GB ancer Flashcards
(26 cards)
What is the most common type of gallbladder cancer?
Adenocarcinoma
How common is gallbladder cancer in patients with gallstones?
It occurs in <1% of patients with gallstones.
What are the risk factors for gallbladder cancer?
• Gallstones
• Cholecystoenteric fistula
• Porcelain gallbladder (50% risk of cancer)
• Typhoid carrier
What is the most common location of gallbladder cancer?
Gallbladder fundus
What are the clinical features of gallbladder cancer?
• Often asymptomatic until late stage
• Constitutional symptoms: weight loss, fever
• Hepatobiliary symptoms: RUQ mass, pain, jaundice
• Early liver metastasis
What investigations are done for gallbladder cancer?
CBC, LFTs, Ultrasound, ERCP
How is gallbladder cancer managed based on tumor depth?
• Mucosa only: open cholecystectomy
• Beyond mucosa: open radical cholecystectomy (removal of GB, nearby liver segments, lymph node dissection) ± chemotherapy
Why is laparoscopic removal not recommended in gallbladder cancer?
It can cause tumor seeding at the trocar site
What is the prognosis of gallbladder cancer?
Very poor – 5-year survival rate is ~5%, due to late diagnosis
What is cholangiocarcinoma
Adenocarcinoma of bile ducts (originating from cholangiocytes)
What are the risk factors for cholangiocarcinoma?
• Choledochal cysts
• Primary sclerosing cholangitis (PSC)
• Liver flukes (Clonorchis sinensis)
What are the clinical features of cholangiocarcinoma?
• Location: bifurcation of hepatic ducts (proximal)
• Constitutional symptoms: weight loss, fever
• Cholangitis-like symptoms
• Cholestasis: dark urine, pale stools, jaundice, pruritus
• RUQ swelling
How is cholangiocarcinoma investigated?
Ultrasound, CT scan, ERCP biopsy
How is cholangiocarcinoma managed?
• Proximal tumors: Resection + Roux-en-Y anastomosis
• Distal tumors: Whipple procedure
What are the components of bile and their percentages?
- Bile salts & acids (50%) – for fat emulsification and absorption of vitamins A, D, E, K
- Phospholipids (40%) – mainly lecithin
- Bile pigments – conjugated bilirubin
- Cholesterol
Where is most bile reabsorbed?
In the terminal ileum (95%) via enterohepatic circulation
What stimulates gallbladder contraction?
Cholecystokinin (CCK), released in response to dietary fats and amino acids
What is the most common type of bile stone?
Cholesterol stones due to cholesterol supersaturation
What causes black pigmented stones?i
Chronic hemolysis, leading to bilirubin supersaturation
What leads to the formation of brown stones?
Infection of pigmented stones
What type of stones are associated with Crohn’s disease?
Calcium oxalate stones
What is jaundice?
Yellow discoloration due to elevated bilirubin (>2.5–3.5 mg/dL)
Where is jaundice first seen?
Under the tongue, then the sclera (clinically more useful)
What are the types and causes of hyperbilirubinemia?
• Pre-hepatic (lemon-yellow): hemolysis, Gilbert’s, Crigler-Najjar
• Hepatic (mixed): hepatitis, alcoholic cirrhosis, drug/toxin-induced liver damage
• Post-hepatic (olive green): cholestasis due to obstruction (e.g., choledocholithiasis, PSC, PBC, pancreatic cancer)
