@ the duodenum near the opening of the minor pancreatic duct.
What comprises the major duodenal papilla?
combined opening of the minor pancreatic duct & the bile duct.
What does the feline bile duct join prior to entering the duodenum? What does this make them susceptible to?
major pancreatic duct makes them susceptible to ascending infection
Rupture of cholecystitis/cholangiohepatitis may result in _________ _________.
What is the medical txt for cholecystitis/cholangiohepatitis if there is no rupture?
treat for enteric organisms
What are the 4 m.c. enteric organisms?
E. coli Klebsiella Enterobacter Anaerobes
What is the sx txt for cholecysitis/cholangiohepatitis?
assess extrahepatic biliary tree cholecystectomy
What is the etiopathogenesis of a biliary mucocele?
unclear but could be d/t: hyperplasia of mucus-secreting cells & excessive mucus secretion OR alterations in gb motility OR accumulation of inspissated bile OR overdistension of gb can result in rupture may/may not have cholecystitis
Is overdistension of the gb grossly or histologically evident?
grossly ~50% of clinical cases histologically present in >70%
How do you manage a biliary mucocele?
can try med. mgt w/fluids & cholorectics.
If a biliary mucocele isn't septic, how is it managed?
cholecystectomy &/or Abx.
During a cholecystectomy for a biliary mucocele, what do you need to confirm?
patentcy of bile duct.
How do you treat a biliary mucocele if the gb wall is viable?
What is a laboratory result that may indicate rupture of a biliary mucocele?
increased venous lactate.
What are some biochemical abn. seen w/a biliary mucocele?
inreased: alk. phos. ALT GGT total bilirubin
What are the diagnostic procedures to determine presence of a biliary mucocele?
survey rads & U/S
What would you expect to see on U/S of a biliary mucocele?
enlarged gb w/immobile echogenic bile striated or stellate pattern ("Kiwi" sign)
What are the 5 possible causes of intraluminal biliary obstruction?
inflammatory dz choleliths/choledocholiths neoplasia inspissated bile parasites
What are the 2 possible causes of extraluminal biliary obstruction?
pancreatic dz duodenal dz
What are 3 possible causes of bile peritonitis?
trauma spontaneous rupture iatrogenic
What is the more common cause of bile peritonitis?
bile duct trauma
Spontaneous rupture of the _________ can cause bile peritonitis
What are the tools used to diagnose bile peritonitis
abd. effusion --> pos. if abd. fl >/=2X serum abdominocentesis: 4 quad tap U/S guided aspirate DPL
What is the most important prognostic factor in the mgmt of bile peritonitis?
Sterile bile vs. infected bile
What is sterile bile & what is the prog. for the pt. in this case?
sterile bile = chemical peritonitis usu. well tolerated prog. good if underlying cause eliminated
What is infected bile & what is the prog. for the pt. in this case?
infected bile = septic peritonitis porg. fuarded/poor morbidity & mortality are high
What are the 3 type of hepatic sx?
bx partial lobectomy complete lobectomy
What are the 3 biliary surgical methods?
cholecystotomy/cholecystectomy bile duct exploration/reconstruction biliary diversion