Hepato-Biliary Surgery Flashcards
Cholesterosis is a benign condition affecting the gallbladder. What would you find in the gallbladder of those with this condition?
Small dots of cholesterol in the wall of the gallbladder
Gallbladder polyps may occur, and are benign. However, what can these polyps progress to?
Gallbladder cancer
If a polyp is <5mm, what does this mean?
It can be ignored
What happens if a polyp is >1cm?
It is removed
What are one of the most common surgical problems?
Gallstones
What are the two types of gallstones?
Cholesterol gallstones
Pigment gallstones
What are some of the risk factors for gallstones?
Age
Gender
Cholesterol related conditions e.g. obesity
Pigment related conditions e.g. anaemia, bile infections
Oral contraceptive pill
Are gallstones found more in males or females?
Females
How do gallstones present?
Usually asymptomatic
Sometimes dyspeptic symptoms
Biliary colic
Jaundice
What is the most common symptom suggestive of gallstones?
Biliary colic
What is biliary colic?
Recurrent upper abdominal pain, in the epigastrium, can radiate to shoulders
Which condition occurs when a gallstone becomes inflamed and infected?
Acute cholecystitis
What happens when the gallbladder gets pus in it?
Empyema- can perforate if not treated
What can happen if a gallstone sits and blocks the bile duct?
Jaundice
What is choledocho-lithiasis?
The presence of gallstones in the bile duct
Describe the difference between primary choledocho-lithiasis and secondary choledocho-lithiasis.
Primary choledocho-lithiasis- gallstone begins in the bile duct
Secondary choledocho-lithiasis- gallstones that started somewhere else, like the cystic duct and have ended up in the bile duct
What can choledocho-lithiasis cause if obstructing the bile duct?
Jaundice
What can choledocho-lithiasis cause if obstructing the pancreatic duct?
Pancreatitis
Describe what is meant by obstructive jaundice.
Painful condition due to narrow or blocked bile orpancreatic duct
List some of the symptoms of obstructive jaundice
Pain, jaundice, dark yellow urine, pale stool, steatorrhoea (fatty, greasy stool), itch.
Which other conditions can choledocho-lithiasis cause?
Pancreatitis
Ascending cholangitis
What are the three components of Charcot’s triad?
Intermittent abdominal pain, fever, and jaundice
What are some of the investigations for gallstones?
Blood tests
Ultrasound
Endoscopic ultrasound
Oral cholecystography
CT
What is specifically looked at in blood tests for indications of gallstones?
LFT’s- AST, ALP, ALT
Amylase, Lipase
WCC
Which investigative technique is the gold standard for gallstones?
Ultrasound
What is the treatment/management for asymptomatic gallstones?
Nothing
(unless more than 1cm I’m guessing)
What are some non-operative treatment options for gallstones?
Dissolution (using drugs to break them up)
Lithotripsy (using shocks to break them up)
List some of the operative treatments for gallstones.
Open cholecystectomy
Mini cholecystectomy
Laparoscopic cholecystectomy
Subtotal cholecystectomy
Single port cholecystectomy
NOTES cholecystectomy
basically loads of different cholecystectomys
What is the gold standard procedure for gallstones?
Laparoscopic cholecystectomy
Describe briefly what happens in a single port cholecystectomy.
Insert instruments through the umbilicus
How can the gallbladder be removed in a NOTES cholecystectomy?
Through the vagina or oesophagus
->very very rarely used by means there is no scar
If a gallbladder is threatening to perforate, what should be done before it is removed?
Use a drain to get rid of the pus
Common bile duct stones are slightly different. List some of the ways they can be reoved.
Lap trans-cystic CBD exploration
Lap exploration of CBD
ERCP
Transhepatic stone retrieval
What can ERCP be used for?
Stenting for pancreatic cancers
Removing small gallstones from the CBD
What is biliary atresia?
When babies are born without a bile duct
What is a choledochal cyst?
Congenital anomaly meaning the bile duct is dilated in different locations
What do choledochal cysts increase risks of?
Biliary cancer in later years
What is meant by an iatrogenic bile duct injury?
Bile duct injury when performing a cholecystectomy
Name two autoimmune biliary conditions.
Primary biliary cholangitis
Primary sclerosing cholangitis
What is a biliary enteric fistula?
Gallstones ending up in the bile duct via pipe-like ulcers (?)
How does ampullary cancer arise?
Polyp in the ampulla turned malignant
What are some of the risk factors for cholangiocarcinoma?
Age
Primary sclerosing cholangitis
Congenital cystic disease
Biliary-enteric drainage
Carcinogens
Bile duct stones (hepatolithiasis)
What are the three types of cholangiocarcinoma?
Mass forming
Peri-ductal
Intra-ductal
What is the only treatment option for cholangiocarcioma?
Surgery to remove gallbladder
How does cholangiocarcinoma present?
Obstructive jaundice
Itching
Weight loss
Which investigations can be used for diagnosis of chalongiocarcinoma?
-Lab bloods
-Radiology e.g. ultrasound, endoscopic ultrasound, CT, MRI, MRCP
-ERCP, cholangioscopy
When is PTC used?
Stenting of the biliary tree
Which type of radiography is good for looking if metastatic disease has spread elsewhere?
PET scan
Discuss some of the palliative care options for cholangiocarcinoma
Chemo
Radiotherapy
Liver transplant-sometimes
Stenting
Surgical bypass
What are the treatment options for ampullary tumours?
Endoscopic excision
Trans-duodenal excision
Pancreatic-duodenectomy
What is the gold standard of treatment for ampullary tumours?
Pancreatic-duodenectomy
Which ducts, if blocked, can lead to jaundice?
Common bile duct
->blocking of the hepatic duct or cystic duct will not lead to jaundice
