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CR Cameron Biliary > Cystic Disorders of the Bile Duct > Flashcards

Cystic Disorders of the Bile Duct Flashcards

1
Q

Where are cystic disorders of the bile duct most common?

A

East Asia (incidence 1 in 13,000

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2
Q

What are Type I choledochal cysts?

A

cystic, fusiform, saccular extrahepatic biliary dilation

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3
Q

What are Type II choledochal cysts?

A

extrahepatic biliary diverticulum (supraduodenal)

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4
Q

What are Type III choledochal cysts?

A

dilation of extrahepatic intraduodenal biliary tree (choledochocele)

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5
Q

What are Type IV choledochal cysts?

A

A) intra and extra-hepatic saccular/cystic dilations, B) multiple extrahepatic cysts

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6
Q

What are Type V choledochal cysts?

A

Caroli disease, intrahepatic biliary cust

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7
Q

What is the classic triad of symptoms described for children with choledochal cysts and what percentage present with this triad?

A

abdominal pain, jaundice, palpable abdominal mass; 10-15%

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8
Q

What is the reported incidence of hepatopancreaticobiliary cancers in patients with choledochal cysts?

A

2.5-26%

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9
Q

Which choledochal cyst types have the highest risk of malignancy?

A

Types I, IV, and V

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10
Q

What are contraindications to operative management of choledochal cysts?

A

severe portal hypertension, uncorrected coagulopathy, and end-stage liver failure

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11
Q

What is the surgical treatment of choice for type I choledochal cyst?

A

45-60cm Roux-en-Y end to side hepaticojejunostomy

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12
Q

What is the treatment for Type II choledochal cysts?

A

simple cyst excision

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13
Q

What are treatment options for patients with Type III choledochal cysts?

A

Endoscopic sphincterotomy; complete excision via lateral duodenotomy, excision of the cyst, sphincteroplasty between bile duct mucosa and duodenal mucosa; pancreaticoduodenectomy if malignancy is suspected

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14
Q

What is the surgical treatment of choice for Type IVA choledochal cysts?

A

Unilateral cystic disease-hepatic lobectomy +hepaticojejunostomy; bilobar disease-complete extrahepatic excision, biliary enteric bypass, drainage of intra-hepatic biliary tree with bilateral silastic stents

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15
Q

What is the surgical treatment of choice for Type IVB choledochal cysts?

A

complete extrahepatic ductal excision with Roux-en-Y hepaticojejunostomy

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16
Q

What additional signs are indications for liver transplantation in patients with Type IVA choedochal cysts?

A

cirrhosis, portal hypertension

17
Q

What is the surgical treatment of choice for type V choledochal cysts?

A

Unilobar disease - hepatectomy + biliary enteric bypass; bilateral disease + portal hypertension/cirrhosis - liver transplantation

18
Q

True/False. Resection of choledochal cysts eliminates increase risk of cholangiocarcinoma.

A

FALSE

CR Cameron Biliary (12 decks)

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