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Systems: Alimentary AB > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

1
Q

What is the function of the gallbladder?

A
  • Bile reservoir
  • Concentrates bile
  • Secretes after meal (CKK)
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2
Q

What type of variation can the gallbladder exhibit?

A

Anatomical

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3
Q

What is the most common condition of the gallbladder?

A

Gallstone disease

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4
Q

Give 2 other examples of benign gallbladder conditions other than gallstone disease.

A
  • Cholesterosis

- GB polyps

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5
Q

How can gallstones be found?

A
  • Symptomatic presentation

- Autopsy

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6
Q

What different compositions of gallstones are there?

A
  • Mixed
  • Cholesterol
  • Pigment
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7
Q

What are the risk factors for gallstones?

A
  • Age
  • Female
  • Parity + OCP
  • Cholesterol
  • Pigment
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8
Q

What conditions are related to cholesterol and therefore increase the relative risk of gallstones?

A
  • Obesity
  • Ilieal disease
  • Cirrhosis
  • Cystic fibrosis
  • Diabetes
  • TPN
  • Heart transplant
  • Delayed GB emptying
  • Clofibrate
  • Long term low fat diet
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9
Q

How can gallstones present?

A
  • Asymptomatic
  • Dyspeptic symptoms
  • Biliary colic
  • Acute cholecystitis
  • Empyema
  • Perforation
  • Jaundice
  • Gallstone ileus
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10
Q

How does obstructive jaundice present?

A
  • Painful
  • Jaundice
  • Dark urine
  • Pale stool
  • Pruritus
  • Steatorrhoea
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11
Q

What are the 2 types of choledocho-lithiasis?

A
  • Primary

- Secondary

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12
Q

When is choledocho-lithiasis usually discovered?

A

Incidental at cholecystectomy

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13
Q

What is choledocho-lithiasis associated with?

A
  • Post cholecystectomy pain
  • Acute pancreatitis
  • Ascending cholangitis
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14
Q

What investigations are there for gallstones?

A
  • Blood tests
  • USS
  • EUS
  • Oral cholecystography
  • CT
  • Radio iso-tope scan
  • IV cholangiography
  • MRCP
  • PTC
  • ERCP
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15
Q

What blood should be done for gallstones?

A
  • LFTs: ALT, AST, ALP
  • Amylase
  • Lipase
  • WCC
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16
Q

What is the management for gallstones that are asymptomatic?

A

Watchful waiting

17
Q

What non-operative treatment options are there for gallstones?

A
  • Open cholecystectomy
  • Mini-cholecystectomy
  • Laparoscopic cholecystectomy +/- OTC
  • Single port cholecystectomy
  • NOTES cholecystectomy
  • Cholecystectomy
  • Subtotal cholecystectomy
18
Q

How should common bile duct stones be managed?

A
  • Expectant treatment (incidental)
  • Lap trans-cystic CBD exploration
  • Lap exploration of CBD
  • Open exploration of CBD
  • ERCP
  • Transhepatic stone retrieval
19
Q

Give 2 examples of congenital benign biliary tract disease.

A
  • Biliary atresia

- Choledochal cysts

20
Q

What is the aetiology of benign biliary stricture?

A
  • Iatrogenic
  • Gallstone related
  • Inflammatory
21
Q

What inflammatory cause of benign biliary stricture are there?

A
  • Pyogenic
  • Parasitic
  • PSC
  • Pancreatitis
  • HIV
22
Q

What are the types of cholecochal cysts?

A
  • Type I
  • Type II
  • Type III
  • Type IVA
  • Type IVB
  • Type V
23
Q

What classification is used for iatrogenic bile duct injuries?

A

Strasberg classification

24
Q

What malignant tumours can cause jaundice?

A
  • Cholangiocarcinoma (intrahepatic, extrahepatic, gallbladder cancer, ampullary cancer)
  • Cancer of the head of the pancreas
25
Q

What is the occurrence of cholangiocarcinomas?

A

Rare

26
Q

What is the peak age for cholangiocarcinomas?

A

80

27
Q

What are the risk factors for cholangiocarcinomas?

A
  • PSC
  • Congenital cystic disease
  • Biliary enteric drainage
  • Thorotrast
  • Hepatolithiasis
  • Carcinogens
28
Q

What are the 3 types of intrahepatic cholangiocarcinomas?

A
  • Mass forming
  • Peri-ductal
  • Intra-ductal
29
Q

What is the only option for intrahepatic cholangiocarcinomas?

A

Surgery

30
Q

How does cholangiocarcinoma present?

A
  • Obstructive jaundice
  • Itching
  • Non-specific symptoms
31
Q

What investigations should be carried out for cholangiocarcinoma?

A
  • Lab
  • USS
  • EUS
  • MRA
  • MRCP
  • PTC
  • FDG
  • PET
  • ERCP
  • Angiography
  • Cholangioscopy
  • Cytology
32
Q

What palliative options are there for cholangiocarcinoma?

A
  • Surgical bypass
  • Stenting
  • Palliative radiotherapy
  • Chemotherapy
  • PDT
  • Liver transplant
33
Q

What is usually already present in gallbladder cancer?

A

Gallstones

34
Q

What is the treatment of gallbladder cancer dependent on?

A

Stage

35
Q

What is the prognosis of gallbladder cancer?

A

Poor as it is agressive

36
Q

What are the treatment options for ampullary tumours?

A
  • Endoscopic excision
  • Trans-duodenal excision
  • Pancreatico-duodenectomy
37
Q

What ampullary tumours can occur?

A
  • Adenoma vs adenocarcinoma

- FAP and peri-ampullary tumours

Systems: Alimentary AB (37 decks)

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