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Year 2- GIT > Hepato-Biliary Surgery > Flashcards

Hepato-Biliary Surgery Flashcards

(53 cards)

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1
Q

Cholesterosis is a benign condition affecting the gallbladder. What would you find in the gallbladder of those with this condition?

A

Small dots of cholesterol in the wall of the gallbladder

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2
Q

Gallbladder polyps may occur, and are benign. However, what can these polyps progress to?

A

Gallbladder cancer

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3
Q

If a polyp is <5mm, what does this mean?

A

It can be ignored

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4
Q

What happens if a polyp is >1cm?

A

It is removed

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5
Q

What are one of the most common surgical problems?

A

Gallstones

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6
Q

What are the two types of gallstones?

A

Cholesterol gallstones
Pigment gallstones

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7
Q

What are some of the risk factors for gallstones?

A

Age
Gender
Cholesterol related conditions e.g. obesity
Pigment related conditions e.g. anaemia, bile infections
Oral contraceptive pill

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8
Q

Are gallstones found more in males or females?

A

Females

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9
Q

How do gallstones present?

A

Usually asymptomatic
Sometimes dyspeptic symptoms
Biliary colic
Jaundice

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10
Q

What is the most common symptom suggestive of gallstones?

A

Biliary colic

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11
Q

What is biliary colic?

A

Recurrent upper abdominal pain, in the epigastrium, can radiate to shoulders

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12
Q

Which condition occurs when a gallstone becomes inflamed and infected?

A

Acute cholecystitis

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13
Q

What happens when the gallbladder gets pus in it?

A

Empyema- can perforate if not treated

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14
Q

What can happen if a gallstone sits and blocks the bile duct?

A

Jaundice

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15
Q

What is choledocho-lithiasis?

A

The presence of gallstones in the bile duct

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16
Q

Describe the difference between primary choledocho-lithiasis and secondary choledocho-lithiasis.

A

Primary choledocho-lithiasis- gallstone begins in the bile duct
Secondary choledocho-lithiasis- gallstones that started somewhere else, like the cystic duct and have ended up in the bile duct

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17
Q

What can choledocho-lithiasis cause if obstructing the bile duct?

A

Jaundice

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18
Q

What can choledocho-lithiasis cause if obstructing the pancreatic duct?

A

Pancreatitis

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19
Q

Describe what is meant by obstructive jaundice.

A

Painful condition due to narrow or blocked bile orpancreatic duct

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20
Q

List some of the symptoms of obstructive jaundice

A

Pain, jaundice, dark yellow urine, pale stool, steatorrhoea (fatty, greasy stool), itch.

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21
Q

Which other conditions can choledocho-lithiasis cause?

A

Pancreatitis
Ascending cholangitis

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22
Q

What are the three components of Charcot’s triad?

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A

Intermittent abdominal pain, fever, and jaundice

23
Q

What are some of the investigations for gallstones?

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A

Blood tests
Ultrasound
Endoscopic ultrasound
Oral cholecystography
CT

24
Q

What is specifically looked at in blood tests for indications of gallstones?

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A

LFT’s- AST, ALP, ALT
Amylase, Lipase
WCC

25
Which investigative technique is the gold standard for gallstones?
Ultrasound
26
What is the treatment/management for asymptomatic gallstones?
Nothing (unless more than 1cm I'm guessing)
27
What are some non-operative treatment options for gallstones?
Dissolution (using drugs to break them up) Lithotripsy (using shocks to break them up)
28
List some of the operative treatments for gallstones.
Open cholecystectomy Mini cholecystectomy Laparoscopic cholecystectomy Subtotal cholecystectomy Single port cholecystectomy NOTES cholecystectomy basically loads of different cholecystectomys
29
What is the gold standard procedure for gallstones?
Laparoscopic cholecystectomy
30
Describe briefly what happens in a single port cholecystectomy.
Insert instruments through the umbilicus
31
How can the gallbladder be removed in a NOTES cholecystectomy?
Through the vagina or oesophagus ->very very rarely used by means there is no scar
32
If a gallbladder is threatening to perforate, what should be done before it is removed?
Use a drain to get rid of the pus
33
Common bile duct stones are slightly different. List some of the ways they can be reoved.
Lap trans-cystic CBD exploration Lap exploration of CBD ERCP Transhepatic stone retrieval
34
What can ERCP be used for?
Stenting for pancreatic cancers Removing small gallstones from the CBD
35
What is biliary atresia?
When babies are born without a bile duct
36
What is a choledochal cyst?
Congenital anomaly meaning the bile duct is dilated in different locations
37
What do choledochal cysts increase risks of?
Biliary cancer in later years
38
What is meant by an iatrogenic bile duct injury?
Bile duct injury when performing a cholecystectomy
39
Name two autoimmune biliary conditions.
Primary biliary cholangitis Primary sclerosing cholangitis
40
What is a biliary enteric fistula?
Gallstones ending up in the bile duct via pipe-like ulcers (?)
41
How does ampullary cancer arise?
Polyp in the ampulla turned malignant
42
What are some of the risk factors for cholangiocarcinoma?
Age Primary sclerosing cholangitis Congenital cystic disease Biliary-enteric drainage Carcinogens Bile duct stones (hepatolithiasis)
43
What are the three types of cholangiocarcinoma?
Mass forming Peri-ductal Intra-ductal
44
What is the only treatment option for cholangiocarcioma?
Surgery to remove gallbladder
45
How does cholangiocarcinoma present?
Obstructive jaundice Itching Weight loss
46
Which investigations can be used for diagnosis of chalongiocarcinoma?
-Lab bloods -Radiology e.g. ultrasound, endoscopic ultrasound, CT, MRI, MRCP -ERCP, cholangioscopy
47
When is PTC used?
Stenting of the biliary tree
48
Which type of radiography is good for looking if metastatic disease has spread elsewhere?
PET scan
49
Discuss some of the palliative care options for cholangiocarcinoma
Chemo Radiotherapy Liver transplant-sometimes Stenting Surgical bypass
50
What are the treatment options for ampullary tumours?
Endoscopic excision Trans-duodenal excision Pancreatic-duodenectomy
51
What is the gold standard of treatment for ampullary tumours?
Pancreatic-duodenectomy
52
Which ducts, if blocked, can lead to jaundice?
Common bile duct ->blocking of the hepatic duct or cystic duct will not lead to jaundice
53

Year 2- GIT (37 decks)

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