Hepato-biliary surgery

Question 1

Homone stimulus for gall bladder?

Answer 1

CCK

Question 2

Most comon condition in biliary tree?

Answer 2

Gall stones!

Question 3

Cholesterosis and Gall bladder polyps benign or malig?

Answer 3

Cholesterosis (small white dots in the wall of the gall bladder, makes it look like a strawberry).

Gall bladder polyps - usually benign, however usually behind every caner is a polyps so they are kept an eye on and if they become too big they’re resected.

Question 4

are gall stones symptomatic?

Answer 4

Usually no.

Question 5

What are gallstones composed of?

Answer 5

Cholesterol (most common, due to either over saturation of cholesterol so it isn’t in solution any more, or a reduction in the acids/things that keep it in solution, or stasis of the gall bladder so that everything separates out into different layers and solidifies), bilirubin (pigmentted gall stones)

Question 6

Risk factors for gall stones?

Answer 6

Use to be 4 F’s but now a broader range of patients presenting.
Female
Fat
Forty’s
Fertile/Fair

Question 7

Presentation of gallstones

Answer 7

Dyspepstic symptoms, biliary colic. Later stages my present with cholecystitis, empyema in the gall bladder, perforation, jaundice.

Question 8

How can gallstones present with jaundice?

Answer 8

If they are compressing/blocking any of the bile ducts

Question 9

What is Choledocholithiasis?

Answer 9

gall stones in the bile duct

Question 10

WHat other symptoms come with obstructive jaundice?

Answer 10

Pain, jaundice, dark urine, pale stool, pruritus, steatorrhoea

Question 11

Ascending cholangitis 3 factors (Charcot’s triad)?

Answer 11

Jaundice, pain with fever, rigors

Question 12

Gold standard investigtion to findgall stones?

Answer 12

Ultrasound

Question 13

Management of gallstones: asymptomatic. non-operative, operatice?

Answer 13

Asymptomatic, often leave/monitor
Non-operative - dissolution using oxycolic acid - thins bile, not necessarily breaking down the gall stones
Operative - laproscopic removal (“Laparoscopic cholecystectomy +/- OTC”)

Question 14

WHat is biliary atresia?

Answer 14

Embyological change meaning there is a missing connection within the biliary tree

Question 15

What is choledochal cysts? Recommended treatment?

Answer 15

Congenital dilatation of different areas within the biliary system. Bile duct removal and reconstruction due to increased cancer risk.

Question 16

Primary Sclerosing Cholangitis (PSC) presentation. Risk of developing into what?

Answer 16

Jaundice, pain. Risk of deveopin nto cancers, so is monitorred/

Question 17

Obstruction of bowels and air in bile duct is diagnostic of what condition?

Answer 17

Gallstone illius (billiary enteric fistular - stone moved down small bowel and starts blocking bowel)

Question 18

What is cholangiocarcinoma? Where is it often found?

Answer 18

Cancer of the biliary tree

Question 19

Risk factos for Cholangiocarcinoma

Answer 19

Age. Rare cancer

Also:
PSC (strong association)
Congenital cystic disease
Biliary-enteric drainage
Thorotrast (contrast)
Hepatolithiasis
Carcinigens: aflatoxins, etc.

Question 20

Treatment of Cholangiocarcinoma

Answer 20

surgical resection if possible, otherwise stenting is used to maintain function

Question 21

What are the 3 descriptive classification of the cholangio-carcinoma? What are the classifications for the type (I-V) locaitonwise? WHich ones are resectable?

Answer 21

Intraductal, mass like and periductal

Question 22

Cholangiocarcinoma presentation symptoms and signs?

Answer 22

Obstructive jaundice, itching and non-specific cancer symptoms

Question 23

Which scan is diagnostic?

Answer 23

CT

Question 24

Which investigation type is used for stenting?

Answer 24

PTC

Question 25

USS used for what in relation to the glalbladder?

Answer 25

Gall stones

Question 26

What does an Endoscopic ultrasoudn scan usually look at?

Answer 26

Lymph

Question 27

What can an MRCP look at and tell us?

Answer 27

The billiary tree

Question 28

What is ERPC used for?

Answer 28

Diagnosis/stenting

Question 29

Gall bladder cancer - prognosis? WHat is ussually presened with it?

Answer 29

Generally poor prognosis as it is veyr agressive, unless incidently found earlier eg through gallstone removal etc. Usally presented with gallstones