Hepato-Biliary Surgery Flashcards by Isla Anderson

What are the functions of the gallbladder?

Bile reservoir

Concentrates bile

Secretes after meal (CKK)

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

Anatomical variations exist

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

Anatomical variations exist

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What are some examples of conditions of the gallbladder?

Gallstone disease

Cholesterosis

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What is the procedure where the gallbladder is removed called?

Cholecystectomies

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What is the composition of gallstones?

Mixed (>50% cholesterol), 80%

Cholesterol 10%

Pigment 10%

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What are risk factors for gallstones?

Age

Gender

Parity + oral contraceptives (OCP)

Cholesterol

Pigment (haemolytic anaemia, bile infection)

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What are risk factors for high cholesterol?

Obesity

Ileal disease

Cirrhosis

Cystic fibrosis

TPN

Heart transplant

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What is the presentation of gallstones?

Asymptomatic

Dyspeptic symptoms

Biliary colic

Acute cholecystitis

Empyema

Perforation

Jaundice

Gallstone ileus

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What is inflammation of the gallbladder?

Cholecystitis

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

Choledocholthiasis

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What is the presentation of choledocholithiasis?

Post-cholecystectomy pain

Obstructive jaundice (painful)

Dark urine

Pale stool

Steatorrhoea

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What investigations are done for gallstones?

Blood tests (LFTs, amylase, lipase, WCC)

USS

EUS

Oral cholecystography

CT scan

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What are the two broad categories of gallstone management?

Non-operative treatment

Operative treatment

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What is the non-operative management for gallstones?

Dissolution

Lithotripsy

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

Lithotripsy

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What is the operative management of gallstones?

Open cholecystectomy

Mini-cholecystectomy

Laparoscopic cholecystectomy

Singl eport cholecystectomy

Cholecystectomy

Subtotal cholecystectomy

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What does CBD stand for?

Common bile duct

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What does the management of common bile duct stones involve?

Expectant treatment (incidental)

Lap trans-cystic, lap or open exploration of CBD

ERCP

Transhepatic stone retrieval

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

Endoscopic retrograde cholangiopancreatography (ERCP)

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What are benign biliary tract diseases?

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

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What are examples of benign biliary tract diseases?

Biliary atresia

Choledochal cysts

What is biliary atresia?

congenital

Biliary atresia is a condition in infants in which the bile ducts outside and inside the liver are scarred and blocked. Bile can’t flow into the intestine, so bile builds up in the liver and damages it. The damage leads to scarring, loss of liver tissue and function, and cirrhosis.

What are choledochal cysts?

A choledochal cyst (CC) or biliary cyst is a congenital or acquired anomaly affecting the biliary tree. It involves the dilation of the biliary tree that could affect the extrahepatic and/or the intrahepatic segments.

What are the different categories of biliary atresia

Iatrogenic Gallstone related (Mirrizi’s) Inflammatory: Pyogenic Parasitic PSC Pancreatitis HIV

What are examples of inflammatory causes of biliary atresia?

Pyogenic Parasitic PSC Pancreatitis HIV

What are the different types of choledochal cysts?

type 1, 2, 3, 4A, 4B, 5

What are examples of malignant tumours that can cause jaundice?

Cholangiocarcinoma Cancer of the Head of Pancreas

What is the name of bile duct cancer?

Cholangiocarcinoma

What are the broad categories of cholangiocarcinoma?

Intrahepatic 6% Extrahepatic Hilar (Klatskin 1965) 67% Distal 27% Gallbladder Cancer Ampullary Cancer

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

extrahepatic

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

hilar

What are risk factors for cholangiocarcinoma?

Increases with age Peak at 80 years Risk factors: PSC (strong association) Congenital cystic disease Biliary-enteric drainage Thorotrast (contrast) Hepatolithiasis Carcinigens: aflatoxins, etc.

What is the presentation of cholangiocarcinoma?

Obstructive jaundice Itching None-specific symptoms

What investigations are done for cholangiocarcinoma?

Lab Radiology: USS, EUS, CT, MRA, MRCP, PTC, Angiography, FDG PET ERCP, Cholangioscopy and Cytology

what are the three types of intrahepatic cancer

Mass forming Peri-ductal Intra-ductal Surgery is only option

What is MRA?

use MRA to: identify abnormalities, such as aneurysms, in the aorta, both in the chest and abdomen, or in other arteries.

What is MRCP?

Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary stones/tumour/inflammation

What is PTC?

A percutaneous transhepatic cholangiography is a way of looking at your bile ducts using x-rays. Your doctor puts a long thin needle through the skin and into your liver and bile ducts.

How is cytology different from histology?

Cytology generally involves looking at a single cell type. Histology is the exam of an entire block of tissue.

What is the management of cholangiocarcinoma?

Surgical: only potential curative option Palliative: Surgical bypass Stenting (Percutaneous vs Endoscopic) Palliative radiotherapy Chemotherapy PDT liver transplant (not standard)

What can be done for palliative care for cholangiocarcinoma?

Surgical bypass Stenting (Percutaneous vs Endoscopic) Palliative radiotherapy Chemotherapy PDT liver transplant (not standard)

What is PDT?

involves administration of a photosensitizing drug with affinity for neoplastic tissue and subsequent selective irradiation with light of a defined wavelength.

What is the incidence of gallbladder cancer like?

Rare 2-5% of GI cancers 90% existing Gallstones Aggressive

What is the prognosis of gallbladder cancer?

poor Except if detected early Incidental in gallstones

How is gallbladder cancer usually diagnosed?

blood tests. scans, like an ultrasound scan (sometimes from inside your body using an endoscope), CT scan, PET scan, MRI scan, or a type of X-ray called a cholangiography. collecting a small sample of cells from the gallbladder (called a biopsy) to be checked for cancer.

What does the treatment of gallstone cancer depend on?

whether tumour is adenoma vs. adenocarcinoma

What is ampullary cancer?

Ampullary cancer is a rare type of cancer. It occurs when cancer starts in the part of the body called the ampulla of Vater. The ampulla of Vater is a small opening where the pancreatic and bile ducts (from the liver) connect to the first part of the small intestine (the duodenum)

What is the ampulla of Vater?

small opening that enters into the first portion of the small intestine, known as the duodenum. The ampulla of Vater is the spot where the pancreatic and bile ducts release their secretions into the intestines.

What are the 2 histological classifications of ampullary tumours?

adenoma vs. adenocarcinoma

What is an adenoma?

An adenoma is a benign (noncancerous) tumor.

What is an adenocarcinoma?

type of cancer that starts in mucus-producing (glandular) cells

What are the treatment options for ampullary tumours?

Endoscopic excision Trans-duodenal excision Pancreatico-duodenectomy

What is a pancreatico-duodenctomy?

The Whipple procedure, also called pancreaticoduodenectomy, is an operation to remove the head of the pancreas.