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Hepato-Biliary Surgery Flashcards

1
Q

What are the functions of the gallbladder?

A

Bile reservoir

Concentrates bile

Secretes after meal (CKK)

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2
Q

What can be said about the anatomy of the gallbladder from person to person?

A

Anatomical variations exist

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3
Q

What can be said about the anatomy of the blood supply to the gallbladder?

A

Anatomical variations exist

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4
Q

What are some examples of conditions of the gallbladder?

A

Gallstone disease

Cholesterosis

Gallbladder

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5
Q

What is the procedure where the gallbladder is removed called?

A

Cholecystectomies

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6
Q

What is the composition of gallstones?

A

Mixed (>50% cholesterol), 80%

Cholesterol 10%

Pigment 10%

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7
Q

What are risk factors for gallstones?

A

Age

Gender

Parity + oral contraceptives (OCP)

Cholesterol

Pigment (haemolytic anaemia, bile infection)

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8
Q

What are risk factors for high cholesterol?

A

Obesity

Ileal disease

Cirrhosis

Cystic fibrosis

DM

TPN

Heart transplant

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9
Q

What is the presentation of gallstones?

A

Asymptomatic

Dyspeptic symptoms

Biliary colic

Acute cholecystitis

Empyema

Perforation

Jaundice

Gallstone ileus

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10
Q

What is inflammation of the gallbladder?

A

Cholecystitis

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11
Q

What is the presence of a small gallstone in the comment bile duct?

A

Choledocholthiasis

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12
Q

What is the presentation of choledocholithiasis?

A

Post-cholecystectomy pain

Obstructive jaundice (painful)

Dark urine

Pale stool

Steatorrhoea

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13
Q

What investigations are done for gallstones?

A

Blood tests (LFTs, amylase, lipase, WCC)

USS

EUS

Oral cholecystography

CT scan

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14
Q

What are the two broad categories of gallstone management?

A

Non-operative treatment

Operative treatment

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15
Q

What is the non-operative management for gallstones?

A

Dissolution

Lithotripsy

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16
Q

What is a treatment that uses shock waves to treat gallstones?

A

Lithotripsy

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17
Q

What is the operative management of gallstones?

A

Open cholecystectomy

Mini-cholecystectomy

Laparoscopic cholecystectomy

Singl eport cholecystectomy

Cholecystectomy

Subtotal cholecystectomy

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18
Q

What does CBD stand for?

A

Common bile duct

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19
Q

What does the management of common bile duct stones involve?

A

Expectant treatment (incidental)

Lap trans-cystic, lap or open exploration of CBD

ERCP

Transhepatic stone retrieval

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20
Q

What procedure allows examination of the CBD or pancreatic duct using an endoscopy through the mouth?

A

Endoscopic retrograde cholangiopancreatography (ERCP)

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21
Q

What are benign biliary tract diseases?

A

Diseases that affect the bile ducts, gallbladder and other structures involved in the production and transportation of bile

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22
Q

What are examples of benign biliary tract diseases?

A

Biliary atresia

Choledochal cysts

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23
Q

What kind of diseases are benign biliary tract diseases?

A

Congenital

24
Q

What is biliary atresia?

A

Narrowing, blockage or absent bile ducts

25
What are choledochal cysts?
Cystic dilations of the biliary tree
26
What is a cyst?
Membraneous sac or cavity of abnormal character in the body containing fluid
27
What are the different categories of biliary atresia?
Iatrogenic Gallstone related Inflammatory
28
What are examples of inflammatory causes of biliary atresia?
Pyogenic Parasitic Primary sclerosing cholangitis (PSC) Pancreatitis HIV
29
What are the different types of choledochal cysts?
30
What are examples of malignant tumours that can cause jaundice?
Cholangiocarcinoma Cancer of the head of the pancreas
31
What is the name of bile duct cancer?
Cholangiocarcinoma
32
What are the broad categories of cholangiocarcinoma?
Extra-hepatic Intra-hepatic Gallbladder cancer Ampullary cancer
33
Which of intra and extra-hepatic cholangiocarcinoma occurs more often?
Extrahepatic (94%) Intrahepatic (6%)
34
Out of hilar and distal, where do most extrahepatic cholangiocarcinomas occur?
Hilar (67%) Distal (27%)
35
What are risk factors for cholangiocarcinoma?
PSC (strong association) Congenital cystic disease Biliary-enteric drainage Thorotrast (contrast) Hepatolithiasis Carcinogens (such as aflatoxins)
36
What is the presentation of cholangiocarcinoma?
Obstructive jaundice Itching Non-specific symptoms
37
What investigations are done for cholangiocarcinoma?
Lab Radiology (USS, EUS, CT, MRA, MRCP, PTC, angiography, FDG PET) ERCP, cholangioscopy and cytology
38
What is MRA?
Magnetic resonance angiogram Lets doctor see inside your blood vessels
39
What is MRCP?
Magnetic resonance cholangiopancreatography Visualises biliary and pancreatic ducts in a non-invasive manner using magnetic resonance
40
What is PTC?
Percutaneous transhepatic cholangiography Uses contrast injected into the biliary duct and x-rays to visualuse the anatomy of the biliary tract
41
How is cytology different from histology?
Cytology is the study of individual cells Histology is the study of individual tissues
42
What is the management of cholangiocarcinoma?
Surgery is the only potential curative option Palliative care
43
What can be done for palliative care for cholangiocarcinoma?
Surgical bypass Stenting (percutaneous vs endoscopic) Palliative radiotherapy Chemotherapy PDT Liver transplant (not standard)
44
What is PDT?
Photodynamic therapy Uses a drug and a particular kinds of light to form oxygen and kill cells
45
What is the incidence of gallbladder cancer like?
Rare, is 2-5% of all GI cancers
46
What is the prognosis of gallbladder cancer?
Poor, except if detected early
47
How is gallbladder cancer usually diagnosed?
Incidently whilst investigating gallstones
48
What does the treatment of gallstone cancer depend on?
What stage the cancer is
49
What is ampullary cancer?
Cancer that forms in th ampullar of Vater
50
What is the ampulla of Vater?
Small opening that enters into the first portion of the duodenum
51
What are the 2 histological classifications of ampullary tumours?
Adenoma Adenocarcinoma
52
What is an adenoma?
Benign tumour of glandular tissue
53
What is an adenocarcinoma?
Malignant tumour of gland tissue
54
What are the treatment options for ampullary tumours?
Endoscopic excision Trans-duodenal excision Pancreatico-duodenctomy
55
What is a pancreatico-duodenctomy?
Operation to remove the head of the pancreas

Alimentary System (41 decks)

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