Upper GI & Hepatobiliary Surgery

Persistent cystic-duct obstruction inflames the gallbladder rather than causing transient biliary colic: assess for sepsis and common-bile-duct disease, give supportive and antimicrobial treatment when indicated, and arrange early source control.

Bacteria multiply in bile trapped behind an obstructed common bile duct, and rising pressure in the duct drives them into the bloodstream.

Gallstones are often silent; when a stone transiently obstructs the cystic duct, it causes biliary colic, while persistent or downstream obstruction produces cholecystitis, jaundice, cholangitis or pancreatitis.

Gastric cancer is usually adenocarcinoma: early disease can be subtle, while alarm symptoms should trigger a current NICE suspected-cancer pathway, biopsy-based diagnosis, whole-body CT and specialist MDT staging before treatment is selected by resectability and tumour biology.

A hiatus hernia is upward displacement of stomach through the oesophageal hiatus; sliding hernia can impair the reflux barrier, while para-oesophageal or mixed hernia can cause early satiety, bleeding, obstruction or volvulus, so treatment is driven by symptoms, complications, anatomy and operative risk.

Progressive dysphagia is an urgent cancer symptom: confirm oesophageal cancer with endoscopy and biopsy, stage it with CT and selected PET-CT, EUS or laparoscopy, then use histology, stage, fitness and MDT review to guide curative or palliative treatment.