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Clinical > HBP surgery > Flashcards

HBP surgery Flashcards

1
Q

Borders of Calot’s triangle

A

Medial - common hepatic duct
Inferior - cystic duct
superior - inferior surface of liver

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2
Q

Contents of Calot’s triangle

A

Right hepatic artery
cystic artery
lymph node of Lund

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3
Q

What are the ducts of luschha?

A

The small ducts draining bile from the liver directly into the gallbladder

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4
Q

What artery is susceptible to injury in a cholecystectomy?

A

Right hepatic

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5
Q

Why dark urine with obstructive jaundice?

A

Increased conj bilirubin in serum is water soluble and is excreted in urine

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6
Q

Need to visualise biliary tract. Imaging of choice?

A

US - trans abdominal or endoscopic

ERCP

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7
Q

define obstructive jaundice

A

Jaundice ( hyperbilirubinaemia >2.5) from obstruction of bile flow to the duodenum

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8
Q

most common type of gallstones

A

Cholesterol stones 75%

pigmented 25%

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9
Q

What proportion of people with gallstone disease are asymptomatic?

A

80%

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10
Q

Imaging for suspected choledocholithiasis

A

MRCP

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11
Q

Imagine for gallstone cholecystitis / biliary colic / acute cholecystitis

A

US

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12
Q

Indications for cholecystectomy in asymptomatic patients

A

Sickle cell disease
Calcified / porcelain GB because risk of carcinoma
Child

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13
Q

Complication of ERCP

A

5% risk of pancreatitis

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14
Q

Management of choledocholithiasis

A

ERCP w papillotomy + balloon retrieval of stones

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15
Q

Murphy’s +ve

A

Acute cholecsystitis

not usually choledocholithiasis

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16
Q

Risk factors for calculus cholecystitis

A 
Prolonged fasting
TPN
Trauma
Multiple transfusions
Dehydration 
Prolonged post-op or ICU
17
Q

Most common cause of cholangitis

A

Choledocholithiasis

18
Q

What is Charcot’s Triad?

A

S&S of cholangitis

  • fever / chills
  • RUQ pain
  • Jaundice
19
Q

Reynolds Pentad

A

Charcots + altered mental status + shock

20
Q

Management of cholangitis

A 
non suppurative - IVFluids + abx
suppurative - IV fluids + abs + decompression 
ERCP w/ papillotomy
PTC with catheter drainage
Lap w/ T tube placement
21
Q

Most common type of gallbladder cancer

A

Adenocarcinoma

22
Q

Prognosis of GB carcinoma

A

if T1 and early resection 95% 5yr survival

but most are asymptomatic and present late as unresecable so <5% 5yr survival

23
Q

Importance of spread of GB cancer to the muscluaris / serosa

A

tx will be radical cholecystectomy + wedge resection of overlying liver + lymph node disection ± chemo/radio tx

24
Q

Needed for definitive diagnosis of acute cholecystitis

A

All three of
A. local signs of inflammation ( RUQ pain / mass/ Murphys)
B. Systemic signs of inflammation ( fever, CRP, WCC)
C. image findings

25
Q

timing of cholecystectomyoperation

A

early 24-72hrs

delayed 6-12wks

26
Q

Classic site for gallstone ileus to obstruct

gallstone ileus is most common in ?

A

Ileocaecal valve

women >70yrs

27
Q

Air in biliary tract on abdo Xray is…

A

Gallstone ileus

28
Q

Signs of gallstone ileus on xray

A

gallstone in bowel
air in biliary tract
small bowel distension
air fluid levels

29
Q

CT findings of gallstone ileus

A

Air in biliary tract
SBO
± gallstone in the bowel

30
Q

What type of IBD is most commonly associated with sclerosing cholangitis

A

Ulcerative colitis

31
Q

complications / sequelae of sclerosis cholangitis

A

cirrhosis + liver failure

10% develop cholangiocarcinoma

32
Q

How does sclerosis cholangitis manifest

A

Often asymptomatic

but may present as obstructive jaundice w. weight lots and fatigue

33
Q

Beads on a string dx

A

sclerosis cholangitis seen with PTC or ERCP with contrast

34
Q

management options for sclerosing cholangitis

A
  • Resection of extra hepatic bile ducts + hepatoenteric anastomosis
  • Transplant if dx is primarily intra-hepatic or cirrhosis
  • Endoscopic balloon dilations

Clinical (45 decks)

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