Biliary Surgery, Gallstones

Question 1

Gall bladder is a bile reservoir that secretes bile when stimulated by what?

Answer 1

CCK

Question 2

composition of gallstones

Answer 2

mixed (80%)

cholesterol

pigment (20% between the two)

Question 3

risk factors for gall stones

Answer 3

age

gender

cholesterol (obesity, ileal disease, cystic fibrosis)

pigment

fertile

woman

Question 4

Gallstones presentation

Answer 4

asymptomatic

dyspeptic symptoms

biliary colic

empyema

perforation

jaundice

Question 5

biliary colic

Answer 5

sudden pain due to a gall stone blocking the bile duct

Question 6

Choledocho-lithiasis

Answer 6

is the presence of a gallstone in the common bile duct

Question 7

side effects of choldocho-lithiasis

Answer 7

pain

jundice

dark urine

pale stool

pruritis

steatorrhoea

acute pancreatitis

Question 8

Investigations for gall stones

Answer 8

blood tests (LFTs, Amylase, WCC)

Ultrasound

Endoscopic ultrasound

oral cholecystography

CT scan

Question 9

Gall stones management

non-operative

Answer 9

dissolution

lithrotripsy

Question 10

Gall stones management

operative

Answer 10

open cholecystectomy

mini cholecystectomy

laproscopic cholecystectomy

cholecystostomy

Question 11

Benign biliary tract disease if congenital can lead to

Answer 11

biliary atresia

choledochal cysts

benign biliary stricture

Question 12

Cholangiocarcinoma

4 types

Answer 12

intrahepatic

extrahepatic

gallbladder cancer

ampullary cancer

Question 13

hepatolithiasis

Answer 13

gall stones in the liver bile ducts

Question 14

three types of cholangicarcinoma (intrahepatic)

Answer 14

mass forming

peri-ductal

intra-ductal

Question 15

treatment for cholangicarcinoma (intrahepatic)

Answer 15

only surgery is available

Question 16

cholangicarcinoma presentation

Answer 16

obstructive jaundice

itching

non-specific symptoms

Question 17

cholangicarcinoma investigations

Answer 17

lab

radiology (USS, EUS, CT, angiography)

cholangioscopy

cytology

Question 18

Management of cholangicarcinoma CURATIVE

Answer 18

surgery

Question 19

Management of cholangicarcinoma

PALLIATIVE

Answer 19

surgical bypass

stenting

palliative radiotherapy

chemotherapy

liver transplant

Question 20

Gall baller cancer rarity

Answer 20

rare (2-5% of GI cancers)

Question 21

gall baller cancer prognosis

Answer 21

poor

except if its detected early

Question 22

Ampullary tumours

Answer 22

adenoma Vs adenocarcinoma

in the bile duct usually

Question 23

treatment for ampullary tumours

Answer 23

endoscopic excision

trans-duodenal excision

pancreatico-duodenectomy