NMS. Surgery

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Part IV ♦ Gastrointestinal Disorders B. Type II: Saccular diverticulum of extrahepatic ducts.

C. Type III: Choledochocele (dilation of the duct within the duodenum). D. Type IV: Cystic dilations of both intrahepatic and extrahepatic ducts. E. Type V: Caroli disease (intrahepatic cysts). III. Clinical presentation: A. Intermittent jaundice and RUQ pain. B. Females > males. IV. Diagnosis: Ultrasound, ERCP, and MRCP. V. Treatment: Includes cholecystectomy. 1. Type I: Cyst resection and roux-en-y hepaticojejunostomy. 2. Type II: Diverticulectomy. 3. Type III: Endoscopic sphincterotomy or transduodenal excision, based on size. 4. Type IV: Cyst resection, roux-en-y hepaticojejunostomy, and partial hepatectomy. 5. Type V: Symptom management (i.e., cholangitis), surveillance for cholangiocarcinoma, and hepatic resection or liver transplant. VI. Prognosis: 5% risk of malignancy. Quick Cuts • Early stage gallbladder carcinoma is cured by cholecystectomy; advanced stage is seldom curable. • ERCP is the preferred treatment of choledocholithiasis. • Ascending cholangitis can be lethal if not treated with decompression and antibiotics. • Biliary dyskinesia is diagnosed with HIDA scan and effectively treated with cholecystectomy. • PSC is biliary cirrhosis associated with ulcerative colitis. • Primary biliary cirrhosis leads to liver failure and may recur after transplantation. • Choledochal cysts are removed due to the risk of malignant degeneration.