Week 3.6 - Hepato-Biliary Surgery Flashcards
What are 7 presentations of gallstones?
ABE DA PJ
- asymptomatic most commonly
- biliary colic
- empyema
- dyspepsia
- acute cholecystitis
- perforation
- jaundice
what is choledocho-lithiasis?
gallstones in common bile duct.
- primary starts in bile duct
- secondary starts in cystic duct.
What are bile stones made of?
in uk mix of cholesterol and pigments. in rest of world usually either fully cholesterol or fully pigment.
What are risk factors for gallstones?
- women
- age
- contraceptive pills and parity
What is biliary colic?
recurring epigastric pain radiating to shoulder with nausea and vomiting, comonly following eating fatty foods
What signs do you see in acute cholecystitis?
colic pain. increased WBC, temp, CRP
Who do you see empyema in as a presentation of gallstones?
diabetics - have neuropathy so cant detect pain so turn up in worse condition
what is a risk of choledocho-lithiasis?
- may get stuck in ampulla and cause pancreatitis
When do bilestones become apparent?
usually during cholecystectomy.
What signs does choledocholithiasis (bilestones) cause?
- obstructive jaundice
- dark urine
- pale stool
- pruritis
- steatorrhea
How do you investigate gallstones and why?
- LFT’s - ALP, AST, ALT for obstruction
- amylase and lipase for pancreatitis
- WBC count- may raise suspicion of acute cholecystitis or cholangitis
What are different screening tests for gallstones? (4)
- ultrasound gold standard
- EUS small stones
- HIDA shows gallbladder function
- CT rule out cancer, perforation, infection
How do you manage gallstones? inc. non-op (2) and op (5)
- asymptomatic nothing
- non-operative is dissolution and lithotripsy to dissolve and break down
- open cholecystectomy, mini cholecystectomy, laparoscopic cholecystectomy (gold standard), NOTES, cholecystostomy
How do you manage bile duct stones?
- if asymptomatic and no harm, leave it
- if cystic duct, do laparoscopic trans-cystic CBD exploration
- if elsewhere, do laparoscopic exploration of bile duct. allows retreival of stones
What are the benign biliary tract diseases? (5)
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- PSC
- iatrogenic bile duct injuries
- choledochal cysts
- biliary atresia
- biliary enteric fistula
What is biliary atresia?
babies born with absence of bile duct. treat with reconstruction.
What is Choledochal cysts ?
congenital enlargements of bile ducts in different locations - type 1-6. recommended that bile duct removed and reconstruction done due to risk of cancer.
What is iatrogenic bile duct injuries?
injury acquired during cholecystectomy - not closed off bile duct properly
What is PSC?
autoimmune - finds dilatation of ducts in different areas, causing fibrosis and strictures - risk of cholangiocarcinoma.
What is biliary enteric fistula?
gallbladder may perforate into and form fistula with small intestine, stomach, colon or common bile duct following inflammation. stones can pass and block various parts of GIT. needs surgery.
What are the malignant tumours? (4)
called cholangiocarcinoma
- intrahepatic
- extrahepatic
- gallbladder
- ampullary
what are risk factors for cholangiocarcinoma?
- PSC,
- age 80,
- congenital disease like choledochal cysts,
- biliary enteric drainage,
- hepatolithiasis
- carcinogens
What is intrahepatic cholangiocarcinoma?
- cancer in the liver hilum,
- mass around duct or in duct.
- surgery to treat.
- if metastasises treat jaundice with stent
What is gallbladder cancer?
presentation usually too late and unsuitable for surgery so treat depending on stage. palliatively can treat jaundice. stent, chemo, radiotherapy
What is ampullary cancer?
tumour starts as benign polyp. from lining of duodenum or ampulla. if possible remove using pancreatico-duodenoscopy if high dysplasia.
What is FAP?
genetic condition presenting with many polyps in colon. at early age do colonoscopy to avoid cancer. in 40’s develop duodenal polyps - low survival of 50/60.
What does extrahepatic cholangiocarcinoma present as?
obstructive jaundice typically. non-specific cancer symptoms. check if metastasised to determine treatment. radiology and labs to diagnose. stent if not resectable.
