Hepato-Biliary Surgery Flashcards
What are examples of benign conditions of the gallbladder?
Gallstone disease
Cholesterosis (change in the gallbladder wall due to excess cholesterol)
Gallbladder polyps
What is the composition of gallstones?
- Mixed (>50% cholesterol) 80%
- 20% -
- Cholesterol
- Pigment
What are risk factors for gallstones?
Age
Gender
Parity + OCP (4F)
(n biology and human medicine, gravidity and parity are the number of times a female is or has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity)) OCP - contraceptive pill
Cholesterol: Obesity, ileal disease, cirrhosis, cystic fibrosis
Pigment (Far east): M=F, haemolytic anaemia, bile infections (e-coli and bacteriodes)
What is the presentation of gallstones?
Asymptomatic
Dyspeptic symptoms (flatulent dyspepsia)
Biliary colic (gallstone temporarily blocking the bile duct)
Acute cholecystitis
Empyema
Perforation
Jaundice (Mirrizi’s Syn.)
Gallstone Ileus
Define choledoco-lithiasis?
When a gallstone blocks the common bile duct
What are the causes of primary choledoco-lithiasis?
Stones develop within the common bile duct many years after a cholecystectomy, sometimes related to biliary sludge arising from the dysfunction of the sphincter of oddi
What percentage of patients with gallstones get common bile duct obstruction?
10-15%
What are the clinical features of choledoco-lithiasis?
May be asymptomatic
Right upper quadrant abdominal pain with or without jaundice
Prutitis
Dark urine
Steatorrhoea
Acute pancreatitis
Ascending cholangitis (charcot’s triad) - infection of the bile duct
What are the investigations for Gallstones?
Blood tests:
–LFT’s: AST, ALT, ALP
–Amylase, Lipase
–WCC
USS
EUS
Oral cholecystography
CT scan
Radio iso-tope scan (HIDA)
IV cholangiography
MRCP (Magnetic resonance cholangiopancreatography)
PTC (Percutaneous transhepatic cholangiography - A contrast medium is injected into a bile duct in the liver, after which X-rays are taken)
ERCP (Endoscopic retrograde cholangio-pancreatography)
What is management of gallstones?
Non-operative treatment: Dissolution, lithotripsy (typically using ultrasound shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body.)
Operative:
–Open cholecystectomy - not acceptable first line treatment anymore
–Mini-cholecystectomy
–Laparoscopic cholecystectomy +/- OTC “Gold Standard”
–Single port cholecystectomy
–NOTES cholecystectomy (natural orifice transluminal endoscopic surgery)
–Cholecystostomy (cholecystotomy is a procedure where a stoma is created in the gallbladder, which can facilitate placement of a tube for drainage)
–Subtotal Cholecystectomy
What is the management of common bile duct stones?
Expectant treatment (incidental)
Lap trans-cystic CBD exploration
Lap exploration of CBD
Open exploration of CBD
ERCP
–Pre-op
–Intra-op
–Post-op
Transhpatic stone retrieval
What are the congenital forms of benign biliary tract disease?
–biliary atresia
–Choledochal cysts - Choledochal cysts (a.k.a. bile duct cyst) are congenital conditions involving cystic dilatation of bile ducts - common in eastern countries like china and japan
What are the causes of benign biliary stricture?
Iatrogenic
Gallstone related
Inflammatory
(pyogenic, parasitic, PSC, Pancreatitis, HIV)
What fails to form in biliary artresia?
Bile duct or cystic duct
What are the forms of cholangiocarcinoma?
Cholangiocarcinoma is a cancer that arises from the cells within the bile ducts; both inside and outside the liver. When the tumors arise within the liver, the tumors can be small or large
–Intrahepatic 6%
–Extrahepatic
Hilar (Klatskin 1965) 67%
Distal 27%
–Gallbladder Cancer
–Ampullary Cancer
