Hepato-Biliary Surgery Flashcards
(37 cards)
What is the function of the gallbladder?
- Bile reservoir
- Concentrates bile
- Secretes after meal (CKK)
What type of variation can the gallbladder exhibit?
Anatomical
What is the most common condition of the gallbladder?
Gallstone disease
Give 2 other examples of benign gallbladder conditions other than gallstone disease.
- Cholesterosis
- GB polyps
How can gallstones be found?
- Symptomatic presentation
- Autopsy
What different compositions of gallstones are there?
- Mixed
- Cholesterol
- Pigment
What are the risk factors for gallstones?
- Age
- Female
- Parity + OCP
- Cholesterol
- Pigment
What conditions are related to cholesterol and therefore increase the relative risk of gallstones?
- Obesity
- Ilieal disease
- Cirrhosis
- Cystic fibrosis
- Diabetes
- TPN
- Heart transplant
- Delayed GB emptying
- Clofibrate
- Long term low fat diet
How can gallstones present?
- Asymptomatic
- Dyspeptic symptoms
- Biliary colic
- Acute cholecystitis
- Empyema
- Perforation
- Jaundice
- Gallstone ileus
How does obstructive jaundice present?
- Painful
- Jaundice
- Dark urine
- Pale stool
- Pruritus
- Steatorrhoea
What are the 2 types of choledocho-lithiasis?
- Primary
- Secondary
When is choledocho-lithiasis usually discovered?
Incidental at cholecystectomy
What is choledocho-lithiasis associated with?
- Post cholecystectomy pain
- Acute pancreatitis
- Ascending cholangitis
What investigations are there for gallstones?
- Blood tests
- USS
- EUS
- Oral cholecystography
- CT
- Radio iso-tope scan
- IV cholangiography
- MRCP
- PTC
- ERCP
What blood should be done for gallstones?
- LFTs: ALT, AST, ALP
- Amylase
- Lipase
- WCC
What is the management for gallstones that are asymptomatic?
Watchful waiting
What non-operative treatment options are there for gallstones?
- Open cholecystectomy
- Mini-cholecystectomy
- Laparoscopic cholecystectomy +/- OTC
- Single port cholecystectomy
- NOTES cholecystectomy
- Cholecystectomy
- Subtotal cholecystectomy
How should common bile duct stones be managed?
- Expectant treatment (incidental)
- Lap trans-cystic CBD exploration
- Lap exploration of CBD
- Open exploration of CBD
- ERCP
- Transhepatic stone retrieval
Give 2 examples of congenital benign biliary tract disease.
- Biliary atresia
- Choledochal cysts
What is the aetiology of benign biliary stricture?
- Iatrogenic
- Gallstone related
- Inflammatory
What inflammatory cause of benign biliary stricture are there?
- Pyogenic
- Parasitic
- PSC
- Pancreatitis
- HIV
What are the types of cholecochal cysts?
- Type I
- Type II
- Type III
- Type IVA
- Type IVB
- Type V
What classification is used for iatrogenic bile duct injuries?
Strasberg classification
What malignant tumours can cause jaundice?
- Cholangiocarcinoma (intrahepatic, extrahepatic, gallbladder cancer, ampullary cancer)
- Cancer of the head of the pancreas
