Hepato-Biliary Surgery Flashcards
What are the sommon diseases of the gall bladder?
- Gallstones (Cholelithiasis)
- Cholesterosis (cholesterol in cells lining gallbladder wall)
- GB Polyps
What are the types of gall stones?
Some are all cholesterol
Some are all pigments
Most are mixed
What are the risk factors for gall strones?
Age
Female
High cholesterol (e.g. obese)
Pigment conditions (e.g. bile infection or haemolytic anaemia)
Female sex hormones e.g. OCP, hormone replacement
Remmeber 5Fs (Fat Female Fertile Forty Fair) but don’t say them to patients its derogatory man
How can gallstones present?
- Asymptomatic
- Biliary Colic (RUQ or epigastric pain)
- Sometimes nausea, heatburn, dyspepsia & flatulence
- Jaundice if in the CBD or impacted in the neck of the cystic duct (Mirrizis syndrome)
What is gallstone ileus?
Gallstones become stuck in the narrowest part of the ileum
What is choledocho-lithiasis?
Lithiasis = Formation of stones in the body
Chole - in gall bladder
Choledoco - In biliary ducts
So basically stones forming or collecting in the bile ducts. Can cause obstructive jaundice, acute pancreatitis and ascending cholangitis
What is mirrizis syndrome?
A gallstone impacted in the cystic duct/neck of gallbladder
Results in obstruction jaundice
What investigations are there for gall stones?
LFTs, Amyase, Lipase, WCC
Ultrasound/Endoscopic ultrasound
CT scan
MRCP
What treatment is there for gall stones?
If asymptomatic just leave them
Non-operative:
- Dissolution (bile acid therapy)
- Lithotripsy (shock waves)
Operative:
- Laparascopic Cholecystectomy +/- on table cholangiography
For common bile duct stones: (Indicated by a dilated CBD on US, Elevated liver or pancreatic enzymes & biliary colic)
- ERCP +/- adjunct lithotripsy or stenting
List some benign biliary tract disease?
Congenital:
- Biliary Atresia
- Choledochal Cysts (congenital cystic dilatation of bile ducts)
Benign Biliary stricture:
- Iatrogenic
- Gallstone related (mirrizis syndrome)
- Inflammatory stricture
Biliary Enteric Fistula
Jaundice can be caused by tumours, what kind?
Cholangiocarcinoma
- Intrahepatic
- Extrahepatic (hilar or distal)
- Gallbladder
- Ampullary
Cancer of the head of the pancreas
What are the types of cholangiocarcinoma?
Mass Forming
Peri-ductal
Intra-ductal
How does a cholangiocarcinoma present?
- Non-specific systemic symptoms
- Pruritis
- Obstructive Jaundice
What investigations are there for cholangicarcinoma?
- Lab Tests
- Radiology (US, CT)
- ERCP
Management of a cholangiocarcinoma?
Curative:
- Surgery
Palliative:
- Surgical bypass or stenting (percutaneous/endoscopic)
- Palliative radiotherapy or chemo