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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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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…
38 year old female, 6 month history of recurrent attacks of severe epigastric pain -> back. Possibly dark urine at times USS… Lap chole…
Hepatobiliary Pathology Or how I learned to stop worrying and love the gallstone…
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
Pigment (haem) Stones • Calcium bilirubinate • Chronic haemolysis
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
USS (CT) Unremarkable What else …
How might we identify preop which patients may harbour CBD stones….
44 year old female with 2 week history of obstructive jaundice OK LFTs but so what USS:
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
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
Self-expanding stent placed in the CBD of patient with non-resectable pancreatic tumour
Palliative Treatment: (Biopsy) – including EUS Gemcitabine
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.