Hepato-Biliary Surgery Flashcards
Is the anatomy of the gall bladder and bile ducts relatively constant from individual to individual?
No, there are several anatomical variations of how the gall bladder attaches to the bile duct and how the arteries are arranged around the GB (lec. for diagrams)
Main constituent of gallstones?
Most are mixed cholesterol and bilirubin (pigment)
About 20% are pure cholesterol or blirubin
Risk factors for gallstones?
- *High cholesterol
- *Gender (F)
Age
Oral contraceptives
Pigment issues (eg. bile infection)
Presenting symptoms of gallstones?
Often asymptomatic
Jaundice if obstructive
RUQ pain
Vomiting
Pale stools, dark urine & pruritus if obstructive
Investigations for gallstones?
Bloods (WCC, LFT's, AST) Ultrasound Endoscopic ultrasound Oral cholecystography CT scan IV cholangiography MRCP PTC (Percutaneous transhepatic cholangiography) ERCP
Treatment for gallstones in proximal (non-CBD) ducts?
- Laparoscopic cholecystectomy + OTC
- Open cholecystectomy
- Mini cholecystectomy
Management of common bile duct stones? (CBD stones)
Explore CBD obstruction - ERCP
- ERCP stone removal
- Cholecystectomy (6-12 weeks)
Malignant causes of jaundice?
Cholangiocarcinoma
Cancer of head of pancreas
What is a cholangiocarcinoma? Where are they usually found?
It is bile duct cancer
Mostly extrahepatic - intrahepatic only 6%
Risk factors for cholangiocarcinoma?
Age
Primary sclerosing cholangitis (and therefore with UC)
Congenital cystic disease
Presentation of cholangiocarcinoma?
Obstructive jaundice Itching Abdominal Pain Pale stools / dark urine / pruritus Cancer related symptoms
Investigations for cholangiocarcinoma?
ERCP Ultrasound (or EUS) CT Cholangioscopy MRCP PTC
Management of cholangiocarcinoma?
Surgery - Cholecystectomy (only curative option)
Palliative: Surgical bypass Stenting (endosc. or percut) Chemotherapy Radiotherapy
Risk factors for gallbladder cancer? What’s the prognosis like?
Gallstones - present in 90%
Aggressive cancer with poor prognosis unless caught early
