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Gastrointestinal and genitourinary systems
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
For each of the following questions, select the most appropriate answer from the above list of options. Each option may be used once, more than once or not at all. The pancreatic duct joins with which other structure to enter the duodenum at the ampulla of Vater?Which structure is found between the neck of the gall bladder and the cystic duct?The hepatic duct joins with which structure to form the common bile duct?Which structure is responsible for the formation of bile?The breakdown of which structure results in the formation of unconjugated bilirubin?
Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
The majority of cases of acute cholecystitis result from obstruction of the cystic duct by gallstones [2, 23]. Inflammation of the gallbladder results from three factors: Mechanical inflammation from increased intraluminal pressure, resulting in ischemia of the gallbladder wall and mucosa, chemical inflammation from release of tissue factors, and bacterial inflammation. Bacterial inflammation may play a role in 20% of all patients with acute cholecystitis [23]. Characteristic bacteria involved include Escherichia coli, Klebsiella, Streptococcus faecalis, Staphylococcus, and Clostridium [3, 23].
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The laparoscopic removal of a gallbladder involves the same basic principles as removing it with an open surgical procedure. A laparoscopic procedure involves injecting gas into the abdominal cavity. This creates a space between the lining of the abdomen and the guts allowing visualization of the gallbladder and its surrounding structures. After identifying the gallbladder dissection of the cystic duct and cystic artery takes place. Once these have been positively identified the cystic duct and cystic artery are ligated. Many surgeons apply clips to these structures, dividing between the first and second clip leaving two clips on the cystic artery and two clips on the cystic duct within the abdominal cavity. This reduces the risk of the clips dislodging and either bile leaking into the abdominal cavity or bleeding. Once the cystic duct and cystic artery are ligated the gallbladder can be detached from the liver bed by blunt dissection, often using diathermy.
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
Between January 2011 and December 2019, 249 consecutive patients underwent ETGBD for acute cholecystitis. Among them, seven were excluded because they underwent endoscopic transpapillary gallbladder aspiration without stent or drainage catheter placement. A total of 242 patients were enrolled in this study (Figure 1). The most common cystic duct directions and locations were the proximal branches in 187 patients, right branches in 169, and cranial branches in 231 (Table 1). Gallstones (83%) were the most common cause of cholecystitis. The stones were located in the cystic duct in 26 patients (11%) and gall bladder neck in 40 (17%). Mild cholecystitis was diagnosed in approximately half of the patients, moderate in 83 (34%), and severe in 40 (17%). In this study, 106 patients were administered antithrombotic agents including aspirin, cilostazol, ticlopidine, clopidogrel, prasugrel, sarpogrelate, icosapentate, warfarin, dabigatran, apixaban, and edoxaban.
Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study
Published in International Journal of Hyperthermia, 2022
Oriano Bottauscio, Irene Rubia-Rodríguez, Alessandro Arduino, Luca Zilberti, Mario Chiampi, Daniel Ortega
The bile duct is a tube that connects the gallbladder and the duodenum in the small intestine to transport there the bile, where it performs essential tasks for food digestion [11]. This tube is part of the biliary tree, which starts in the liver. The part of this tree that comes out from the gallbladder is called cystic duct which is joined along with the common hepatic duct into the common bile duct. This goes through the pancreas and joins with the pancreatic duct, ending up in the ampulla of Vater in the duodenum. It is very common to see that the tumor blocks this path in pancreatic ductal adenocarcinoma (PDAC) patients, avoiding the bile to reach the small intestine [12]. This is clinically shown as jaundice (yellow colored skin) due to the accumulation of bilirubin in the blood, which is a component of the bile.
Developments in the Diagnosis and Management of Cholecystoenteric Fistula
Published in Journal of Investigative Surgery, 2022
Ying-Yu Liu, Shi-Yuan Bi, Quan-Run He, Ying Fan, Shuo-Dong Wu
Studies have shown that the gallbladder inflammation caused by gallstones is the main cause of CEF. Acute cholecystitis with cystic duct obstruction can lead to adhesions between the gallbladder and adjacent visceral organs (small intestine, colon, stomach, etc.) where reduced adipose tissue is observed. Blocked bile excretion leads to cholestasis, increased pressure in the gallbladder, and repeated inflammation leads to gallbladder wall ulcers and ischemic gangrene, causing erosion and perforation and eventually resulting in fistula formation [4]. This was consistent with postoperative histopathological examinations, which often show gallbladder edema, severe inflammation, and dense adhesion of surrounding fibrous vessels. Previous abdominal surgery of iatrogenic trauma increases the risk of adhesion and inflammation of the gallbladder with surrounding tissue structures. In addition, the presence of other conditions such as tumors, ameba infection, peptic ulcer disease, and diverticulitis also increase the risk of CEF.