Choledochal cysts Flashcards
Type I
Fusiform dilation of EXTRAhepatic bile ducts
Intrahepatic ducts not involved
What choledochal cysts are NOT involved with intrahepatic ducts?
Type I, II, III, IVb
What choledocal cysts are involve the intrahepatic ducts only?
Type V
Caroli disease
Which choledochal cysts involve only extra-hepatic ducts?
Type I, II, III, IVb
What choledocal cyst has one extrahepatic cyst and many intrahepatic cysts?
Type IVa
What choledochal cyst has multiple small extrahepatic cysts along with no intrahepatic cysts?
Type IVb
Which choledochal cysts involve both intra and extra hepatic ducts?
Type IVa
type II
diverticulum off the CBD
which choledochal cyst has decreased malignant potential?
Type II
diverticulum off the CBD
Type IVa
one extrahepatic cyst and many intrahepatic cysts
Type III
“choledochocele”
cystic dilation of the CBD within the wall of the duodenum
Type IVb
multiple extrahepatic cysts without intrahepatic involvement
Type V
“caroli disease”
only intrahepatic cysts
The majority of choledochal cysts are associated with?
- Anomalous pancreaticobiliary junction (APBJ)
- This anomaly is defined as a long common biliary and pancreatic channel
What is the MC symptom that leads to diagnostic imaging?
Jaundice
What is the first diagnostic imaging ordered for choledochal cyst?
RUQ U/S
What is the ideal imaging for a choledochal cyst?
MRCP
Shows detailed anatomy of the biliary and pancreatic ducts
If you have choledochal cyst on MRCP or obstructive jaundice what is the next step?
ERCP or PTC
to confirm dx and offer intervention
What is the intervention for a Type I cyst?
- Cyst excision
- roux en Y hepaticojejunostomy or hepaticoduodenostomy
What is the intervention for a Type II cyst?
Resect diverticulum off the side of the CBD
What is the intervention for a Type III cyst?
endoscopic sphincterostomy vs transduodenal excision and sphincteroplasty
What is the intervention for a Type IV cyst?
- cyst excision
- Roux en Y hepaticojejunostomy or hepaticoduodenostomy
- consider hepatic resection if cysts limited to one lobe
Which cysts can be treated with hepaticojejunostomy or hepaticoduodenostomy?
Types I and IV
What is the intervention for a Type V cyst?
liver transplant is needed to treat the whole disease
