 80%

17. extra-hepatic cholangioCa most common symptom

    obstructive jaundice

18. treatment for various Bismuth types (Klatskin tumor) I & II: III: IV:

    I & II: enbloc resection of involved duct + hepatojejunostomy III: enbloc resection of involved duct + hepatojejunostomy + involved portion of liver (R or L) IV: not for OP

19. distal cholangioCa treatment

    pancreaticoduodenectomy (切除 pancreas & duodenum) + pancreaticojejunostomy + hepatojejunostomy + duodenojejunostomy (接 pancreas - jejunum, liver - jejunum, 胃處最後一點的 duodenum - jejunum)

20. risk factors of cholangioCa

    primary sclerosing cholangitis PSC recurrent pyogenic cholangitis choledochal cysts intrahepatic stones ulcerative colitis 中華肝吸蟲 NOT CBD stones - not risk factor

21. most common reason for hemobilia 膽道出血

    iatrogenic injury

22. acute mesenteric ischemia 典型症狀

    pneumatosis intestinalis + portal v. gas

23. hemobilia 膽道出血 treatment

    可以先試試 conservative tx - angiographic occlusion surgical ligation

24. GB absorbs or secretes HCO3- ?

    GB absorbs HCO3- from pancreatic bile (DOES NOT secrete HCO3-) then releases concentrated bile of pH 6.9 (lower pH than pancreatic/small intestine juice)

25. emphysematous cholecystitis