Biliary Flashcards
(39 cards)
What is Type I Choledochal cyst?
Fusiform dilation of the extrahepatic bile ducts. The intrahepatic ducts are not involved.
What is a Type II Choledochal cyst?
Diverticulum off the common bile duct. The malignant potential is low
What is a Type III Choledochal cyst?
Also known as a choledochocele. This is defined as cystic dilation of the common bile duct within the wall of the duodenum
What is a Type IV Choledochal cyst?
Both intrahepatic and extrahepatic involvement.
Type IVa: one extrahepatic cyst with intrahepatic cysts
Type IVb: multiple small extrahepatic cyst
What type of choledochal cyst?
One Extrahepatic Cyst with intrahepatic cyst
Type IVa
What type of choledochal cyst?
Multiple small extrahepatic cyst
Type IVb
What is a Type V Choledochal cyst?
Only intrahepatic cysts; also known as Caroli disease
What etiology is most associated with choledochal cyst?
anomalous pancreaticobiliary junction (APBJ). 30% association
APBC: long common biliary and pancreatic channel
Treatment for Type I choledochal cyst?
cyst excision followed by Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy
Treatment for Type II choledochal cyst?
Resection of the diverticulum off the side of the common bile duct
Treatment for Type III choledochal cyst?
Endoscopic sphincterotomy versus transduodenal excision and sphincteroplasty
Treatment for Type IV choledochal cyst?
cyst excision followed by Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy. Hepatic resection should be considered if cysts are limited to one lobe.
Treatment for Type V choledochal cyst?
Typically, liver transplant required to treat entire disease
Up to ____% of patient have anatomic variations in biliary anatomy
40%;
most commonly, insertion of the right posterior sectoral duct into the left hepatic duct
Vascular supply of the biliary system:
Arterial blood supply runs along the common bile duct at the __ and __ o’clock positions
3 and 9
The bile duct below the level of the duodenal bulb is perfused by tributaries of the ______________________ and __________________ arteries
posterosuperior pancreaticoduodenal and gastroduodenal
The supraduodenal bile duct, cystic duct, and hepatic ducts are perfused by the ________________ and ______________ branches
right hepatic; cystic artery
Modified Bismuth/Strasberg classification E1-E5 typically require
biliary-enteric anastomosis for repair
(most commonly Roux-en-Y hepatico- or choledocho-jejunostomy)
Preoperative Preparation for bile duct injury repair with delayed identification
- Control Infection
- Preoperative cholangiography (ERCP to define injury and attempt to bridge with stent, Percutaneous transhepatic cholangiography for decompression, MRI/CT for vascular anatomy)
- Establish plan for definitive biliary enteric drainage
Nonthermal injuries that involve less than ___% of the duct circumference may be considered for ______________
50%; primary repair over a T tube
Injuries caused by electrocautery or those that involve more than _____% of the duct circumference ______________________________
50%; require major biliary reconstruction
Defects shorter than _____ and distal to the hilum and hepatic duct bifurcation may be repaired with ____________________________________ if adequate mobilization can be performed to allow a tension-free anastomosis
1 cm; end-to-end choledocho-choledochostomy
(A transanastomotic T tube should be placed through a separate vertical choledochotomy.)
_________ bile duct injuries can be reimplanted in the _______________________________________ if a tension-free repair can be achieved with a Kocher maneuver
Distal; duodenum (choledocho-duodenostomy)
(allows for future endoscopic access to the biliary tree but is associated with a higher risk of anastomotic leak than a Roux-en-Y choledocho-jejunal anastomosis)
__________ sectoral ducts (segments V-VIII) join to the ________ ___________ duct
Right; Right hepatic
