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Year 2- GIT > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

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1
Q

Cholesterosis is a benign condition affecting the gallbladder. What would you find in the gallbladder of those with this condition?

A

Small dots of cholesterol in the wall of the gallbladder

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2
Q

Gallbladder polyps may occur, and are benign. However, what can these polyps progress to?

A

Gallbladder cancer

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3
Q

If a polyp is <5mm, what does this mean?

A

It can be ignored

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4
Q

What happens if a polyp is >1cm?

A

It is removed

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5
Q

What are one of the most common surgical problems?

A

Gallstones

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6
Q

What are the two types of gallstones?

A

Cholesterol gallstones
Pigment gallstones

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7
Q

What are some of the risk factors for gallstones?

A

Age
Gender
Cholesterol related conditions e.g. obesity
Pigment related conditions e.g. anaemia, bile infections
Oral contraceptive pill

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8
Q

Are gallstones found more in males or females?

A

Females

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9
Q

How do gallstones present?

A

Usually asymptomatic
Sometimes dyspeptic symptoms
Biliary colic
Jaundice

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10
Q

What is the most common symptom suggestive of gallstones?

A

Biliary colic

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11
Q

What is biliary colic?

A

Recurrent upper abdominal pain, in the epigastrium, can radiate to shoulders

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12
Q

Which condition occurs when a gallstone becomes inflamed and infected?

A

Acute cholecystitis

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13
Q

What happens when the gallbladder gets pus in it?

A

Empyema- can perforate if not treated

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14
Q

What can happen if a gallstone sits and blocks the bile duct?

A

Jaundice

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15
Q

What is choledocho-lithiasis?

A

The presence of gallstones in the bile duct

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16
Q

Describe the difference between primary choledocho-lithiasis and secondary choledocho-lithiasis.

A

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

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17
Q

What can choledocho-lithiasis cause if obstructing the bile duct?

A

Jaundice

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18
Q

What can choledocho-lithiasis cause if obstructing the pancreatic duct?

A

Pancreatitis

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19
Q

Describe what is meant by obstructive jaundice.

A

Painful condition due to narrow or blocked bile orpancreatic duct

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20
Q

List some of the symptoms of obstructive jaundice

A

Pain, jaundice, dark yellow urine, pale stool, steatorrhoea (fatty, greasy stool), itch.

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21
Q

Which other conditions can choledocho-lithiasis cause?

A

Pancreatitis
Ascending cholangitis

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22
Q

What are the three components of Charcot’s triad?

A

Intermittent abdominal pain, fever, and jaundice

23
Q

What are some of the investigations for gallstones?

A

Blood tests
Ultrasound
Endoscopic ultrasound
Oral cholecystography
CT

24
Q

What is specifically looked at in blood tests for indications of gallstones?

A

LFT’s- AST, ALP, ALT
Amylase, Lipase
WCC

25
Q

Which investigative technique is the gold standard for gallstones?

A

Ultrasound

26
Q

What is the treatment/management for asymptomatic gallstones?

A

Nothing

(unless more than 1cm I’m guessing)

27
Q

What are some non-operative treatment options for gallstones?

A

Dissolution (using drugs to break them up)
Lithotripsy (using shocks to break them up)

28
Q

List some of the operative treatments for gallstones.

A

Open cholecystectomy
Mini cholecystectomy
Laparoscopic cholecystectomy
Subtotal cholecystectomy
Single port cholecystectomy
NOTES cholecystectomy

basically loads of different cholecystectomys

29
Q

What is the gold standard procedure for gallstones?

A

Laparoscopic cholecystectomy

30
Q

Describe briefly what happens in a single port cholecystectomy.

A

Insert instruments through the umbilicus

31
Q

How can the gallbladder be removed in a NOTES cholecystectomy?

A

Through the vagina or oesophagus

->very very rarely used by means there is no scar

32
Q

If a gallbladder is threatening to perforate, what should be done before it is removed?

A

Use a drain to get rid of the pus

33
Q

Common bile duct stones are slightly different. List some of the ways they can be reoved.

A

Lap trans-cystic CBD exploration
Lap exploration of CBD
ERCP
Transhepatic stone retrieval

34
Q

What can ERCP be used for?

A

Stenting for pancreatic cancers
Removing small gallstones from the CBD

35
Q

What is biliary atresia?

A

When babies are born without a bile duct

36
Q

What is a choledochal cyst?

A

Congenital anomaly meaning the bile duct is dilated in different locations

37
Q

What do choledochal cysts increase risks of?

A

Biliary cancer in later years

38
Q

What is meant by an iatrogenic bile duct injury?

A

Bile duct injury when performing a cholecystectomy

39
Q

Name two autoimmune biliary conditions.

A

Primary biliary cholangitis
Primary sclerosing cholangitis

40
Q

What is a biliary enteric fistula?

A

Gallstones ending up in the bile duct via pipe-like ulcers (?)

41
Q

How does ampullary cancer arise?

A

Polyp in the ampulla turned malignant

42
Q

What are some of the risk factors for cholangiocarcinoma?

A

Age
Primary sclerosing cholangitis
Congenital cystic disease
Biliary-enteric drainage
Carcinogens
Bile duct stones (hepatolithiasis)

43
Q

What are the three types of cholangiocarcinoma?

A

Mass forming
Peri-ductal
Intra-ductal

44
Q

What is the only treatment option for cholangiocarcioma?

A

Surgery to remove gallbladder

45
Q

How does cholangiocarcinoma present?

A

Obstructive jaundice
Itching
Weight loss

46
Q

Which investigations can be used for diagnosis of chalongiocarcinoma?

A

-Lab bloods
-Radiology e.g. ultrasound, endoscopic ultrasound, CT, MRI, MRCP
-ERCP, cholangioscopy

47
Q

When is PTC used?

A

Stenting of the biliary tree

48
Q

Which type of radiography is good for looking if metastatic disease has spread elsewhere?

A

PET scan

49
Q

Discuss some of the palliative care options for cholangiocarcinoma

A

Chemo
Radiotherapy
Liver transplant-sometimes
Stenting
Surgical bypass

50
Q

What are the treatment options for ampullary tumours?

A

Endoscopic excision
Trans-duodenal excision
Pancreatic-duodenectomy

51
Q

What is the gold standard of treatment for ampullary tumours?

A

Pancreatic-duodenectomy

52
Q

Which ducts, if blocked, can lead to jaundice?

A

Common bile duct

->blocking of the hepatic duct or cystic duct will not lead to jaundice

53
Q
A

Year 2- GIT (37 decks)

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