Hepatobiliary Surgery Flashcards
name some benign conditions of the gallbladder
> gallstones
cholesterosis
polyps
what is the composition of gall stones?
> 80% mixed
> 20% cholesterol, pigment
what are the risk factors for gall stones?
> age > gender (female) > parity + OCP > cholesterol > pigment (Far East)
how may patients with gallstones present?
> asymptomatic > dyspeptic symptoms > biliary colic (pain in upper abdomen, may be referred to shoulder) > jaundice > acute cholecystitis > empyema > perforation > gallstone ileus
what is gallstone ileus?
when the gall stone enters the duodenum and goes through the gi tract until it lodges in the ileum causing obstruction
what is acute cholecystitis?
acute inflammation of the gallbladder, touches the peritoneum causing localised tenderness
what is choledocholithiasis?
gallstones in the common bile duct
what are the signs and symptoms of choledocholithiasis?
> pain > jaundice > dark urine > pale stool > pruritus > steatorrhoea
what can choledocholithiasis cause?
> acute pancreatitis
ascending cholangitis
obstructive jaundice
what investigations would you carry out for gallstones?
> blood tests (LFTs, amylase, lipase, WCC)
USS (or EUS but only for certain patients)
oral cholecystography (no longer used)
CT scan (not good at picking up stones)
MRCP
ERCP or PTC (therapy only now)
how would you manage asymptomatic gallstones?
do nothing, due to surgical risk
what non-operative treatment is there for gallstones?
> dissolution (break down gallstones using chemicals)
> lithotripsy (US shockwaves which break down stones)
what is the “gold standard” surgical treatment for gallstones?
laparoscopic cholecystectomy
what operative treatments are there for gallstones?
> open cholecystectomy > mini chlecysectomy > laparoscopic cholecystectomy > single port cholecystectomy > NOTES (lecturer would not want this one tho)
name some congenital biliary tract diseases
> biliary atresia
> choledochal cysts
what are the causes of a benign biliary stricture?
> iatrogenic
gallstones
inflammatory
what could cause inflammatory benign biliary disease?
> pyogenic > parasitic > pancreatitis > PSC (primary sclerosing cholangitis) > HIV
what malignant tumours can cause jaundice?
> cholangiocarcinoma
> cancer of the head of the pancreas
what cholangiocarcinoma’s can you get?
> intra hepatic
extra hepatic
gallbladder cancer
ampullary cancer
what are the risk factors for cholangiocarcinoma?
> PSC > congenital cystic disease > biliary-enteric drainage > thorotrast > hepatolithiasis > carcinogens
name the three types of intra hepatic cholangiocarcinoma
> mass forming
peri-ductal
intra-ductal
what is the management for cholangiocarcinoma?
> Only curative option is surgery
> Palliative: surgical bypass, stenting, radiotherapy, chemotherapy, PDT, transplantation (not standard)
what is the presentation for cholangiocarcinoma?
> obstructive jaundice
itching
non-specific symptoms
what are the investigations for cholangiocarcinoma?
> Lab tests
Radiology: USS/EUS, CT, MRI, MRCP, PTC, angiography, PET scan
ERCP, cholangioscopy, cytology
what is the treatment of gallbladder cancer dependent on?
the stage of the cancer
what are the treatment options for ampullary tumours?
> endoscopic excision
transduodenal excision
pancreatico-duodenectomy
