Biliary Surgery, Gallstones Flashcards
Gall bladder is a bile reservoir that secretes bile when stimulated by what?
CCK
composition of gallstones
mixed (80%)
cholesterol
pigment (20% between the two)
risk factors for gall stones
age
gender
cholesterol (obesity, ileal disease, cystic fibrosis)
pigment
fertile
woman
Gallstones presentation
asymptomatic
dyspeptic symptoms
biliary colic
empyema
perforation
jaundice
biliary colic
sudden pain due to a gall stone blocking the bile duct
Choledocho-lithiasis
is the presence of a gallstone in the common bile duct
side effects of choldocho-lithiasis
pain
jundice
dark urine
pale stool
pruritis
steatorrhoea
acute pancreatitis
Investigations for gall stones
blood tests (LFTs, Amylase, WCC)
Ultrasound
Endoscopic ultrasound
oral cholecystography
CT scan
Gall stones management
non-operative
dissolution
lithrotripsy
Gall stones management
operative
open cholecystectomy
mini cholecystectomy
laproscopic cholecystectomy
cholecystostomy
Benign biliary tract disease if congenital can lead to
biliary atresia
choledochal cysts
benign biliary stricture
Cholangiocarcinoma
4 types
intrahepatic
extrahepatic
gallbladder cancer
ampullary cancer
hepatolithiasis
gall stones in the liver bile ducts
three types of cholangicarcinoma (intrahepatic)
mass forming
peri-ductal
intra-ductal
treatment for cholangicarcinoma (intrahepatic)
only surgery is available
cholangicarcinoma presentation
obstructive jaundice
itching
non-specific symptoms
cholangicarcinoma investigations
lab
radiology (USS, EUS, CT, angiography)
cholangioscopy
cytology
Management of cholangicarcinoma CURATIVE
surgery
Management of cholangicarcinoma
PALLIATIVE
surgical bypass
stenting
palliative radiotherapy
chemotherapy
liver transplant
Gall baller cancer rarity
rare (2-5% of GI cancers)
gall baller cancer prognosis
poor
except if its detected early
Ampullary tumours
adenoma Vs adenocarcinoma
in the bile duct usually
treatment for ampullary tumours
endoscopic excision
trans-duodenal excision
pancreatico-duodenectomy
