Biliary tract Flashcards
Increased risk of malignancy in these choledochal cyst types?
Types of cancers?
1,4,5
cholangiocarcinoma > Squamous cell carcinoma, anaplastic, undifferentiated
Choledochal Cysts type 1A, 1B, 1C - What is dilated? Involvement of the intrahepatic ducts? Is area cystic duct enters dilated?
Management?
1A – entire extra hepatic biliary tree. Spares intrahepatic bile ducts. Cystic duct from dilated CBD.
1B - Focal dilation of extra
hepatic bile duct. Intrahepatic bile ducts not involved. Cystic duct from normal CBD.
1C - fusiform dilation of entire extra hepatic biliary tree. Extends into intrahepatic bile ducts. Cystic duct from dilated CBD
Management: complete excision and hepaticojejunostomy
Choledochal cysts - type II and III?
Management?
Type II - True diverticulum of the extra hepatic bile duct
Management: cyst excision
Type III - dilation of the distal, intraduodensl portion of the CBD
Management: sphincterotomy
Choledochal cysts - type IVa and type IVb?
Management?
type IVa - Multiple intra- and extrahepatic bile duct dilations
type IVb - Multiple dilations of the extra hepatic biliary tree
Management: cyst excision and hepaticojejunostomy; segmental hepatectomy of localized intrahepatic liver involvement
Choledochal cysts - type V?
Management?
Caroli disease – multiple dilations of the intrahepatic bile ducts
Segmental hepatectomy if localized; otherwise liver transplant
Most common type of gallstone?
Black stones associated with?
Brown stones associated with?
Cholesterol stones
Chronic hemolytic anemia
Biliary stasis and infection
Impacted cystic duct stone obstructing the common hepatic duct – named?
Mirizzi syndrome
Gastric outlet obstruction due to impaction of a gallstone in the pylorus or duodenum - named?
Bouveret’s Syndrome
Gallstone Obstructing terminal ileum - named?
Gallstone ileus
Who/what conditions qualify for prophylactic cholecystectomy?
-Porcelain gallbladder
-abnormal pancreaticobiliary junction
-gallbladder polyps over 1 cm
-native Americans
-morbidly obese patients undergoing bariatric surgery
-patients who undergo resection of small intestinal NETs with planned treatment with somatostatin analogs
Most common site of a bile leak after cholecystectomy?
Cystic duct stump ; ducts of Luschka
Gallbladder polyps caused by hyperplasia of the gallbladder mucosa associated with foamy macrophages?
Cholesterolosis
Gallbladder polyps characterized by thickened mucosa with invaginations into the muscularis propria?
Adenomyomatosis
Patients with gallbladder polyps under 1 cm - surveillance?
Ultrasound every 6-12 months
Risk factors for Cholangiocarcinoma: genetic conditions? Anatomic conditions? Inflammatory diseases? Infection?
Lynch syndrome
Choledochal cyst types 1,4,5 (Caroli disease)
PSC
Hepatitis C, liver flukes (clonorchis, opisthorchis)
