Lecture 17 Hepato-Biliary Surgery Flashcards
What are the functions of the gall bladder
- Bile reservoir
* Concentrates bile
When is bile secreted and what causes it
After a meal
CC
What is Cholesterolosis
Change in gall bladder wall due to excess cholesterol
Name Gallstone diseases
Cholesterolosis
Polyps
What compositions can gallstones be
Mixed
Cholesterol
Pigment
What are the risk factors for gallstones
- Age
- Gender
- Parity + OCP (4F)- Fat, Female, Forty, fertile
- Cholesterol: obesity, ileal disease, cirrhosis, cystic fibrosis, DM, TPN, heart transplant, delayed GB emptying, clofibrate, long-term low-fat diet
- Pigment (far east): M=F, haemolytic anaemia, bile infection (e-coli, Bacteroides)
What is the presentation of someone who has gallstones
- Asymptomatic
- Dyspeptic symptoms (flatulence)
- Biliary colic (pain causes by a gallstone temporarily blocking the cystic duct)
- Acute cholecystitis
- Empyema
- Perforation
- Jaundice (Mirrizi’s Syn.)
- Gallstone Ileus
What is Choledocho-lithiasis
Common bile duct stones
What signs and symptoms comes with gall stones in the common bile duct
Obstructive jaundice Pain Dark urine Pale stule Pruritus Steatorrhea
Why does a blockage in the common bile duct cause jaundice
When the bile ducts become blocked, bile builds up in the liver, and jaundice (yellow colour of the skin) develops due to the increasing level of bilirubin in the blood
How is bilirubin formed
Formed by the breakdown of red blood cells and the liver helps excrete it
What is ascending cholangitis
Charcot’s triad
Infection of the bile duct in the liver
What are the symptoms of ascending cholangitis
Jaundice
Fever
Rigors
RUQ abdominal pain
Investigations for gallbladder disease
• Blood tests: – LFT’s: AST, ALT, ALP – Amylase, Lipase – WCC • USS • EUS • Oral cholecystography • CT scan • Radio iso-tope scan (HIDA) • IV cholangiography • MRCP (Magnetic resonance cholangiopancreatography) • PTC (Percutaneous transhepatic cholangiography)- • ERCP (Endoscopic retrograde cholangiopancreatography)
Treatment
- Open cholecystectomy- large incision
- Mini-cholecystectomy- small incision under the rib
- Laparoscopic cholecystectomy +/- OTC “Gold Standard” – 4 incisions are made and a laparoscope with a camera is used with instruments to remove gall bladder
- Subtotal Cholecystectomy
Name a benign biliary tract disease
Biliary atresia
What is primary sclerosing Cholangitis
inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder (autoimmune disease)
What are the types of Cholangiocarcinoma
Intrahepatic or extra hepatic
Mass like
Periductal
Intra-ductal
Presentation of cholangiocarcinoma
- Obstructive jaundice
- Itching
- None-specific symptoms
What are the investigations for Cholangiocarcinoma
- Radiology: USS, EUS, CT, MRA, MRCP, PTC, Angiography, FDG PET
- ERCP, Cholangioscopy and Cytology
Management of Cholnagiocarcinoma
• Surgical: only potential curative option Palliative: • Surgical bypass • Stenting (Percutaneous vs Endoscopic) • Palliative radiotherapy • Chemotherapy • PDT • liver transplant (not standard)
What are Ampullary Tumours
cancer between the bile duct and small opening that enters into the first portion of the small intestine, known as the duodenum
Treatment options for ampullary tumours
Endoscopic excision
Transduodenal excision
Pancreatico-duodenectomy
