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HPB DAY

HPB DAY. Plan today 4 cases Images Present range of approaches Discussion. 38 year old female, 6 month history of recurrent attacks of severe epigastric pain -> back. Possibly dark urine at times USS….

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HPB DAY

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  1. HPB DAY

  2. Plan today 4 cases Images Present range of approaches Discussion

  3. 38 year old female, 6 month history of recurrent attacks of severe epigastric pain -> back. Possibly dark urine at times USS…

  4. 38 year old female, 6 month history of recurrent attacks of severe epigastric pain -> back. Possibly dark urine at times USS… Lap chole…

  5. Hepatobiliary Pathology Or how I learned to stop worrying and love the gallstone…

  6. Cholesterol Stones • Hypersecretion of cholesterol • Decreased bile salt secretion • Odd gallbladder • Old, female, pregnant, obesity, rapid weight loss, ethnicity,impaired GB motility e.g. parenteral nutrition

  7. Pigment (haem) Stones • Calcium bilirubinate • Chronic haemolysis

  8. 38 year old female, 6 month history of recurrent attacks of severe epigastric pain -> back. Possibly dark urine at times USS… Lap chole… 5 days postop readmitted with severe abdominal pain….. Why, what investigations

  9. USS (CT) Unremarkable What else …

  10. How might we identify preop which patients may harbour CBD stones….

  11. 44 year old female with 2 week history of obstructive jaundice OK LFTs but so what USS:

  12. 68 year old female with 2 week history of obstructive jaundice USS: CBD 16mm GB distended, no stones CT scan – unresectable ca pancreas Palliative R…. Stent - route

  13. ERCP Stent

  14. Percutaneous transhepatic cholangiography • Indications • Determination of obstructive jaundice • Level of obstruction • Persistent pain after GB removal • Contraindications • Close to 100% sensitivity and specificity in identifying cause and level of obstruction

  15. Self-expanding stent placed in the CBD of patient with non-resectable pancreatic tumour

  16. Palliative Treatment: (Biopsy) – including EUS Gemcitabine

  17. Pancreatic Cancer • Adenocarcinoma • Exocrine Pancreas • Older, males > females, fags, booze, fat, carbs. BRACA-2, PJS • 60, 10, 10% (Head, body, tail) • 80% outside pancreas at diagnosis • CA 19/9.

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