Biliary Surgery

Question 1

Function of the gallbladder

Answer 1

Stores concentrated bile
Secretion of bile after meal
CCK

Question 2

2 Benign diseases of the gallbladder

Answer 2

Cholesterolosis

Galbladder polyps

Question 3

What other name is given to cholesterolosis of the gallbladder?

Answer 3

Strawberry gallbladder

Question 4

Risk factors for gallbladder disease

Answer 4

Age
Gender
Parity and OCP
Cholesterol
Pigmentation

Question 5

Presentation of gallbladder disease

Answer 5

Asymptomatic
Dyspeptic (flatulent)
Biliary colic
Acute cholecystitis
Jaundice
Empyaema
Perforation
Gallstone ileus

Question 6

Jaundice, fevers and rigors associated with obstruction and perforation of the bile duct are signs and symptoms of which condition?

Answer 6

Mirrizi’s syndrome

Question 7

Signs and symptoms of obstructive jaundice

Answer 7

Pain
Jaundice
Dark urine
Pale stool
Pruritus
Steatorrhoea

Question 8

Charcot’s triad is seen in which condition?

Answer 8

Ascending cholangitis

Question 9

What are the features of Charcot’s triad?

Answer 9

Fever/rigors
Jaundice
RUQ pain

Question 10

Investigations for choldeocholithiasis

Answer 10

Bloods - LFTs, Amylase, Lipase, WCC
Ultrasound - posterior acoustic shadow
EUS
Oral cholecystography (OCG)
CT scan - for obstructed ducts or pancreatitis
Radioisoptope scan
IV cholangiography
MRCP
PTC
ERCP

Question 11

Which investigations are used for treatment and not diagnosis of choledocholithiasis?

Answer 11

Percutaneous transhepatic cholangiography

Endoscopic Retrograde Cholangiopancreatography

Question 12

What risks are associated with PTC and ERCP?

Answer 12

Perforation

Pancreatitis

Question 13

Management of gallstones

Answer 13

Nothing if asymptomatic
Non operative - Dissolution, Lithotripsy
Operative - Open cholecystectomy, Mini cholescystectomy
Laparoscopic cholecystectomy - Gold Standard - with or without OTC
Cholecystectomy
Subtotal cholecystectomy

Question 14

Management of CBD stones

Answer 14

Laparoscopic/ Laparoscopic trans cystic/Open exploration of CBD
ERCP - Pre op, intra op, post op
Transhepatic stone retrieval

Question 15

Congenital causes of Biliary tract disease

Answer 15

Biliary atresia

Choledochal cysts

Question 16

Causes of biliary stricture

Answer 16

Iatrogenic
Gallstone related - Mirrizi’s
Inflammatory - Pyogenic, Parasitic, Primary Sclerosing Cholangitis, Pancreatitis, HIV

Question 17

Consequence of prolonged stricture

Answer 17

Dilated lumen leading to fibrotic stricture

Inflammation can occur leading to Cholangiocarcinoma

Question 18

4 types of cholangiocarcinoma

Answer 18

Intrahepatic
Extrahepatic - Hilar, Distal
Gallbladder cancer
Ampullary cancer

Question 19

Peak age for cholangiocarcinoma

Answer 19

80 years old

Question 20

Risk factors for cholangiocarcinoma

Answer 20

Primary Sclerosing Cholangitis
Congenital cystic disease
Biliary enteric draingage
Thorotrast 
Hepatolithiasis
Carcinogens - aflatoxin

Question 21

3 types of intrahepatic cholangiocarcinoma

Answer 21

Mass forming
Periductal
Intraductal

Question 22

Presentation of cholangiocarcinoma

Answer 22

Obstructive Jaundice
Itching
Non-specific symptoms - weight loss, pale stool

Question 23

Investigation of cholangiocarcinoma

Answer 23

USS, EUS, CT, MRA, MRCP, PTC, Angiography, FDG PET, ERCP
Cholangioscopy
Cytology

Question 24

Management of cholangiocarcinoma

Answer 24

Surgical - only curative

Palliative - bypass, stenting, radiotherapy, chemo, PDT, liver transplant

Question 25

2 types ampullary tumour

Answer 25

Adenoma

Adenocarcinoma

Question 26

Treatment for ampullary tumour

Answer 26

Excision via endoscopy
Transduodenal excision
Pancreaticoduodenectomy
FAP and peri-ampullary tumours