Biliary surgery and Gallstones Flashcards
What is the function of the gallbladder?
Bile reservoir
Concentrates bile
Secretion of bile after meal
What are the risk factors for gallstones?
Age Gender (9:1 females) 4F (female, forty, fertile, fair) Oral contraceptives Long term low fat diet
How do gallstones present?
Jaundice
Empyema
Acute cholecystitis (RUQ pain)
Biliary colic
What are choledocho-lithiasis?
Bile duct stones
What are the symptoms of obstructive jaundice?
Pain Jaundice Dark urine Pale stools Pruritis Steatorrhoea
What are the investigations for gallstones?
Bloods
Ultrasound
EUS
CT
What are the management options for gallstones?
Dissolution
Lithotripsy
Cholecystectomy
What are the causes of benign biliary tract disease?
Congenital (biliary atresia, choledochal cysts)
Benign biliary stricture (iatrogenic, gallstone related, inflammatory)
What is the cause of primary sclerosis cholangitis?
Association with inflammatory bowel disease especially ulcerative colitis, thought to be autoimmune
What are the risk factors for cholangiocarcinoma?
Primary sclerosis cholangitis
Congenital cystic disease
Biliary enteric drainage
Hepatolithiasis
What are the 3 types of cholangiocarcinoma
Mass forming
Peri ductal
Intra ductal
How does cholangiocarcinoma present?
Obstructive jaundice
Itching
None specific symptoms
What investigations are used for cholangiocarcinoma?
Lab ERCP Ultrasound EUS CT MRCP
How is cholangiocarcinoma managed?
Surgery only potential curative option
Palliative (bypass, stenting)
Radio/chemo don’t work
What are the treatment options for ampullarf tumours?
Endoscopic excision
Trans duodenal excision
Pancreaticoduodenectomy (Whipple)
