Hepatobiliary surgery Flashcards
What is the function of the gallbladder?
to store and concentrate bile
What hormone initiates the gallbladder to secrete?
CCK after a meal
What is cholesterosis?
“strawberry gallbladder”
excess cholesterol
What are gallstones made of?
cholesterol + pigment
Who is more likely to have gallstones? (male or female)
females (9:1)
What are the risk factors for cholesterol gallstones?
obesity, CF, ileal disease and cirrhosis
What are the risk factors for pigment gallstones?
bile infection
How are some ways a patient may present?
incidentally
empyema, dyspepsia, perforation, biliary colic, acute choleycystitis, jaundice
What is Mirrizi’s syndrome?
When a gallstone becomes impacted in the cystic duct or gallbladder causing compression of the common bile duct or common hepatic duct leading to obstruction and jaundice
What is choledolithiasis?
Presence of a gallstone in the common bile duct
What are the symptoms of choledolithiasis?
obstructive painful jaundice, dark urine, steathorrea and pale stool and pruiritis
What is charcot’s triad?
RUQ pain, jaundice and fever
What are some investigations of gallstones?
blood - LFT, AST, ALT, amylase, WCC, CRP, lipase
USS, EUS, CT, ERCP,
What are some non operable treatments of gallstones?
Flush them out by the kidneys using dissolution or try and break them up to be excreted
Describe the difference between open, mini, laparascopic and single port cholecystectomy
open - large incision no longer done
mini - using special retractors
laparascopic - routinely done 4 holes 1 for camera and 3 for instruments
single port - through umbilicus
What natural orifices can be used for laparascopy?
vagina, stomach and colon
What is a cholecystostomy?
Drain the gallbladder but no with people with co morbidities
How are CBD stones retrieved?
ERCP
What are 2 congenital biliary tract diseases?
biliary atresia
choledochal cysts
What happens in biliary atresia?
the bile or cystic duct or both fail to form and the patient becomes more and more jaundice
What are iatrogenic benign biliary tract diseases?
caused by surgery - injury to bile duct
What is PSC and what does it have a high risk of developing in to?
stricture autoimmune disease
cancer
What is biliary-enteric fistula?
abnormal connection of small bowel and gallbladder
What are the 3 types of intrahepatic cholangiocarcinoma?
mass forming
periductal
intraductal
What is the only curative option for intrahepatic cholangiocarcinoma?
surgery
What are some palliative treatments for intrahepatic cholangiocarcinoma?
chemo, radio, stent, bypass
Presentation of cholangiocarcinoma
itching, jaundice - painless and general symptoms
What are ampullary tumours?
Tumours arising from ampulla in duodenum
What is the prognosis for bladder cancer?
poor - 90% have gallstones
How are ampullary tumours treated?
polypectomy
How are patients with FAP handled?
screening for cancer
