Hepato-biliary Surgery Flashcards
What are the risk factors for gallstones?
Age, gender, parity + OCP (4F), obesity, cirrhosis, CF, heart transplant, haemolytic anaemia and bile infection
What is the presentation of gallstones?
Asymptomatic, dyspepsia, biliary colic, acute cholecystitis, empyema, perforation and jaundice
What is choledocho-lithiasis?
The presence of gallstones in the common bile duct
What are the presentations of choledocho-lithiasis?
Obstructive jaundice, pain, dark urine, pale stool, pruritus and steatorrhoea
Acute Pancreatitis
Ascending Cholangitis
What investigations - blood tests can be done when gallstones are suspected?
LFTs: AST, ALT and ALP
Amylase, lipase and WCC
What investigations (apart from blood tests) can be done when gallstones are suspected?
USS, EUS, oral cholecystography, CT scan, radio-isotope scan, IV cholangiography, MRCP, PTC and ERCP
What is the management of gallstones?
Non-operative: dissolution and lithotripsy
Operative: cholecystectomy (open, mini, LAPAROSCOPIC etc.)
What is the management of CBD stones?
Lap exploration of the CBD, ERCP and transhepatic stone retrieval
What is the most common malignancy of the liver and gallbladder that causes jaundice?
Extrahepatic hilar cholangiocarcinoma
What are the risk factors for cholangiocarcinoma?
PSC, congenital cystic disease, biliary-enteric drainage, thorotrast, hepatolithiasis and carcinogens
What is the only curative treatment option for cholaiocarcinoma?
Surgery
What palliative treatment options are available for cholangiocarcinoma?
Surgical bypass, stenting, palliative radiotherapy, chemotherapy, PDT and liver transplant (not standard treatment)
What are the treatment options for ampullary tumours?
Endoscopic excision, trans-duodenal excision and pancreatico-duodenectomy
