Hepato-Biliary surgery

Question 1

What is the functions of the Gallbladder

Answer 1

Bile reservoir
Concentrates bile
Secretes after meal

Question 2

What hormone control bile secretion after a meal

Answer 2

CKK

Question 3

Where can anatomical variation occur with the gallbladder

Answer 3

With the cystic duct the hepatic duct

and blood supply to the gallbladder

Question 4

What are the benign condition of the Gallbladder

Answer 4

Gallstones

Cholesterosis
(change in gallbladder wall due to excess cholesterol)

GB Polyps

Question 5

What is in the composition of gallstones

Answer 5

Cholesterol and pigment

Question 6

What is the risk factors of gallstones

Answer 6

age 
gender 
Oral contraceptive pill
Obesity
diabetes

Question 7

What symptoms occur in gallstones

Answer 7

Asymptomatic 10-30%

Flatulent

dyspepsia/indegestion

Bilary colic: Nausea, vomiting, upper abdomen pain

Tenderness

Jaundice signs

Question 8

What is the complications that can occur inn gallstones

Answer 8

Acute cholecystitis

Empyemma

Perforation

Mirrizis syndrome

Gallstone illeus

Question 9

What occurs in gallstone ileus

Answer 9

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

Question 10

What occurs in Mirrzis syndrome

Answer 10

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

Question 11

What is biliary colic

Answer 11

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

Question 12

What happens in secondary gallstones =Choledocholithiasis

Answer 12

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

Question 13

What is the complications of secondary choledocholithiasis. gallstones

Answer 13

acute pancreaitis

Obstructibe jaundice

ascending cholangitis

Question 14

What is the symptoms of obstructive jaundice

Answer 14

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

Question 15

What is the blood test investigations for Gallstones

Answer 15

LFT (AST, ALT, ALP)

Amylase
Lipase
WCC

Question 16

What are the imaging techniques used for the investigations of gallstones

Answer 16

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

Question 17

What are the two non operative treatments of gallstones

Answer 17

Dissolution - split up gallstones

Lithotripsy - ultrasound waves to break up gallstones

Question 18

What are the operative treatment options for gallstones

Answer 18

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)

Question 19

What surgery for gallstones is the gold standard treatment option

Answer 19

Laparoscopic cholecystectomy

Question 20

How does Cholecystostomy procedure work

Answer 20

Creating an opening into the gallbladder for drainage

Question 21

When is operative not an option in gallstone removal

Answer 21

Diabetic
Co-morbidies
Obesity

Question 22

Define Choledocholithiasis

Answer 22

Presence of gallstones in common bile duct

Question 23

**What is the management on of Choledocholithiasis

Answer 23

Lap trans-cystic CBD exploration

Lap exploration of CBD

Open exploration of CBD

ERCP - Transhpatic stone retrieval

Question 24

What are congenital problems that result in biliary tract diseases

Answer 24

Bilary atresia - bile duct narrowing

Choledochal cysts - cystic dilation of bile ducts

Question 25

How does benign biliary strictures occur

Answer 25

Iatrogenic - damage to the bile ducts during surgery trauma to the abdomen pyogenic (pus) Gallstones primary sclerosing cholangitis (PSC) parasitic Pancreatitis

Question 26

Define Cholangiocarcinoma

Answer 26

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

Question 27

What does Cholangiocarcinoma develop from

Answer 27

PSC (strong association) Congenital cystic disease Biliary-enteric drainage Thorotrast (contrast) Hepatolithiasis: gallstones in the biliary ducts Carcinigens: aflatoxins, etc Risk increases with age

Question 28

What is the different forms of cholangiocarcinoma

Answer 28

Intrahepatic Extrahepatic Gallbladder Cancer Ampullary Cancer

Question 29

What is the three classification types of intrahepatic cholangicarcinoma

Answer 29

Mass forming Peri-ductal Intra-ductal

Question 30

What is the two types of extra hepatic cholangicarcionma

Answer 30

Hilar | Distal

Question 31

What is the symptoms of cholangiocarcioma

Answer 31

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

Question 32

What is the investigations for cholangiocarcinoma

Answer 32

``` Utrasound scan, Endoscopic US, CT, MRA, MRCP, PTC, Angiography, FDG PET ERCP, Cholangioscopy Cytology ```

Question 33

What is the management of cholangiocarcinoma

Answer 33

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

Question 34

What causes the majority of gallbladder cancer

Answer 34

existing gallstones

Question 35

Ampullary tumours are either

Answer 35

adenoma or adenocarcinoma

Question 36

What is the treatment options for ampullarf tumours

Answer 36

Endoscopic excision Trans-duodenal excision Pancreatico-duodenectomy

Question 37

What increases risk of ampullary tumours

Answer 37

FAP - inherited gene