Calot's Node
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Calot's Node
The cystic node (also known as the cystic lymph node, cystic lymph node of Lund, Lund's node, or Mascagni's lymph node and often erroneously referred to as Calot's node) is the sentinel lymph node of the gall bladder. It is located within the cystohepatic triangle (Calot's triangle). Structure The cystic lymph node is situated at the neck of the gallbladder. It is invariably situated lateral to the biliary tree. The node receives lymphatic drainage from the gallbladder, cystic duct, hepatic duct, and the superior portion of the common bile duct. It in turn drains lymph into the hepatic lymph nodes. Clinical significance It increases in size in cholecystitis and cholangitis; it becomes enlarged in most cases of acute cholecystitis which serendipitously also makes it easier to identify in case of subsequent surgery. It is an anatomic landmark and may be removed along with the gallbladder in cholecystectomy. The node can be used as a landmark to prevend iatrogenic injury du ...
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Sentinel Lymph Node
The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor. The sentinel node procedure (also termed sentinel lymph node biopsy or SLNB) is the identification, removal and analysis of the sentinel lymph nodes of a particular tumour. Physiology The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on, since the flow of lymph is directional, meaning that some cancers spread in a predictable fashion from where the cancer started. In these cases, if the cancer spreads it will spread first to lymph nodes (lymph glands) close to the tumor before it spreads to other parts of the body. The concept of sentinel lymph node surgery is to determine if the cancer has sprea ...
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Gallbladder
In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although the structure and position of the gallbladder can vary significantly among animal species. It receives and stores bile, produced by the liver, via the common hepatic duct, and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats. The gallbladder can be affected by gallstones, formed by material that cannot be dissolved – usually cholesterol or bilirubin, a product of haemoglobin breakdown. These may cause significant pain, particularly in the upper-right corner of the abdomen, and are often treated with removal of the gallbladder (called a cholecystectomy). Cholecystitis, inflammation of the gallbladder, has a wide range of causes, including result from the impaction of gallstones, inf ...
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Cystohepatic Triangle
The cystohepatic triangle (or hepatobiliary triangle) is an anatomic space bordered by the cystic duct inferiorly, the common hepatic duct medially, and the inferior surface of the liver superiorly. The cystic artery lies within the hepatobiliary triangle, which is used to locate it during a laparoscopic cholecystectomy. Structure The hepatobiliary triangle is the area bound by the: * cystic duct inferiorly. * common hepatic duct medially. * inferior margin of the liver superiorly.Schwartz's Manual of Surgery BRUNICARDI C.F 10th edition It is covered in peritoneum both anteriorly and posteriorly. It contains the cystic artery and cystic lymph nodes. The right hepatic artery may also pass through the hepatobiliary triangle. Clinical significance General surgeons frequently quiz medical students on this term and the name for the lymph node located within the triangle, Mascagni's lymph node or Lund's node, however many often erroneously refer to it as "Calot's node". The latter ...
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Biliary Tree
The biliary tract, (biliary tree or biliary system) refers to the liver, gallbladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Some components are synthesized by hepatocytes (liver cells), the rest are extracted from the blood by the liver. Bile is secreted by the liver into small ducts that join to form the common hepatic duct. Between meals, secreted bile is stored in the gallbladder. During a meal, the bile is secreted into the duodenum (part of the small intestine) to rid the body of waste stored in the bile as well as aid in the absorption of dietary fats and oils. Structure The biliary tract refers to the path by which bile is secreted by the liver then transported to the duodenum, the first part of the small intestine. A structure common to most members of the mammal family, the biliary tract is often referred to as a tree because ...
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Hepatic Lymph Nodes
The hepatic lymph nodes consist of the following groups: * (a) hepatic, on the stem of the hepatic artery, and extending upward along the common bile duct, between the two layers of the lesser omentum, as far as the porta hepatis; the cystic gland, a member of this group, is placed near the neck of the gall-bladder; * (b) subpyloric, four or five in number, in close relation to the bifurcation of the gastroduodenal artery, in the angle between the superior and descending parts of the duodenum; an outlying member of this group is sometimes found above the duodenum on the right gastric (pyloric) artery. The lymph nodes of the hepatic chain receive Afferent lymphatics, afferents from the stomach, duodenum, liver, gall-bladder, and pancreas; their Efferent lymphatics, efferents join the celiac group of preaortic lymph nodes. Cancer prognosis and treatment Hepatic artery lymph nodes are commonly Resection (surgery), resected during a Whipple procedure. In a Whipple procedure, outcom ...
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Cholecystitis
Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct. More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone. Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss. Occasionally, acute cholecystitis occurs as a result of vasculitis or chemotherapy, or during recovery from major trauma or burns. Cholecystitis is suspected based on symptoms and laboratory testing. Abdom ...
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Acute Cholecystitis
Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct. More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone. Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss. Occasionally, acute cholecystitis occurs as a result of vasculitis or chemotherapy, or during recovery from major trauma or burns. Cholecystitis is suspected based on symptoms and laboratory testing. Abdom ...
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Cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, or via an open surgical technique. The surgery is usually successful in relieving symptoms, but up to 10 percent of people may continue to experience similar symptoms after cholecystectomy, a condition called postcholecystectomy syndrome. Complications of cholecystectomy include bile duct injury, wound infection, bleeding, retained gallstones, abscess formation and stenosis (narrowing) of the bile duct. Medical use Pain and complications caused by gallstones are the most common reasons for removal of the gallbladder. The gallbladder can also be removed in order to treat biliary dyskinesia or gallbladder cancer. Gallstones are very common but ...
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Iatrogenic Injury
A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment. Definitions The word ''error'' in medicine is used as a label for nearly all of the clinical incidents that harm patients. Medical errors are often described as human errors in healthcare. Whether the label is a medical error or human error, one definition used in medicine says that it occurs when a healthcare provider chooses an inappropriate method of care, improperly executes an appropriate method of care, or reads the wrong CT scan. It has been said that the definition should be the subject of more debate. For instance, studies of hand hygiene compliance of physicians in an ICU show that compliance varied from 19% to 85%. The deaths that result from infections caught as a result of treatment providers ...
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Porta Hepatis
The porta hepatis or transverse fissure of the liver is a short but deep fissure, about 5 cm long, extending transversely beneath the left portion of the right lobe of the liver, nearer its posterior surface than its anterior border. It joins nearly at right angles with the left sagittal fossa, and separates the quadrate lobe in front from the caudate lobe and process behind. Function It transmits the following (in anterior to posterior order): * common hepatic duct (leaving) * proper hepatic artery (entering) * hepatic portal vein (entering) The hepatic duct lies in front and to the right, the hepatic artery to the left, and the portal vein behind and between the duct and artery. It also transmits nerves and lymphatics. * Sympathetic nerves - these provide afferent pain impulses from the liver and gall bladder to the brain. Pain may be referred to the lower pole of the right scapula (T7). * Hepatic branch of the vagus nerve (CN X). Location The porta hepatis runs in t ...
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Cystic Artery
The cystic artery (also known as bachelor artery) supplies oxygenated blood to the gallbladder and cystic duct. Most common arrangement In the classic arrangement, occurring with a frequency of approximately 70%, a singular cystic artery originates from the geniculate flexure of the right hepatic artery in the upper portion of the hepatobiliary triangle. A site of origin from a more proximal or distal portion of the right hepatic artery is also considered relatively normal. After separating from the right hepatic artery, the cystic artery travels superiorly to the cystic duct and produces 2 to 4 minor branches, known as ''Calot’s arteries'', that supply part of the cystic duct and cervix of the gallbladder before dividing into the major superficial and deep branches at the superior aspect of the gallbladder neck: * The ''superficial branch'' (or ''anterior branch'') passes subserously over the left aspect of the gallbladder. * The ''deep branch'' (or ''posterior branch'') runs b ...
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