Hepato-Biliary Surgery Flashcards
What types of conditions can occur in the gallbladder?
Gallstones
Cholesterosis
Gallbladder polyps (which can develop into cancer)
What are the risk factors for gallstones?
Age Gender Parity Cholesterol Pigment
What are the signs of gallstones?
Asymptomatic Dyspeptic symptoms Biliary colic Acute cholecystitis Empyema Perforation Jaundice Gallstone ileus
What are the investigations for gallstones?
Bloods (LFTs, AST, ALT, ALP, amylase, lipase, WCC) Ultrasound EUS Oral cholecystography CT scan Radio isotope scan (HIDA) IV cholangiography MRCP PTC ERCP
What are the non-operative treatments for gallstones?
Dissolution
Lithotripsy
What are the operative treatments for gallstones?
Open cholecystectomy Mini-cholecystectomy Laparoscopic cholecystectomy +/- OTC Single port cholecystectomy NOTES cholecystectomy (through stomach) Cholecystostomy Subtotal cholecystectomy
What are congenital benign biliary tract diseases?
Biliary atresia
Choledochal cysts
What are benign biliary stricture caused by?
Iatrogenic
Gallstone related
Inflammatory (pyogenic, parasitic, PSC, pancreatitis, HIV)
What is primary sclerosing cholangitis (PSC)?
Autoimmune disease that causes inflammation which results in scarring in bile duct = strictures
Some strictures can turn into cancer
What is a biliary-enteric fistula?
When the gallbladder connects to another structure (e.g. duodenum, small bowel)
What malignant tumours would cause jaundice?
Cholangiocarcinoma (intrahepatic 6%, extrahepatic 94%, gallbladder cancer, ampullary cancer)
Cancer of the head of pancreas
What are the risk factors for cholangiocarcinoma?
PSC Congenital cystic disease Biliary-enteric drainage Thorotrst Hepatolithiasis Carcinogens
What are the 3 types of intrahepatic cholangiocarcinoma?
Mass forming
Peri-ductal
Intra-ductal
What is the treatment for intrahepatic cholangiocarcinoma?
Surgery
What is type 1 cholangiocarcinoma?
Tumour is below the right and left hepatic ducts
What is type 2 cholangiocarcinoma?
Tumour is at the right and left hepatic ducts
What is type 3a cholangiocarcinoma?
Tumour is occluding the common hepatic and right hepatic ducts
What is type 3b cholangiocarcinoma?
Tumour occluding common hepatic and left hepatic ducts
What is type 4 cholangiocarcinoma?
Tumour occluding both right and left hepatic ducts
What is type 5 cholangiocarcinoma?
Tumours are multicentric
What are the clinical signs of cholangiocarcinoma?
Obstructive jaundice
Itching
Non-specific symptoms
What investigations are done for cholangiocarcinoma?
Radiology: USS, EUS, CT, MRA, MRCP, PTC, angiography, FDG PET
ERCP, cholangioscopy and cytology
What is the management of cholangiocarcinoma?
Surgical: only potential curative option Palliative: - surgical bypass - stenting - palliative radiotherapy/chemotherapy - PDT - liver transplant (not standard)
What is the prognosis for gallbladder cancer?
Poor unless detected early (rare)
Treatment depends on stage
What are the treatment options for ampullary tumours?
Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy
