Hepatobiliary Surgery Flashcards
What is the function of the gall bladder?
Stores and concentrates bile
Releasing it after a meal
What do you need to be aware of when operating on the gall bladder?
Anatomical variations between people
What is a common disease of the gallbladder?
Gallstones
What are the different composistions of gall stones?
Mixed
Cholesterol
Pigment
What are the risk factors for gall stones?
Age Gender Parity + OCP Female Forty Fertile Fat Cholesterol Obestiy
How do gallstones typically present?
Asymptomatic
Dyspeptic symptoms
Biliary colic
What is acute cholecystitis?
Acute inflammation of the gall bladder causing upper right quadrant pain
What investigations should be done for gallstones?
Blood tests - LFT, amylase, lipase, WCC USS EUS CT - picks up obstructive jaundice MRCP
What is the management of gallstones?
o Asymptomatic – do nothing o Non-operative treatment: o Trying to break down the stones to smaller pieces - Dissolution - Lithotripsy o Operative
Why is open cholecystectomy not the first line of treatment anymore/
Open surgery More invasive More complications Incision hernias are a risk Open surgery just to remove the GB
What is the gold standard of GB removal?
Laparoscopic cholecystectomy
Describe laparoscopic cholecystectomy?
Using a camera
Have one port for camera
3 port dissection to retract the GB
What is a cholecystotomy?
A procedure where a stoma is created in the gall bladder
What does a cholecystotomy allow?
Pus or infected bile to be drained out from the GB
If they are having to wait for a cholecystectomy
What are congenital causes of benign biliary tract disease?
Biliary atresia
Choledochal cysts
What is biliary atresia?
Where the bile duct and cystic duct has failed to form
What is a presentation of biliary atresia?
Jaundice baby
Need intervention surgery early in life
What do choledochal cysts carry a risk of?
Developing cancer
What is cholangiocarcinoma?
Cancer of the bile duct
Is gall bladder cancer rare?
Yes very
What are the risk factors for cholangiocarcinoma?
PSC
IBD
Malignancy history
Gallstones
What is the presentation of cholangiocarcinoma?
Itching Fever Abdominal pain Weight loss Jaundice
What investigations should be done for cholangiocarcinoma?
USS
CT
ERCP
What is the only curative Rx for cholangiocarcinoma?
Surgery
What 2 types of tumours can arise from the ampulla?
Adenoma
Adenocarcinoma
What are the treatment options for ampullary tumours?
Endoscopic excision
Go through the duodenum
Or the pancreas
What is cholangiocarcinoma?
Cancer of the biliary tree
What can be a symptom relieving treatment for cholangiocarcinoma?
Stenting
What is murphys sign?
When the GB is palpated and as the patient inhales it causes pain as the liver and GB is moving down onto the doctors hand
