Hepato-Biliary surgery Flashcards

1
Q

What is the functions of the Gallbladder

A

Bile reservoir
Concentrates bile
Secretes after meal

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2
Q

What hormone control bile secretion after a meal

A

CKK

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3
Q

Where can anatomical variation occur with the gallbladder

A

With the cystic duct the hepatic duct

and blood supply to the gallbladder

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4
Q

What are the benign condition of the Gallbladder

A

Gallstones

Cholesterosis
(change in gallbladder wall due to excess cholesterol)

GB Polyps

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5
Q

What is in the composition of gallstones

A

Cholesterol and pigment

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6
Q

What is the risk factors of gallstones

A
age 
gender 
Oral contraceptive pill
Obesity
diabetes
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7
Q

What symptoms occur in gallstones

A

Asymptomatic 10-30%

Flatulent

dyspepsia/indegestion

Bilary colic: Nausea, vomiting, upper abdomen pain

Tenderness

Jaundice signs

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8
Q

What is the complications that can occur inn gallstones

A

Acute cholecystitis

Empyemma

Perforation

Mirrizis syndrome

Gallstone illeus

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9
Q

What occurs in gallstone ileus

A

small bowel obstruction due to gallstone at the lumen of the small intestine

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10
Q

What occurs in Mirrzis syndrome

A

Gallstone becomes stuck on the neck of the gallbladder, compressing bile duct resulting in jaundice

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11
Q

What is biliary colic

A

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

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12
Q

What happens in secondary gallstones =Choledocholithiasis

A

Incidental in Cholecstectomy which results in gallstone movement into the common bile duct

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13
Q

What is the complications of secondary choledocholithiasis. gallstones

A

acute pancreaitis

Obstructibe jaundice

ascending cholangitis

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14
Q

What is the symptoms of obstructive jaundice

A

Pain,
jaundice,
dark urine,
pale stool, pruritus, steatorrhoea

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15
Q

What is the blood test investigations for Gallstones

A

LFT (AST, ALT, ALP)

Amylase
Lipase
WCC

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16
Q

What are the imaging techniques used for the investigations of gallstones

A
Ultrasound scan
Endoscopic ultrasound 
Oral cholecystography
CT scan
Radio iso-tope scan (HIDA)
IV cholangiography
MRCP
PTC
ERCP
17
Q

What are the two non operative treatments of gallstones

A

Dissolution - split up gallstones

Lithotripsy - ultrasound waves to break up gallstones

18
Q

What are the operative treatment options for gallstones

A

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)

19
Q

What surgery for gallstones is the gold standard treatment option

A

Laparoscopic cholecystectomy

20
Q

How does Cholecystostomy procedure work

A

Creating an opening into the gallbladder for drainage

21
Q

When is operative not an option in gallstone removal

A

Diabetic
Co-morbidies
Obesity

22
Q

Define Choledocholithiasis

A

Presence of gallstones in common bile duct

23
Q

**What is the management on of Choledocholithiasis

A

Lap trans-cystic CBD exploration

Lap exploration of CBD

Open exploration of CBD

ERCP - Transhpatic stone retrieval

24
Q

What are congenital problems that result in biliary tract diseases

A

Bilary atresia - bile duct narrowing

Choledochal cysts - cystic dilation of bile ducts

25
Q

How does benign biliary strictures occur

A

Iatrogenic - damage to the bile ducts during surgery

trauma to the abdomen

pyogenic (pus)

Gallstones

primary sclerosing cholangitis (PSC)

parasitic

Pancreatitis

26
Q

Define Cholangiocarcinoma

A

cancer that arises from the cells within the bile ducts; both inside and outside the liver

27
Q

What does Cholangiocarcinoma develop from

A

PSC (strong association)

Congenital cystic disease

Biliary-enteric drainage

Thorotrast (contrast)

Hepatolithiasis: gallstones in the biliary ducts

Carcinigens: aflatoxins, etc

Risk increases with age

28
Q

What is the different forms of cholangiocarcinoma

A

Intrahepatic
Extrahepatic
Gallbladder Cancer
Ampullary Cancer

29
Q

What is the three classification types of intrahepatic cholangicarcinoma

A

Mass forming
Peri-ductal
Intra-ductal

30
Q

What is the two types of extra hepatic cholangicarcionma

A

Hilar

Distal

31
Q

What is the symptoms of cholangiocarcioma

A

Obstructive jaundice:
Pain,
dark urine,
pale stool, pruritus, steatorrhoea

Itching

32
Q

What is the investigations for cholangiocarcinoma

A
Utrasound scan, 
Endoscopic US, CT, 
MRA, 
MRCP, 
PTC, Angiography, FDG PET
ERCP, Cholangioscopy  Cytology
33
Q

What is the management of cholangiocarcinoma

A

Surgical bypass

Stenting (Percutaneous vs Endoscopic)

Palliative radiotherapy

Chemotherapy

PDT (Photodynamic therapy)

liver transplant (not standard)

34
Q

What causes the majority of gallbladder cancer

A

existing gallstones

35
Q

Ampullary tumours are either

A

adenoma or adenocarcinoma

36
Q

What is the treatment options for ampullarf tumours

A

Endoscopic excision

Trans-duodenal excision

Pancreatico-duodenectomy

37
Q

What increases risk of ampullary tumours

A

FAP - inherited gene