Hepato-Biliary surgery Flashcards
What is the functions of the Gallbladder
Bile reservoir
Concentrates bile
Secretes after meal
What hormone control bile secretion after a meal
CKK
Where can anatomical variation occur with the gallbladder
With the cystic duct the hepatic duct
and blood supply to the gallbladder
What are the benign condition of the Gallbladder
Gallstones
Cholesterosis
(change in gallbladder wall due to excess cholesterol)
GB Polyps
What is in the composition of gallstones
Cholesterol and pigment
What is the risk factors of gallstones
age gender Oral contraceptive pill Obesity diabetes
What symptoms occur in gallstones
Asymptomatic 10-30%
Flatulent
dyspepsia/indegestion
Bilary colic: Nausea, vomiting, upper abdomen pain
Tenderness
Jaundice signs
What is the complications that can occur inn gallstones
Acute cholecystitis
Empyemma
Perforation
Mirrizis syndrome
Gallstone illeus
What occurs in gallstone ileus
small bowel obstruction due to gallstone at the lumen of the small intestine
What occurs in Mirrzis syndrome
Gallstone becomes stuck on the neck of the gallbladder, compressing bile duct resulting in jaundice
What is biliary colic
The generalised pain experienced after a meal or the early hours due to stretch in the gut wall of the upper abdomen
Can causes nausea and vomiting
What happens in secondary gallstones =Choledocholithiasis
Incidental in Cholecstectomy which results in gallstone movement into the common bile duct
What is the complications of secondary choledocholithiasis. gallstones
acute pancreaitis
Obstructibe jaundice
ascending cholangitis
What is the symptoms of obstructive jaundice
Pain,
jaundice,
dark urine,
pale stool, pruritus, steatorrhoea
What is the blood test investigations for Gallstones
LFT (AST, ALT, ALP)
Amylase
Lipase
WCC
What are the imaging techniques used for the investigations of gallstones
Ultrasound scan Endoscopic ultrasound Oral cholecystography CT scan Radio iso-tope scan (HIDA) IV cholangiography MRCP PTC ERCP
What are the two non operative treatments of gallstones
Dissolution - split up gallstones
Lithotripsy - ultrasound waves to break up gallstones
What are the operative treatment options for gallstones
Open cholecystectomy
(big scar)
Mini-cholecystectomy
(little scar, little instuments )
Laparoscopic cholecystectomy
Single port cholecystectomy
(access through umbilicus)
NOTES cholecystectomy
(through natural office, mouth, anus, vagina)
What surgery for gallstones is the gold standard treatment option
Laparoscopic cholecystectomy
How does Cholecystostomy procedure work
Creating an opening into the gallbladder for drainage
When is operative not an option in gallstone removal
Diabetic
Co-morbidies
Obesity
Define Choledocholithiasis
Presence of gallstones in common bile duct
**What is the management on of Choledocholithiasis
Lap trans-cystic CBD exploration
Lap exploration of CBD
Open exploration of CBD
ERCP - Transhpatic stone retrieval
What are congenital problems that result in biliary tract diseases
Bilary atresia - bile duct narrowing
Choledochal cysts - cystic dilation of bile ducts
How does benign biliary strictures occur
Iatrogenic - damage to the bile ducts during surgery
trauma to the abdomen
pyogenic (pus)
Gallstones
primary sclerosing cholangitis (PSC)
parasitic
Pancreatitis
Define Cholangiocarcinoma
cancer that arises from the cells within the bile ducts; both inside and outside the liver
What does Cholangiocarcinoma develop from
PSC (strong association)
Congenital cystic disease
Biliary-enteric drainage
Thorotrast (contrast)
Hepatolithiasis: gallstones in the biliary ducts
Carcinigens: aflatoxins, etc
Risk increases with age
What is the different forms of cholangiocarcinoma
Intrahepatic
Extrahepatic
Gallbladder Cancer
Ampullary Cancer
What is the three classification types of intrahepatic cholangicarcinoma
Mass forming
Peri-ductal
Intra-ductal
What is the two types of extra hepatic cholangicarcionma
Hilar
Distal
What is the symptoms of cholangiocarcioma
Obstructive jaundice:
Pain,
dark urine,
pale stool, pruritus, steatorrhoea
Itching
What is the investigations for cholangiocarcinoma
Utrasound scan, Endoscopic US, CT, MRA, MRCP, PTC, Angiography, FDG PET ERCP, Cholangioscopy Cytology
What is the management of cholangiocarcinoma
Surgical bypass
Stenting (Percutaneous vs Endoscopic)
Palliative radiotherapy
Chemotherapy
PDT (Photodynamic therapy)
liver transplant (not standard)
What causes the majority of gallbladder cancer
existing gallstones
Ampullary tumours are either
adenoma or adenocarcinoma
What is the treatment options for ampullarf tumours
Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy
What increases risk of ampullary tumours
FAP - inherited gene
