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Alimentary System > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

1
Q

What are the functions of the gallbladder?

A

Bile reservoir

Concentrates bile

Secretes after meal (CKK)

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2
Q

What can be said about the anatomy of the gallbladder from person to person?

A

Anatomical variations exist

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3
Q

What can be said about the anatomy of the blood supply to the gallbladder?

A

Anatomical variations exist

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4
Q

What are some examples of conditions of the gallbladder?

A

Gallstone disease

Cholesterosis

Gallbladder

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5
Q

What is the procedure where the gallbladder is removed called?

A

Cholecystectomies

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6
Q

What is the composition of gallstones?

A

Mixed (>50% cholesterol), 80%

Cholesterol 10%

Pigment 10%

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7
Q

What are risk factors for gallstones?

A

Age

Gender

Parity + oral contraceptives (OCP)

Cholesterol

Pigment (haemolytic anaemia, bile infection)

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8
Q

What are risk factors for high cholesterol?

A

Obesity

Ileal disease

Cirrhosis

Cystic fibrosis

DM

TPN

Heart transplant

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9
Q

What is the presentation of gallstones?

A

Asymptomatic

Dyspeptic symptoms

Biliary colic

Acute cholecystitis

Empyema

Perforation

Jaundice

Gallstone ileus

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10
Q

What is inflammation of the gallbladder?

A

Cholecystitis

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11
Q

What is the presence of a small gallstone in the comment bile duct?

A

Choledocholthiasis

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12
Q

What is the presentation of choledocholithiasis?

A

Post-cholecystectomy pain

Obstructive jaundice (painful)

Dark urine

Pale stool

Steatorrhoea

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13
Q

What investigations are done for gallstones?

A

Blood tests (LFTs, amylase, lipase, WCC)

USS

EUS

Oral cholecystography

CT scan

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14
Q

What are the two broad categories of gallstone management?

A

Non-operative treatment

Operative treatment

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15
Q

What is the non-operative management for gallstones?

A

Dissolution

Lithotripsy

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16
Q

What is a treatment that uses shock waves to treat gallstones?

A

Lithotripsy

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17
Q

What is the operative management of gallstones?

A

Open cholecystectomy

Mini-cholecystectomy

Laparoscopic cholecystectomy

Singl eport cholecystectomy

Cholecystectomy

Subtotal cholecystectomy

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18
Q

What does CBD stand for?

A

Common bile duct

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19
Q

What does the management of common bile duct stones involve?

A

Expectant treatment (incidental)

Lap trans-cystic, lap or open exploration of CBD

ERCP

Transhepatic stone retrieval

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20
Q

What procedure allows examination of the CBD or pancreatic duct using an endoscopy through the mouth?

A

Endoscopic retrograde cholangiopancreatography (ERCP)

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21
Q

What are benign biliary tract diseases?

A

Diseases that affect the bile ducts, gallbladder and other structures involved in the production and transportation of bile

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22
Q

What are examples of benign biliary tract diseases?

A

Biliary atresia

Choledochal cysts

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23
Q

What kind of diseases are benign biliary tract diseases?

A

Congenital

24
Q

What is biliary atresia?

A

Narrowing, blockage or absent bile ducts

25
Q

What are choledochal cysts?

A

Cystic dilations of the biliary tree

26
Q

What is a cyst?

A

Membraneous sac or cavity of abnormal character in the body containing fluid

27
Q

What are the different categories of biliary atresia?

A

Iatrogenic

Gallstone related

Inflammatory

28
Q

What are examples of inflammatory causes of biliary atresia?

A

Pyogenic

Parasitic

Primary sclerosing cholangitis (PSC)

Pancreatitis

HIV

29
Q

What are the different types of choledochal cysts?

A
30
Q

What are examples of malignant tumours that can cause jaundice?

A

Cholangiocarcinoma

Cancer of the head of the pancreas

31
Q

What is the name of bile duct cancer?

A

Cholangiocarcinoma

32
Q

What are the broad categories of cholangiocarcinoma?

A

Extra-hepatic

Intra-hepatic

Gallbladder cancer

Ampullary cancer

33
Q

Which of intra and extra-hepatic cholangiocarcinoma occurs more often?

A

Extrahepatic (94%)

Intrahepatic (6%)

34
Q

Out of hilar and distal, where do most extrahepatic cholangiocarcinomas occur?

A

Hilar (67%)

Distal (27%)

35
Q

What are risk factors for cholangiocarcinoma?

A

PSC (strong association)

Congenital cystic disease

Biliary-enteric drainage

Thorotrast (contrast)

Hepatolithiasis

Carcinogens (such as aflatoxins)

36
Q

What is the presentation of cholangiocarcinoma?

A

Obstructive jaundice

Itching

Non-specific symptoms

37
Q

What investigations are done for cholangiocarcinoma?

A

Lab

Radiology (USS, EUS, CT, MRA, MRCP, PTC, angiography, FDG PET)

ERCP, cholangioscopy and cytology

38
Q

What is MRA?

A

Magnetic resonance angiogram

Lets doctor see inside your blood vessels

39
Q

What is MRCP?

A

Magnetic resonance cholangiopancreatography

Visualises biliary and pancreatic ducts in a non-invasive manner using magnetic resonance

40
Q

What is PTC?

A

Percutaneous transhepatic cholangiography

Uses contrast injected into the biliary duct and x-rays to visualuse the anatomy of the biliary tract

41
Q

How is cytology different from histology?

A

Cytology is the study of individual cells

Histology is the study of individual tissues

42
Q

What is the management of cholangiocarcinoma?

A

Surgery is the only potential curative option

Palliative care

43
Q

What can be done for palliative care for cholangiocarcinoma?

A

Surgical bypass

Stenting (percutaneous vs endoscopic)

Palliative radiotherapy

Chemotherapy

PDT

Liver transplant (not standard)

44
Q

What is PDT?

A

Photodynamic therapy

Uses a drug and a particular kinds of light to form oxygen and kill cells

45
Q

What is the incidence of gallbladder cancer like?

A

Rare, is 2-5% of all GI cancers

46
Q

What is the prognosis of gallbladder cancer?

A

Poor, except if detected early

47
Q

How is gallbladder cancer usually diagnosed?

A

Incidently whilst investigating gallstones

48
Q

What does the treatment of gallstone cancer depend on?

A

What stage the cancer is

49
Q

What is ampullary cancer?

A

Cancer that forms in th ampullar of Vater

50
Q

What is the ampulla of Vater?

A

Small opening that enters into the first portion of the duodenum

51
Q

What are the 2 histological classifications of ampullary tumours?

A

Adenoma

Adenocarcinoma

52
Q

What is an adenoma?

A

Benign tumour of glandular tissue

53
Q

What is an adenocarcinoma?

A

Malignant tumour of gland tissue

54
Q

What are the treatment options for ampullary tumours?

A

Endoscopic excision

Trans-duodenal excision

Pancreatico-duodenctomy

55
Q

What is a pancreatico-duodenctomy?

A

Operation to remove the head of the pancreas

Alimentary System (41 decks)

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