AH2 ‐ Hepatopancreaticobiliary - Don Cameron Flashcards
What is the standard bilary anatomy?
1.
What is a cholangiogram? WHat are its uses?
What are the complications associated with cholagiogram/cholecystectomy
Gallstone disease:
Clinical feature?
What is bilary colic? - ampulla contraction - crystalization- gallbladder contracts- causing high pressure in gallbladder – thus causing severe pain - last 30 minutes to 2 hours
RUQ pain, epigastrium, umbilical, Pain radiates to back!
What is cholecytisis?
What bloods will show? WBC? CRP?
What are different types of bilary pathology and their meaning?
Need to know these for exams:
What is the cause of these different bilary pathology?
What can chronic gallstones cause? (stuck in the duct) e.g cholangitis/can cause pancreatitis, ileus - some of the most common causes (severe pancreatitis)
Gallstone ileus- Very good going - can cause necrosis - and can get stuck in Small bowel- lodge in terminal ileus- leading to SBO! (bowel obstruction)- classically obstruction seen on Xray + air in the bilary tree - (CT can be seen very clearly gallstones location)
How do you describe a stone on abdo US?
Gallstones (cholelithiasis) describe stone formation at any point along the biliary tree. Specific names can be given to gallstones depending on their location:
cholecystolithiasis: gallstones within the gallbladder
the terms cholelithiasis or gallstones have been largely used in clinical practice by their own to refer to stones in the gallbladder
choledocholithiasis: gallstones within the bile ducts
Biliary microlithiasis refers to gallstones <3 mm in diameter.
Ultrasound:
Ultrasound is considered the gold standard for detecting gallstones 6:
greyscale ultrasound
highly reflective echogenic focus within gallbladder lumen, normally with prominent posterior acoustic shadowing regardless of pathological type (acoustic shadowing is independent of the composition and calcium content) 11
gravity-dependant movement is often seen with a change of patient position (the rolling stone sign)
What are the following cholagiography techniques and there +/-
Endoscopic US- Pancreatic masses causing bilary obstruction (EUC)
ERCP
PTC - Sticking a needle into dilated bile duct, pictures can be taken then when
MRCP is used to visualize the biliary and pancreatic ducts in a non-invasive manner.[1][2] It is used to diagnose gallstones. It can also diagnose choledochal cysts very reliably.[3] This is useful for visualisation, making other surgeries easier.[
MRCP
Top Left- Blokcing off at common bile duct -suspicious stone at bottom of commonbile duct
Top right: not hyper intense, filling defects noted
ERCP
Standard treatments for gallstones (simplified)
- Need to know these terms and associated treatments
- Need to know aeitology, and management of each
What is charcots triad? Why is it important?
Treatment of choledocholithiasis
What are the complications of ERCP??? (NEED to know) Pancreatitis, Bleeding and perforation!
When is common bile duct exploration in conjunction with cholecystectomy (one procedure) - Lap or open - via cytic duct or choledochotomy (if multiple stones)
risk: Bile leak, bile duct injury or stricture!!!
1) Usually ERCP - usually with ERCP
2) Baskets and ballons, and stents to remove stone (ie two procedures)
3) Usually preferred option if significant cholangitis (ERCP)
Case 1: 17 year female
Bloods show the following:
need to perform US abdominal
What can be seen in abdo US? Gallbladder findings?
Bilary colic! - need to refer to GI clinic to consider gallbladder removal
Case continued 3 weeks post partum
- Increaing pain
- Deranged LFTS
Imaging shows:
– Filling defect on cholangiogram
–> Thus stones
Patient 2: Patient post op with t2dm
Fits picture for cholangitis !
What are we going for this patient?
Cholangitis - obstruction seen, pathces of necrosis when removed
- Grew clostridium perfrigens (gallbladder necrosis)
Liver abcess and gallstones malignancy
