Cholangiocarcinoma

Question 1

What is the double duct sign on U/S?

Answer 1

Dilated pancreatic and common ducts suggests malignant obstruction distal to this point

Question 2

What is cholangiocarcinoma?

Answer 2

Malignancy of intra- or extra- hepatic bile ducts

Question 3

What is the most common presenting symptom for cholangiocarcinoma?

Answer 3

Obstructive jaundice

Question 4

RFx for cholangiocarcinoma?

Answer 4

• Age 50-70
• Gallstones
• Ulcerative Colitis
• Primary Sclerosing Cholangitis
• Choledochal cyst
• Chronic intrahepatic stones

Question 5

What is Courvoisier’s sign / law?

Answer 5

Palpable, nontender distended gallbladder due to CBD obstruction. Distended gallbladder could not be due to acute cholecystitis or stone disease because gallbladder would be scarred and small, not larger.

Question 6

What are the majority of cholangiocarcinomas?

Answer 6

Adenocarcinoma

Question 7

Signs of cholangiocarcinoma?

Answer 7

Gradual signs of biliary obstruction:
-jaundice
-pruritus
-dark urine
-pale stools
\+ anorexia, LoW, RUQ pain, Courvoisier's sign, hepatomegaly.

Question 8

Where does cholangiocarcionma commonly grow?

Answer 8

• Hepatic artery

- Portal vein

Question 9

What is Klatskin tumour?

Answer 9

Cholangiocarcinoma located at bifurcation of common hepatic duct.

Question 10

Ix in cholangiocarcinoma?

Answer 10

• LFTs: obstructive picture
• U/S + CT: ducts usually dilated
• ERCP: determine resectability
• CXR, bone scan: met work up

Question 11

Rx cholangiocarcinoma?

Answer 11

• Generally palliative

- If resectable: biliary drainage and wide excision margin