Biliary Surgery Overview

Biliary Anatomy

• Includes the liver, gallbladder, pancreas, spleen, and biliary ductal system.
• Triangle of Calot: crucial landmark for cholecystectomy, consisting of the common hepatic duct, cystic duct, and cystic artery.
• Common hepatic duct: junction of left and right biliary ducts; receives blood from the cystic artery (branch of the hepatic artery).
• Sphincter of Oddi: regulates bile and pancreatic duct flow into the duodenum.

Gallbladder

• Positioned behind the liver, it concentrates and stores bile with a capacity of 40 to 70 mL.
• Bile secretion aids digestion in the duodenum, supplied by the cystic artery.

Perioperative Nursing Considerations

• General anesthetic utilized during surgeries.
• Patients positioned supine for procedures.
• Scrub nurses play a critical role in blood loss prevention, including surgical counts.

Surgical Interventions

• Cholecystectomy: gallbladder removal due to chronic inflammation or cholelithiasis, predominantly performed laparoscopically.
• Other biliary surgeries include endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment of biliary tract issues.
• Spleen and liver surgeries involve splenectomy and hepatic resection or transplant procedures.

ERCP Procedure

• Endoscopic approach to diagnose biliary tract problems; X-ray and catheter used to visualize the biliary tree.
• Contrast dye highlights blockages, such as stones leading to choledocholithotomy for stone removal.

Pancreas Overview

• Exocrine function involves secretion of pancreatic enzymes; endocrine function involves insulin and glucagon secretion.
• Location: behind the stomach, approximately 25 cm long, supplied by celiac axis and SMA.

Pancreatic Cancer

• Primary tumors arise predominantly from the head of the pancreas (ductal adenocarcinoma).
• Symptoms include bile duct obstruction leading to jaundice; prognosis is often poor due to late diagnosis.

Whipple Resection

• Known as pancreaticoduodenectomy, involves removal of the pancreas head, duodenum, part of jejunum, distal stomach, and lower common bile duct.
• Pylorus-preserving variant aims to improve the patient’s quality of life by preserving the pyloric sphincter.

Pancreatic Transplant

• Multiple options: pancreas transplant alone, simultaneous pancreas-kidney transplant (SPK), or pancreas after kidney transplant (PAK).
• SPK is the most common method, involves anastomosing donor pancreas to the jejunum for drainage.

Spleen Anatomy and Function

• Located in the upper left quadrant, filtering blood and producing white blood cells; also stores blood and platelets.
• Blood supply comes from the splenic artery and vein.

Splenectomy

• Indications include trauma, malignancies, and infections.
• Requires general anesthesia, significant intraoperative counting, and hemostatic management.

Liver Transplantation

• Involves anastomosis of donor liver with recipient’s blood vessels and bile ducts to restore function.
• Solutions used for preservation include University of Wisconsin solution.

Trillium Gift of Life Network

• Ontario agency coordinating organ and tissue donation and transplantation services.
• Emphasizes the significance of maintaining aseptic technique throughout organ donation procedures.

Organ Donation

• Types: neurological determination of death (NDD) and after circulatory death (DCD).
• Consents and legally required signatures are necessary before donation; meticulous procedure planning essential for efficacy and ethics.

This quiz covers essential topics related to biliary surgery, including anatomy and procedural considerations for surgeries involving the liver, gallbladder, pancreas, and spleen. It also addresses the transplant process in Canada and issues related to death in the operating room. Ideal for RPN perioperative program students seeking to deepen their understanding of biliary surgeries.