Hepatobiliary Surgery

Question 1

What is the function of the gall bladder?

Answer 1

Stores and concentrates bile

Releasing it after a meal

Question 2

What do you need to be aware of when operating on the gall bladder?

Answer 2

Anatomical variations between people

Question 3

What is a common disease of the gallbladder?

Answer 3

Gallstones

Question 4

What are the different composistions of gall stones?

Answer 4

Mixed
Cholesterol
Pigment

Question 5

What are the risk factors for gall stones?

Answer 5

Age 
Gender
Parity + OCP 
Female 
Forty 
Fertile 
Fat
Cholesterol 
Obestiy

Question 6

How do gallstones typically present?

Answer 6

Asymptomatic
Dyspeptic symptoms
Biliary colic

Question 7

What is acute cholecystitis?

Answer 7

Acute inflammation of the gall bladder causing upper right quadrant pain

Question 8

What investigations should be done for gallstones?

Answer 8

Blood tests - LFT, amylase, lipase, WCC 
USS 
EUS 
CT - picks up obstructive jaundice 
MRCP

Question 9

What is the management of gallstones?

Answer 9

o	Asymptomatic – do nothing 
o	Non-operative treatment:
o	Trying to break down the stones to smaller pieces 
-	Dissolution 
-	Lithotripsy 
o	Operative

Question 10

Why is open cholecystectomy not the first line of treatment anymore/

Answer 10

Open surgery 
More invasive 
More complications 
Incision hernias are a risk 
Open surgery just to remove the GB

Question 11

What is the gold standard of GB removal?

Answer 11

Laparoscopic cholecystectomy

Question 12

Describe laparoscopic cholecystectomy?

Answer 12

Using a camera
Have one port for camera
3 port dissection to retract the GB

Question 13

What is a cholecystotomy?

Answer 13

A procedure where a stoma is created in the gall bladder

Question 14

What does a cholecystotomy allow?

Answer 14

Pus or infected bile to be drained out from the GB

If they are having to wait for a cholecystectomy

Question 15

What are congenital causes of benign biliary tract disease?

Answer 15

Biliary atresia

Choledochal cysts

Question 16

What is biliary atresia?

Answer 16

Where the bile duct and cystic duct has failed to form

Question 17

What is a presentation of biliary atresia?

Answer 17

Jaundice baby

Need intervention surgery early in life

Question 18

What do choledochal cysts carry a risk of?

Answer 18

Developing cancer

Question 19

What is cholangiocarcinoma?

Answer 19

Cancer of the bile duct

Question 20

Is gall bladder cancer rare?

Answer 20

Yes very

Question 21

What are the risk factors for cholangiocarcinoma?

Answer 21

PSC
IBD
Malignancy history
Gallstones

Question 22

What is the presentation of cholangiocarcinoma?

Answer 22

Itching 
Fever
Abdominal pain 
Weight loss
Jaundice

Question 23

What investigations should be done for cholangiocarcinoma?

Answer 23

USS
CT
ERCP

Question 24

What is the only curative Rx for cholangiocarcinoma?

Answer 24

Surgery

Question 25

What 2 types of tumours can arise from the ampulla?

Answer 25

Adenoma

Adenocarcinoma

Question 26

What are the treatment options for ampullary tumours?

Answer 26

Endoscopic excision
Go through the duodenum
Or the pancreas

Question 27

What is cholangiocarcinoma?

Answer 27

Cancer of the biliary tree

Question 28

What can be a symptom relieving treatment for cholangiocarcinoma?

Answer 28

Stenting

Question 29

What is murphys sign?

Answer 29

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