Choledochal cysts

Question 1

Answer 1

Type I

Fusiform dilation of EXTRAhepatic bile ducts

Intrahepatic ducts not involved

Question 2

What choledochal cysts are NOT involved with intrahepatic ducts?

Answer 2

Type I, II, III, IVb

Question 3

What choledocal cysts are involve the intrahepatic ducts only?

Answer 3

Type V

Caroli disease

Question 4

Which choledochal cysts involve only extra-hepatic ducts?

Answer 4

Type I, II, III, IVb

Question 5

What choledocal cyst has one extrahepatic cyst and many intrahepatic cysts?

Answer 5

Type IVa

Question 6

What choledochal cyst has multiple small extrahepatic cysts along with no intrahepatic cysts?

Answer 6

Type IVb

Question 7

Which choledochal cysts involve both intra and extra hepatic ducts?

Answer 7

Type IVa

Question 8

Answer 8

type II

diverticulum off the CBD

Question 9

which choledochal cyst has decreased malignant potential?

Answer 9

Type II

diverticulum off the CBD

Question 10

Answer 10

Type IVa

one extrahepatic cyst and many intrahepatic cysts

Question 11

Answer 11

Type III

“choledochocele”

cystic dilation of the CBD within the wall of the duodenum

Question 12

Answer 12

Type IVb

multiple extrahepatic cysts without intrahepatic involvement

Question 13

Answer 13

Type V

“caroli disease”

only intrahepatic cysts

Question 14

The majority of choledochal cysts are associated with?

Answer 14

• Anomalous pancreaticobiliary junction (APBJ)
• This anomaly is defined as a long common biliary and pancreatic channel

Question 15

What is the MC symptom that leads to diagnostic imaging?

Answer 15

Jaundice

Question 16

What is the first diagnostic imaging ordered for choledochal cyst?

Answer 16

RUQ U/S

Question 17

What is the ideal imaging for a choledochal cyst?

Answer 17

MRCP

Shows detailed anatomy of the biliary and pancreatic ducts

Question 18

If you have choledochal cyst on MRCP or obstructive jaundice what is the next step?

Answer 18

ERCP or PTC

to confirm dx and offer intervention

Question 19

What is the intervention for a Type I cyst?

Answer 19

1. Cyst excision
2. roux en Y hepaticojejunostomy or hepaticoduodenostomy

Question 20

What is the intervention for a Type II cyst?

Answer 20

Resect diverticulum off the side of the CBD

Question 21

What is the intervention for a Type III cyst?

Answer 21

endoscopic sphincterostomy vs transduodenal excision and sphincteroplasty

Question 22

What is the intervention for a Type IV cyst?

Answer 22

1. cyst excision
2. Roux en Y hepaticojejunostomy or hepaticoduodenostomy
3. consider hepatic resection if cysts limited to one lobe

Question 23

Which cysts can be treated with hepaticojejunostomy or hepaticoduodenostomy?

Answer 23

Types I and IV

Question 24

What is the intervention for a Type V cyst?

Answer 24

liver transplant is needed to treat the whole disease