Hepato-Biliary Surgery Flashcards Preview

GI - Year 2 > Hepato-Biliary Surgery > Flashcards

Flashcards in Hepato-Biliary Surgery Deck (25)
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1
Q

What types of conditions can occur in the gallbladder?

A

Gallstones
Cholesterosis
Gallbladder polyps (which can develop into cancer)

2
Q

What are the risk factors for gallstones?

A
Age
Gender
Parity
Cholesterol 
Pigment
3
Q

What are the signs of gallstones?

A
Asymptomatic
Dyspeptic symptoms
Biliary colic
Acute cholecystitis
Empyema
Perforation
Jaundice
Gallstone ileus
4
Q

What are the investigations for gallstones?

A
Bloods (LFTs, AST, ALT, ALP, amylase, lipase, WCC)
Ultrasound
EUS
Oral cholecystography
CT scan
Radio isotope scan (HIDA)
IV cholangiography
MRCP
PTC
ERCP
5
Q

What are the non-operative treatments for gallstones?

A

Dissolution

Lithotripsy

6
Q

What are the operative treatments for gallstones?

A
Open cholecystectomy
Mini-cholecystectomy
Laparoscopic cholecystectomy +/- OTC
Single port cholecystectomy
NOTES cholecystectomy (through stomach)
Cholecystostomy
Subtotal cholecystectomy
7
Q

What are congenital benign biliary tract diseases?

A

Biliary atresia

Choledochal cysts

8
Q

What are benign biliary stricture caused by?

A

Iatrogenic
Gallstone related
Inflammatory (pyogenic, parasitic, PSC, pancreatitis, HIV)

9
Q

What is primary sclerosing cholangitis (PSC)?

A

Autoimmune disease that causes inflammation which results in scarring in bile duct = strictures
Some strictures can turn into cancer

10
Q

What is a biliary-enteric fistula?

A

When the gallbladder connects to another structure (e.g. duodenum, small bowel)

11
Q

What malignant tumours would cause jaundice?

A

Cholangiocarcinoma (intrahepatic 6%, extrahepatic 94%, gallbladder cancer, ampullary cancer)
Cancer of the head of pancreas

12
Q

What are the risk factors for cholangiocarcinoma?

A
PSC
Congenital cystic disease
Biliary-enteric drainage
Thorotrst
Hepatolithiasis
Carcinogens
13
Q

What are the 3 types of intrahepatic cholangiocarcinoma?

A

Mass forming
Peri-ductal
Intra-ductal

14
Q

What is the treatment for intrahepatic cholangiocarcinoma?

A

Surgery

15
Q

What is type 1 cholangiocarcinoma?

A

Tumour is below the right and left hepatic ducts

16
Q

What is type 2 cholangiocarcinoma?

A

Tumour is at the right and left hepatic ducts

17
Q

What is type 3a cholangiocarcinoma?

A

Tumour is occluding the common hepatic and right hepatic ducts

18
Q

What is type 3b cholangiocarcinoma?

A

Tumour occluding common hepatic and left hepatic ducts

19
Q

What is type 4 cholangiocarcinoma?

A

Tumour occluding both right and left hepatic ducts

20
Q

What is type 5 cholangiocarcinoma?

A

Tumours are multicentric

21
Q

What are the clinical signs of cholangiocarcinoma?

A

Obstructive jaundice
Itching
Non-specific symptoms

22
Q

What investigations are done for cholangiocarcinoma?

A

Radiology: USS, EUS, CT, MRA, MRCP, PTC, angiography, FDG PET
ERCP, cholangioscopy and cytology

23
Q

What is the management of cholangiocarcinoma?

A
Surgical: only potential curative option
Palliative:
- surgical bypass
- stenting
- palliative radiotherapy/chemotherapy
- PDT
- liver transplant (not standard)
24
Q

What is the prognosis for gallbladder cancer?

A

Poor unless detected early (rare)

Treatment depends on stage

25
Q

What are the treatment options for ampullary tumours?

A

Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy