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Gastrointestinal Pathology > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

1
Q

What is the commonest condition of the gallbladder?

A

Gallstones

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2
Q

What is an important risk factor for developing gallbladder cancer?

A

Polyps

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3
Q

Definition of cholesterolosis

A

Gallbladder wall changes due to excess cholesterol

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4
Q

What appearance does the gallbladder have in cholesterolosis?

A

Strawberry gallblader

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5
Q

What % of gallstones are symptomatic?

A

10-30%

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6
Q

What are gallstones made up of?

A

Mixed stones
Cholesterol
Pigment

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7
Q

What % of mixed stones make up all gallstones?

A

80%

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8
Q

What % do cholesterol and pigment stones make up of gallstones?

A

20%

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9
Q

Risk factors for gallstones

A

Age
Gender
Parity + OCP = the 4Fs

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10
Q

Risk factors for cholesterol gallstones

A 
obesity 
ileal disease
cirrhosis
CF
DM
TPN
heart transplant 
delayed GB emptying
clofibrate 
long term low fat diet
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11
Q

Risk factors for pigment gallstones

A

Haemolytic anaemia
Bile infection
- E coli
- Bacteroides

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12
Q

Presentation of gallstones

A 
Asymptomatic 
Dyspeptic symptoms (flatulent dyspepsia)
Bloating after eating 
Biliary colic 
Acute cholecystitis 
Empyema / perforation 
Jaundice
Gallstone ileus
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13
Q

What is biliary colic?

A

Pain typically after having a meal / early hours of morning after dinner
Upper abdomen
Often also nausea and vomiting

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14
Q

Where is the pain in acute cholecystitis?

A

Right upper quadrant

Can be quite tender

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15
Q

What does perforation of the gallbladder result in?

A

Free gas in the abdomen due to the hole

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16
Q

What is Mirrizi’s syndrome?

A

Stone stuck in the neck of the gallbladder obstructing the common hepatic duct - resulting in jaundice

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17
Q

What is gallstone ileus?

A

Stone climbs into the bile duct and duodenum

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18
Q

Definition of choledocho-lithiasis

A

Gallstones in the common bile duct

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19
Q

Presentation of choledocho-lithiasis

A 
Obstructive jaundice
- pain 
- jaundice
- dark urine
- pale stool 
- pruritis 
- steatorrhoea 
Acute pancreatitis 
Ascending cholangitis
Rigors
Fever
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20
Q

What is charcots triad?

A

Rigors
Fever
Ascending cholangitis

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21
Q

Investigations for gallstones

A 
LFTs; AST, ALT, ALP
Amylase, Lipase
WCC
USS
EUS
Oral cholecystography 
Radio isotope cscan 
IV cholangiography 
MRCP 
PTC
ERCP
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22
Q

What is the first line investigation of gallstones?

A

USS

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23
Q

Treatment of gallstones

A

Dissolution
Lithotripsy
Surgery
- cholecystectomy

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24
Q

What is a cholecystostomy?

A

Drainage of the gallbladder

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25
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangio-Pancreatography

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26
Q

Examples of congenital benign biliary tract diseases

A

Biliary atresia

Choledochal cysts

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27
Q

Causes of a benign biliary stricture

A 
Iatrogenic
Gallstone related (Mirrizi's)
Pyogenic
Parasitic
PSC
Pancreatitis
HIV
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28
Q

What is biliary atresia?

A

Bile duct or cystic duct have failed to form

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29
Q

What do choledochal cysts carry the risk of? What is the lifetime risk of this?

A

Cancer malformation

Lifetime 10% cancer risk

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30
Q

What classification is used for iatrogenic bile duct injuries?

A

Strasberg classification

31
Q

What does PSC stand for?

A

Primary sclerosing cholangitis

32
Q

What is a biliary enteric fistula?

A

Fistula between gallbladder and organs that surround it

33
Q

What is a cholangiocarcinoma?

A

Bile duct cancer

34
Q

Types of cholangiocarcinoma

A 
Intrahepatic 6%
Extrahepatic
- hilar 67%
- distal 27%
Gallbladder cancer
Ampullary cancer
35
Q

How common is gallbladder cancer?

A

Very rare

36
Q

What is the peak age for a cholangiocarcinoma?

A

80 y/o

37
Q

Risk factors for cholangiocarcinoma

A 
PSC
Congenital cystic disease
Biliary enteric drainage 
Thorotrast (contrast)
Hepatolithiasis 
Carcinogens e.g. aflatoxins
38
Q

What does a cholangiocarcinoma have the strongest association with?

A

PSC

39
Q

Types of intra hepatic cholangiocarcinoma

A

Mass forming
Peri ductal
Intra ductal

40
Q

Presentation of cholangiocarcinoma

A

Obstructive jaundice
Itching
Non -specific symptoms (not feeling right)

41
Q

Investigations for cholangiocarcinoma

A 
USS
EUS
CT
MRA
MRCP
PTC
Angiography 
FDG PET
42
Q

What would be raised in cholangiocarcinoma?

A

Bilirubin

Phosphates

43
Q

Treatment of cholangiocarcinoma

A

Surgery

Palliative

44
Q

What do 90% of gallbladder cancers have?

A

Existing gallstones

45
Q

Prognosis of gallbladder cancer

A

Very poor

Aggressive

46
Q

Types of ampullary tumours

A

Adenoma

Adenocarcinoma

47
Q

Treatment of ampullary tumours

A

Endoscopic excision
Trans duodenal excision
Pancreatico-duodenoectomy

48
Q

Function of the gallbladder

A

Bile reservoir
Concentrates bile
Secretes after meal (CKK)

49
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

50
Q

What is ERCP for?

A

Procedure to see the pancreatic and bile ducts

51
Q

What % of ERCP are done for gallstones?

A

85%

52
Q

What % of ERCP are done for malignancy?

A

25%

53
Q

What does MRCP stand for?

A

Magnetic resonance cholangiopancreatography

54
Q

What does a MRCP show?

A

MRI for the biliary tree

55
Q

What is done in ERCP?

A

Travels to second part of the duodenum, to ampulla and sphinter of oddi, then cannulate, which will pass the stone out

56
Q

What does EUS show?

A

Walls
Bile ducts
Any stones

57
Q

What is the spinchter of oddi?

A

An area where the pancreatic duct and common bile duct empty into the duodenum

58
Q

What happens if there is a stone proximal to the pancreatic duct?

A

Digestive enzymes build up in the pancreas
These eat the pancreas
Causes acute pancreatitis

59
Q

Functions of the biliary system

A

Drain waste products from liver into duodenum

Help in digestion with the controlled release of bile

60
Q

Function of bile

A

Breaks down fats and vitamins during digestion

Carry away waste

61
Q

What is bile made up from?

A

Waste products
Cholesterol
Bile salts

62
Q

What is the ratio of cholesterol to bile salts in gallstones? What happens If this ratio is disturbed?

A

1 : 25

Gallstones are formed

63
Q

What hormone does the gallbladder respond to at mealtimes?

A

CCK

64
Q

Why is bile stored in the gallbladder normally?

A

So that the bile does not constantly drip into the duodenum when there is no food present

65
Q

Complications of gallstones

A 
Cholecystitis
Cholestasis
Jaundice
Cholangitis 
Pancreatitis 
Billiary cirrhosis
66
Q

What would fluroscene show in the biliary tree and why?

A

If obstruction or strictures

These areas would not fill as well

67
Q

Pathology of cholecystitis

A

Inflammation of the gallbladder

Due to stone in the exit of the gallbladder or if it enters the cystic duct

68
Q

What is cholestasis?

A

Stoppage of bile flow from the liver to the duodenum

69
Q

Pathology of cholestasis

A

Stone blocking the common bile duct

70
Q

What is cholangitis?

A

Inflammation of the bile ducts outside of the liver due to bacterial infection of stagnant bile

71
Q

How does pancreatitis occur as a complication of gallstones?

A

Stone blocking the pancreatic duct or the spinchter of oddi

72
Q

What can cholangitis lead to?

A

Hepatitis

73
Q

Pathology of biliary cirrhosis

A

Inflammation and obstruction of the bile ducts inside the liver
Leads to liver cirrhosis
As obstructs other liver cells

74
Q

What would gallstone ileus show on an AXR?

A

SBO and air in the biliary tree

Gastrointestinal Pathology (26 decks)

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