Download Free Medical CBD Stones Stricture Carcinoma Gall Bladder Cholangiocarcinoma PowerPoint Presentation

CBD Stones Stricture Carcinoma Gall Bladder Cholangiocarcinoma PowerPoint Presentation

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Description : Check out this medical presentation on Bile Duct Cancer (Cholangiocarcinoma), which is titled "CBD Stones, Stricture Carcinoma Gall Bladder Cholangiocarcinoma", to know about CBD Stones, Stricture Carcinoma Gall Bladder Cholangiocarcinoma, and more.

Tags : Bile Duct Cancer, Cholangiocarcinoma, CBD Stones, Stricture Carcinoma Gall Bladder Cholangiocarcinoma,

Published on : May 10, 2021 | Views : 1956 | Downloads : 3

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Slide 1-

CBD Stones, Stricture Carcinoma Gall Bladder Cholangiocarcinoma Dr Amit Gupta Associate Professor Dept Of Surgery
Slide 2-

Common Bile Duct Stones (Choledocholithiasis)
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May be small or large Single or multiple Found in 6 to 12% of patients with stones in the gallbladder Incidence increases with age Secondary stones: Formed within the gallbladder and migrate down the cystic duct to the common bile duct Cholesterol stones Primary stones : form in the bile ducts Brown pigment type Associated with biliary stasis and infection
Slide 4-

Clinical Manifestations Silent and often are discovered incidentally May cause obstruction, complete or incomplete Cholangitis or gallstone pancreatitis Pain Mild epigastric or right upper quadrant tenderness
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Clinical Manifestations Mild icterus Symptoms may also be intermittent Elevation of serum bilirubin, alkaline phosphatase, and transaminases are commonly seen in patients with bile duct stones However, in about one third of patients with common bile duct stones, the liver chemistries are normal
Slide 6-

Diagnosis
Slide 7-

Ultrasound shows a normal or mildly dilated common bile duct with a stone
Slide 8-

ERCP shows multiple stones in the common bile duct
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Dilated CBD (>8 mm in diameter) on ultrasonography in a patient with gallstones, jaundice, and biliary pain is highly suggestive Magnetic resonance cholangiography (MRC) provides excellent anatomic detail Endoscopic cholangiography is the gold standard for diagnosing common bile duct stones.
Slide 10-

Management Options– CBD Stones Open cholecystectomy + CBD exploration ERCP + Endoscopic Sphincterotomy (followed by cholecystectomy – most frequently used). Laparoscopic cholecystectomy + Laparoscopic CBD exploration – in specialized centers. Choledochoscopy at laparoscopy or percutaneous choleydochoscopy or choleydochoscopy through T tube.
Slide 11-

ERCP has become a popular technique to clear CBD stones. Currently in the laparoscopic era studies have shown that laparoscopic treatment of CBD stones is possible and is potentially as effective as ERCP. This is most commonly done by a transcystic approach, though evidence of success in large volume cohorts with a more technically demanding laparoscopic Choledochotomy is emerging .
Slide 12-

Common Bile Duct Stricture
Slide 13-

operative injury MC by lap. cholecystectomy fibrosis due to: chronic pancreatitis common bile duct stones acute cholangitis biliary obstruction: cholecystolithiasis (Mirizzi's syndrome) sclerosing cholangitis Cholangiohepatitis strictures of a biliary-enteric anastomosis Causes
Slide 14-

Episodes of cholangitis Jaundice Liver function tests usually show evidence of cholestasis Clinical presentation
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Diagnosis Ultrasound / CT scan will show dilated bile ducts proximal to the stricture MRC : anatomic information about the location and the degree of dilatation Endoscopic cholangiogram will outline the distal bile duct
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ERC showing stricture of the common hepatic duct
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Management Depends on the location and the cause of the stricture Percutaneous or endoscopic dilatation and/or stent placement give good results in more than one half of patients Surgery with Roux-en-Y choledochojejunostomy or hepaticojejunostomy is the standard of care with good or excellent results in 80 to 90% of patients Choledochoduodenostomy may be a choice for strictures in the distal-most part of the common bile duct
Slide 18-

Carcinoma Gallbladder
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Etiology Accounts for 2 to 4% of malignant GI tumors 2-3 times more common in females than males 90% of patients have gallstones Larger stones (3 cm) are associated with tenfold increased risk of cancer Polypoid lesions of the gallbladder (>10 mm) Calcified "porcelain" gallbladder >20% incidence
Slide 20-

Choledochal cysts Sclerosing cholangitis Anomalous pancreaticobiliary duct junction Exposure to carcinogens (azotoluene, nitrosamines)
Slide 21-

Pathology 80 and 90% of the tumors are adenocarcinomas papillary, nodular, and tubular Squamous cell Adenosquamous Oat cell
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Cancer of the gallbladder spreads through: lymphatics venous drainage direct invasion into the liver parenchyma
Slide 23-

Clinical Manifestation Abdominal discomfort Right upper quadrant pain Nausea & vomiting Jaundice Weight loss Anorexia Ascites Abdominal mass
Slide 24-

Diagnosis FNAC /Biopsy (guided) Ultrasonography CT scan Percutaneous transhepatic or endoscopic cholangiogram (in jaundiced pt) MRCP
Slide 25-

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Slide 26-

CT scan of a patient with gallbladder cancer
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Staging: (AJCC 7th Edition)
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Treatment Surgery : Radical Cholecystectomy, Liver resection with regional lymphadenectomy Radiotherapy Adjuvant (pT1b onwards) Chemotherapy Concurrent Adjuvant Palliative
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Prognosis 5-year survival rate of all patients
Slide 30-

Cholangiocarcinoma
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Rare tumor arising from the biliary epithelium May occur anywhere along the biliary tree About 2/3rd are located at the hepatic duct bifurcation Male to female ratio is 1.3:1 Average age of presentation is between 50 to 70 years
Slide 32-

Etiology
Slide 33-

Distribution Right or left hepatic duct = 10% Bifurcation = 20% Proximal CBD = 30% Distal CBD = 30%
Slide 34-

Pathology Over 95% of bile duct cancers are adenocarcinomas. Anatomically they are divided into distal, proximal, or perihilar tumors. Intrahepatic cholangiocarcinomas are treated like hepatocellular carcinoma, with hepatectomy when possible. About two-thirds of cholangiocarcinomas are located in the perihilar location Perihilar cholangiocarcinomas, also referred to as Klatskin tumors, are further classified based on anatomic location by the Bismuth-Corlette classification
Slide 35-

Bismuth-Corlette classification Type I: confined to the common hepatic duct Type II: involve the bifurcation without involvement of the secondary intrahepatic ducts Type IIIA &IIIB: extend into the right and left secondary intrahepatic ducts, respectively Type IV: involve both the right and left secondary intrahepatic ducts
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Slide 37-

Clinical Presentation Painless jaundice Pruritus Mild right upper quadrant pain Anorexia Fatigue Weight loss Cholangitis Elevated ALK PO4 and GGT levels
Slide 38-

Intra and Extra-hepatic Cholangiocarcinoma
Slide 39-

Diagnosis Ultrasound abdomen CT scan Cholangiography : biliary anatomy is defined PTC Defines the proximal extent of the tumor, which is the most important factor in determining resectability. ERC: evaluation of distal bile duct tumors Celiac angiography: evaluation of vascular involvement MRI: has the potential of evaluating the biliary anatomy, lymph nodes, vascular involvement, tumor growth
Slide 40-

ERCP: Distal CBD Cancer
Slide 41-

MRCP of Extra-hepatic Cholangiocarcinoma at the Bifurcation Klatskin tumor
Slide 42-

Treatment Surgical excision is the only potentially curative treatment Location and local extension of the tumor dictates the extent of the resection
Slide 43-

Bismuth-Corlette type I or II with no signs of vascular involvement: local tumor excision with portal lymphadenectomy, cholecystectomy, common bile duct excision, and bilateral Roux-en-Y hepaticojejunostomies Bismuth-Corlette type IIIa or IIIb: right or left hepatic lobectomy respectively should also be performed
Slide 44-

Distal bile duct tumors: pylorus-preserving pancreatoduodenectomy (Whipple procedure) Unresectable distal bile duct cancer: Roux-en-Y hepaticojejunostomy, cholecystectomy and gastrojejunostomy
Slide 45-

Roux-en-Y Hepaticojejunostomy
Slide 46-

Cholangiocarcinoma Extra-hepatic Disease: Positive Margins or Unresectable Stent and Chemo/Radiation Therapy 5-FU based or Gemcitabine or Clinical Trial Survival with surgery and chemo/radiation is 24 to 36 m With chemo/radiation alone survival is 12 to 18 m.
Slide 47-

Cholangiocarcinoma Extra-hepatic Disease: Unstentable Bypass if possible If not use proximal decompression and feeding jejunostomy Chemotherapy/Radiation Therapy/Brachy therapy as tolerated or clinical trial.
Slide 48-

Prognosis Best Result are with distal CBD tumors completely excised. Cure = 40% Incomplete resection plus radiation gives a median survival of 30 m. Stenting plus chemo/radiation gives a median survival of 17 to 27m Those stented alone live only a few months