Biliary Surgery Flashcards
Function of the gallbladder
Stores concentrated bile
Secretion of bile after meal
CCK
2 Benign diseases of the gallbladder
Cholesterolosis
Galbladder polyps
What other name is given to cholesterolosis of the gallbladder?
Strawberry gallbladder
Risk factors for gallbladder disease
Age Gender Parity and OCP Cholesterol Pigmentation
Presentation of gallbladder disease
Asymptomatic Dyspeptic (flatulent) Biliary colic Acute cholecystitis Jaundice Empyaema Perforation Gallstone ileus
Jaundice, fevers and rigors associated with obstruction and perforation of the bile duct are signs and symptoms of which condition?
Mirrizi’s syndrome
Signs and symptoms of obstructive jaundice
Pain Jaundice Dark urine Pale stool Pruritus Steatorrhoea
Charcot’s triad is seen in which condition?
Ascending cholangitis
What are the features of Charcot’s triad?
Fever/rigors
Jaundice
RUQ pain
Investigations for choldeocholithiasis
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
Which investigations are used for treatment and not diagnosis of choledocholithiasis?
Percutaneous transhepatic cholangiography
Endoscopic Retrograde Cholangiopancreatography
What risks are associated with PTC and ERCP?
Perforation
Pancreatitis
Management of gallstones
Nothing if asymptomatic
Non operative - Dissolution, Lithotripsy
Operative - Open cholecystectomy, Mini cholescystectomy
Laparoscopic cholecystectomy - Gold Standard - with or without OTC
Cholecystectomy
Subtotal cholecystectomy
Management of CBD stones
Laparoscopic/ Laparoscopic trans cystic/Open exploration of CBD
ERCP - Pre op, intra op, post op
Transhepatic stone retrieval
Congenital causes of Biliary tract disease
Biliary atresia
Choledochal cysts
Causes of biliary stricture
Iatrogenic
Gallstone related - Mirrizi’s
Inflammatory - Pyogenic, Parasitic, Primary Sclerosing Cholangitis, Pancreatitis, HIV
Consequence of prolonged stricture
Dilated lumen leading to fibrotic stricture
Inflammation can occur leading to Cholangiocarcinoma
4 types of cholangiocarcinoma
Intrahepatic
Extrahepatic - Hilar, Distal
Gallbladder cancer
Ampullary cancer
Peak age for cholangiocarcinoma
80 years old
Risk factors for cholangiocarcinoma
Primary Sclerosing Cholangitis Congenital cystic disease Biliary enteric draingage Thorotrast Hepatolithiasis Carcinogens - aflatoxin
3 types of intrahepatic cholangiocarcinoma
Mass forming
Periductal
Intraductal
Presentation of cholangiocarcinoma
Obstructive Jaundice
Itching
Non-specific symptoms - weight loss, pale stool
Investigation of cholangiocarcinoma
USS, EUS, CT, MRA, MRCP, PTC, Angiography, FDG PET, ERCP
Cholangioscopy
Cytology
Management of cholangiocarcinoma
Surgical - only curative
Palliative - bypass, stenting, radiotherapy, chemo, PDT, liver transplant
2 types ampullary tumour
Adenoma
Adenocarcinoma
Treatment for ampullary tumour
Excision via endoscopy
Transduodenal excision
Pancreaticoduodenectomy
FAP and peri-ampullary tumours
