Hepato-Biliary Surgery Flashcards
What are three functions of the gallbladder?
Bile reservoir
Concentrates bile
Secretes CCK after meal
What are the two benign conditions related to gallbladder disease?
Cholesterosis
Gallbladder polyps
What are gall stones made of?
Mixed - 80% of them
Cholesterol & Pigment - 20% of them
What are the risk factors for gall stones?
Age Gender Parity = OCP (4F) Cholesterol Pigment
What are the presentations of gall stones? (8)
Asymptomatic Dyspeptic symptoms Biliary colic Jaundice Acute cholecystitis Empyema Perforation Gallstone ileus
What is choledocho-lithiasis?
The presence of at least one gallstone in the common bile duct
What issues can arise from gallstones?
Primary vs Secondary Incidental at cholecystectomy Post-cholecystectomy pain Obstructive jaundice Acute pancreatitis Ascending cholangitis (Charcot's triad)
What investigations must be done for gallstones?
Bloods USS EUS Oral cholecystography CT Radio isotope scan IV Cholangiography MRCP PTC ERCP
What are the management options for gallstones?
Non-operative - Dissolution & Lithotripsy
Operative - Any type of cholecystectomy
How are bile duct injuries classified?
Strasberg classification
What are the two types of congenital benign biliary tract disease?
Biliary atresia
Choledochal cysts
What types of benign biliary stricture are there?
Iatrogenic
Gallstone related (Mirrizi’s)
Inflammatory - HIV, Pyogenic, Parasitic, PSC & Pancreatic
What percentage of Cholangiocarcinoma are intra/extrahepatic?
Intrahepatic - 6%
Extrahepatic - 94%
What are the types of intrahepatic tumuor?
Mass forming
Peri-ductal
Intra-ductal
What are the types of extrahepatic tumour?
Hilar
Distal
What are the three treatment options for malignant ampullary tumours?
Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy
What is a cholangiocarcinoma?
Form of cancer that is composed of mutated epithelial cells that originate in the bile ducts which drain bile from the liver into the small intestine
What are the six risk factors for cholangiocarcinoma?
PSC Congenital cystic disease Biliary-enteric drainage Thorotrast Hepatolithiasis Carcinogens
How do cholangiocarcinomas present?
Obstructive jaundice
Itching
Non-specific symptoms
What investigations should be done for cholangiocarcinoma?
Lab Radiology ERCP Cholangioscopy Cytology
What management options should be looked at for cholangiocarcinoma?
Surgical - Potential cure
Palliative - Priority is too remove jaundice
