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The Alimentary Canal > Hepatobiliary Surgery > Flashcards

Hepatobiliary 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

Why do surgeons need to be careful when performing surgery on gall bladder?

A

Anatomical variation

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3
Q

What are some diseases of the gall bladder?

A

Gallstone disease
Benign - cholesterosis and GB polyps

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4
Q

What is the composition of gallstones?

A

Mixed - cholesterol and pigment
20% just cholesterol or pigment

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5
Q

What are the risk factors for gall stones?

A

Age, gender (female), oral contraception pill, cholesterol and pigment

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6
Q

What is the presentation of gall stones?

A

Asymptomatic
Dyspeptic symptoms
Biliary colic - attack
Acute cholecystitis
Empyema, perforation
Jaundice

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7
Q

Describe choledocholithiasis

A

Primary - stones developed in bile duct
Secondary - stones jumped into bile duct
Can get post-cholecystectomy pain

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8
Q

What can be caused from choledocholithiasis?

A

Obstructive jaundice (painful) -pale stools, itching, steatorrhea
Acute pancreatitis
Ascending cholangitis - jaundice, fever, pain and rigors

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9
Q

What are the investigations used for gallstones?

A

USS, EUS
Radio isotope scan (HIDA)
ERCP

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10
Q

What bloods are done for gallstone investigation?

A

LFTs, ALT, AST, ALP
Amylase, lipase
WCC

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11
Q

What is the management for asymptomatic gallstones?

A

Nothing

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12
Q

What are some non-operative treatments for gallstones?

A

Dissolution - thin out solution, oxycolic acid
Lithotripsy - breaks down stones

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13
Q

What are the operative treatments for gall stones?

A

Open or mini cholecystectomy
Laparoscopic cholecystectomy is gold standard
NOTES
Single port

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14
Q

Describe laparoscopic cholecystectomy

A

Best option
Port in umbilicus
Less wound infections
Keyhole surgery

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15
Q

What is used for management of CBD stones?

A

Expectant treatment - incidental
Lap exploration
Open exploration
ERCP
Transhepatic stone retrieval

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16
Q

What are some congenital benign biliary tract diseases?

A

Biliary atresia
Choledochal cysts

17
Q

What are some benign biliary strictures?

A

Iatrogenic
Gallstone related
Inflammatory

18
Q

Describe biliary atresia

A

Born without bile duct
Treated with reconstruction and may need transplant

19
Q

Describe choledochal cysts

A

Dilation of BD in different locations
Recommended BD removed and reconstructed
Risk of cancer

20
Q

Describe Iatrogenic bile duct injuries?

A

Strasberg classification
Bile duct injury performing cholecystectomy
Management is surgery reconstruction

21
Q

Describe primary sclerosing cholangitis

A

Autoimmune condition
Dilation and stones which give beading pattern
Need bio-thinning meds and under observation

22
Q

Describe biliary enteric fistula

A

Bile flows along an abnormal connection from the bile ducts into a nearby hollow structure
Can present with air in BD

23
Q

What are some malignant cancers which cause jaundice?

A

Cholangiocarcinoma - intra and extrahepatic
Gallbladder cancer
Ampullary cancer
Cancer of head of pancreas

24
Q

What are the risk factors of cholangiocarcinoma?

A

PSC, congenital cystic disease, biliary enteric drainage, thorotrast, carcinogens

25
Q

What are the three types of intrahepatic cholangiocarcinoma?

A

Mass forming
Peri-ductal
Intra-ductal

26
Q

What is the treatment for intrahepatic cholangiocarcinoma?

A

Surgery is only option

27
Q

What is the presentations of cholangiocarcinoma?

A

Obstructive jaundice
Itching
Non specific symptoms - weight loss, vomiting

28
Q

What investigations are used for cholangiocarcinoma?

A

Lab
Radiology - USS, EUS, CT, MRA, MRCP and PET
ERCP, cholangioscopy

29
Q

What is the management for cholangiocarcinoma?

A

Surgical but only 10% of patients can be fit
Palliative

30
Q

What is the palliative treatment for cholangiocarcinoma?

A

Surgical bypass, stenting, radiotherapy, chemo, PDT

31
Q

Describe gallbladder cancer

A

Aggressive
Poor prognosis
Treatment depends on stage

32
Q

What are the treatment options for ampullary tumours?

A

Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy is gold standard

The Alimentary Canal (33 decks)

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