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GI System > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

1
Q

In what quadrant in the gall bladder in?

A

Right hypochrium

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2
Q

How is the gall bladder peritonised?

A

Intraperitoneal

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3
Q

Name different parts of the gallbladder

A

Fundus, body and neck

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4
Q

Name three function of the gall bladder

A
  • Bile Reservoir
  • Concentrated bile
  • Secretes bile after meal: stimulated by CCK
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5
Q

Name three common pathologies of the gallbladder

A

• Gallstones
Other:
• Cholesterosis
• GB polyps

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6
Q

What is cholesterosis?

A

A change in the gallbladder wall due to excess cholesterol

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7
Q

What is the composition of gallstones?

A
  • Mixed (>50% cholesterol)
  • Cholesterol
  • Pigment
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8
Q

Name four risk factors for formation of gallstones

A
  • Female
  • Parity (no. of times pregnant) + oral contraceptive pill (OCP)
  • Cholesterol
  • Pigment: haemolytic anaemia, bile infection (e. coli)
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9
Q

What is the presentation of gallstones?

A
  • Asymptomatic
  • Dyspeptic symptoms (flatulent dyspepsia)
  • Biliary colic
  • Acute cholecystitis
  • Empyema (not treated perforate peritonitis)
  • Perforation
  • Jaundice (Mirrizi’s syndrome)
  • Gallstone Ileus
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10
Q

List the investigations used for gallstones

A 
• Blood tests: 
  o LFTs: AST, ALT, ALP
  o Amylase, lipase
• USS
• EUS
• Oral cholecystography 
• CT
• Radio isotope scan 
• MRCP
• PTC*
• ERCP*

*not used to diagnose as risk of perforation and infection high

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11
Q

What is an ERCP?

A

A bendable, lighted tube (endoscope) placed through your mouth and into your stomach and duodenum

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12
Q

What is PTC investigation?

A

Percutaneous transhepatic cholangiography -

this procedure is similar to the ERCP and takes X-ray images of the bile duct

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13
Q

What are the three different types of treatment options used for gallstones?

A
  • Asymptomatic -> no treatment
  • Non-operative
  • Operative
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14
Q

What are the non-operative options used to treat gallstones?

A
  • Dissolution – only palliative as if young then have to have meds all of life
  • Lithotripsy – ultrasound shock waves break stones into smaller particles
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15
Q

What are operative options used to treat gallstones?

A

• Laparoscopic cholecystectomy +/- OTC (on-table cholangiogram)

  • Open cholecystectomy
  • Mini-cholecystectomy
  • Single port cholecystectomy
  • NOTES cholecystectomy
  • Cholecystectomy
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16
Q

What is the management of common bile duct stones?

A
  • Expectant treatment
  • Lap trans-cystic CBD exploration
  • Lap exploration of CBD
  • Open exploration of CBD
  • ERCP: pre-op, intra-op, post-op
  • Transhepatic stone retrieval
17
Q

What are congenital benign biliary tract disease?

A
  • Biliary atresia

* Choledochal cysts

18
Q

Name causes of benign biliary strictures

A 
• Iatrogenic 
• Gallstone related (Mirrizi’s)
• Inflammatory:
  o Pyogenic 
  o Parasitic 
  o PSC
  o Pancreatitis 
  o HIV
19
Q

Name two malignant tumour which cause jaundice

A
  • Cholangiocarcinoma

* Cancer of the Head of Pancreas

20
Q

Name risk factors for cholangiocarcinoma

A
  • Primary Sclerosing Cholangitis
  • Congenital cystic disease
  • Biliary-enteric drainage
  • Thorotrast
  • Hepatolithiasis
  • Carcinogens: aflatoxins
21
Q

What are the main types of cholangiocarcinoma?

A
  • Intrahepatic
  • Extrahepatic (commonest): hilar and distal
  • Gallbladder cancer
  • Ampullary cancer
22
Q

What are the three types of intrahepatic cholangiocarcinoma?

A
  • Mass forming
  • Peri-ductal
  • Intra ductal

Surgery is only option

23
Q

Describe the presentation of cholangiocarcinoma

A
  • Obstructive jaundice
  • Itching
  • Non-specific symptoms
24
Q

What investigations are used for cholangiocarcnoma

A
  • Radiology: USS, EUS, CT, MRS, MRCP, PTC, angiography, FCG PET
  • ERCP, cholangioscopy and cytology
25
Q

Describe the management of cholangiocarcinoma

A

Surgical: only potential curative option

Palliative:
• Surgical bypass
• Stenting 
• Radiotherapy 
• Chemotherapy 
• PDT (activating drug by light source to kill cancer cells)
• Liver transplant (rare)
26
Q

What are treatment options for ampullary tumours

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

GI System (28 decks)

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