Hepato-Biliary Surgery Flashcards
What is the function of the gallbladder?
- Bile reservoir
- Concentrates bile
- Secretes after meal (CKK)
What type of variation can the gallbladder exhibit?
Anatomical
What is the most common condition of the gallbladder?
Gallstone disease
Give 2 other examples of benign gallbladder conditions other than gallstone disease.
- Cholesterosis
- GB polyps
How can gallstones be found?
- Symptomatic presentation
- Autopsy
What different compositions of gallstones are there?
- Mixed
- Cholesterol
- Pigment
What are the risk factors for gallstones?
- Age
- Female
- Parity + OCP
- Cholesterol
- Pigment
What conditions are related to cholesterol and therefore increase the relative risk of gallstones?
- Obesity
- Ilieal disease
- Cirrhosis
- Cystic fibrosis
- Diabetes
- TPN
- Heart transplant
- Delayed GB emptying
- Clofibrate
- Long term low fat diet
How can gallstones present?
- Asymptomatic
- Dyspeptic symptoms
- Biliary colic
- Acute cholecystitis
- Empyema
- Perforation
- Jaundice
- Gallstone ileus
How does obstructive jaundice present?
- Painful
- Jaundice
- Dark urine
- Pale stool
- Pruritus
- Steatorrhoea
What are the 2 types of choledocho-lithiasis?
- Primary
- Secondary
When is choledocho-lithiasis usually discovered?
Incidental at cholecystectomy
What is choledocho-lithiasis associated with?
- Post cholecystectomy pain
- Acute pancreatitis
- Ascending cholangitis
What investigations are there for gallstones?
- Blood tests
- USS
- EUS
- Oral cholecystography
- CT
- Radio iso-tope scan
- IV cholangiography
- MRCP
- PTC
- ERCP
What blood should be done for gallstones?
- LFTs: ALT, AST, ALP
- Amylase
- Lipase
- WCC
What is the management for gallstones that are asymptomatic?
Watchful waiting
What non-operative treatment options are there for gallstones?
- Open cholecystectomy
- Mini-cholecystectomy
- Laparoscopic cholecystectomy +/- OTC
- Single port cholecystectomy
- NOTES cholecystectomy
- Cholecystectomy
- Subtotal cholecystectomy
How should common bile duct stones be managed?
- Expectant treatment (incidental)
- Lap trans-cystic CBD exploration
- Lap exploration of CBD
- Open exploration of CBD
- ERCP
- Transhepatic stone retrieval
Give 2 examples of congenital benign biliary tract disease.
- Biliary atresia
- Choledochal cysts
What is the aetiology of benign biliary stricture?
- Iatrogenic
- Gallstone related
- Inflammatory
What inflammatory cause of benign biliary stricture are there?
- Pyogenic
- Parasitic
- PSC
- Pancreatitis
- HIV
What are the types of cholecochal cysts?
- Type I
- Type II
- Type III
- Type IVA
- Type IVB
- Type V
What classification is used for iatrogenic bile duct injuries?
Strasberg classification
What malignant tumours can cause jaundice?
- Cholangiocarcinoma (intrahepatic, extrahepatic, gallbladder cancer, ampullary cancer)
- Cancer of the head of the pancreas
What is the occurrence of cholangiocarcinomas?
Rare
What is the peak age for cholangiocarcinomas?
80
What are the risk factors for cholangiocarcinomas?
- PSC
- Congenital cystic disease
- Biliary enteric drainage
- Thorotrast
- Hepatolithiasis
- Carcinogens
What are the 3 types of intrahepatic cholangiocarcinomas?
- Mass forming
- Peri-ductal
- Intra-ductal
What is the only option for intrahepatic cholangiocarcinomas?
Surgery
How does cholangiocarcinoma present?
- Obstructive jaundice
- Itching
- Non-specific symptoms
What investigations should be carried out for cholangiocarcinoma?
- Lab
- USS
- EUS
- MRA
- MRCP
- PTC
- FDG
- PET
- ERCP
- Angiography
- Cholangioscopy
- Cytology
What palliative options are there for cholangiocarcinoma?
- Surgical bypass
- Stenting
- Palliative radiotherapy
- Chemotherapy
- PDT
- Liver transplant
What is usually already present in gallbladder cancer?
Gallstones
What is the treatment of gallbladder cancer dependent on?
Stage
What is the prognosis of gallbladder cancer?
Poor as it is agressive
What are the treatment options for ampullary tumours?
- Endoscopic excision
- Trans-duodenal excision
- Pancreatico-duodenectomy
What ampullary tumours can occur?
- Adenoma vs adenocarcinoma
- FAP and peri-ampullary tumours
