Pr. Preap Ley
Cholecystic Challenge: Test Your Knowledge on Choledochal Cysts
Welcome to the Cholecystic Challenge, a quiz designed for medical professionals and students alike to deepen their understanding of choledochal cysts and associated liver conditions. Dive into a series of thought-provoking questions that will not only test your knowledge but also enhance your clinical insight.
In this quiz, you will explore:
- Clinical presentations
- Diagnosis and management of choledochal cysts
- Echinococcal liver cysts and treatment strategies
- Surgical aspects and complications
female presents with RUQ abdominal pain. Workup reveals a choledochal cyst. Which of the following statements is TRUE?
Choledochal cysts are more common in men.
Laparoscopic cholecystectomy is the recommended treatment.
Patients with a choledochal cyst have an increased risk of cholangiocarcinoma.
The etiology is infectious.
A 13-year-old female presenting with RUQ abdominal pain is suspected of having a choledochal cyst. Which of the following studies would be least helpful in confirming the diagnosis in this case?
Computed tomography (CT) scan
Percutaneous transhepatic cholangiography
Endoscopic retrograde cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP)
Upper GI series
An intraoperative cholangiogram is performed during an elective laparoscopic cholecystectomy on a 30-year-old woman. She has no previous surgical history. There is a 0.8-cm filling defect in the distal common bile duct (CBD). The surgeon should:
Complete the laparoscopic cholecystectomy and check liver function tests (LFTs) postoperatively. If they are normal, no further treatment is needed.
Complete the laparoscopic cholecystectomy and repeat an ultrasound postoperatively. Observe the patient if no CBD stone is visualized.
Perform a CBD exploration either laparoscopically or open along with a cholecystectomy.
Complete the laparoscopic cholecystectomy, no further treatment is necessary.
Complete the laparoscopic cholecystectomy and plan for a postoperative hydroxyl iminodiacetic acid (HIDA) scan.
What is the appropriate treatment of a type I choledochal cyst?
Cyst excision with Roux-en-Y hepaticojejunostomy.
Simple excision of the cyst.
Endoscopic sphincterotomy.
Medical treatments
What are the types of choledochal cysts?
- Type I (most common)—fusiform extrahepatic. Treatment is resection and hepaticojejunostomy because of the high rates of recurrent pancreatitis and malignant transformation, Type II—diverticulum of common bile duct (local resection and repair), Type III—intra- and extrahepatic, TypeIV—intrahepatic.
Type I (most common)—fusiform extrahepatic. Treatment is resection and hepaticojejunostomy because of the high rates of recurrent pancreatitis and malignant transformation, Type II—diverticulum of common bile duct (local resection and repair), Type III—periampullary, Type IV—intra- and extrahepatic, Type V—intrahepatic.
Type I (most common)—fusiform extrahepatic. Treatment is resection and hepaticojejunostomy because of the high rates of recurrent pancreatitis and malignant transformation, Type II—diverticulum of common bile duct (local resection and repair), Type III—periampullary, Type IV—intra- and extrahepatic.
Type I (most common)—fusiform extrahepatic. Treatment is resection and hepaticojejunostomy because of the high rates of recurrent pancreatitis and malignant transformation, Type II—periampullary, Type III—intra- and extrahepatic, TypeIV—intrahepatic.
A 35-year-old woman presents with pancreatitis. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) reveals the congenital cystic anomaly of her biliary system illustrated in the film below. Which of the following statements regarding this problem is true?
Treatment consists of internal drainage via choledochoduodenostomy
Malignant changes may occur within this structure
Most patients present with the classic triad of epigastric pain, an abdominal mass, and jaundice
Cystic dilation of the intrahepatic biliary tree may coexist and is managed in a similar fashion
Surgery should be reserved for symptomatic patients
In the management of echinococcal liver cysts:
A large cyst should be treated by percutaneous aspiration of its contents
Medical treatment with albendazole usually preempts the need for surgical drainage
Negative serologic tests suggest that the cyst is chronic and inactive and that no treatment is indicated
Leakage of cyst fluid puts the patient at risk for anaphylactic reaction
Coexistent extrahepatic cysts are uncommon
Choledochal cyst clinical presentation is most commonly:
Abdominal pain, a palpable right upper quadrant mass, or jaundice.
Abdominal pain, a palpable right upper quadrant mass, or fever.
Abdominal ascites, a palpable right upper quadrant mass, or jaundice.
Abdominal pain, fever and Chill, or jaundice.
Nausea and vomiting, a palpable right upper quadrant mass, or jaundice.
Choledochal cyst type I increase risk of cholangiocarcinoma:
In 50 fold.
In 20 fold.
In 5 fold.
In 2 fold.
Percutaneous aspiration-injection-reaspiration (PAIR) is a treatment of Echinococcus granulosus, if it is amenable.
Puncture cyst under USS or CT guidance, Aspirate ~30% of cyst fluid volume, Inject an equal volume of a scolicidal agent such as hypertonic saline (30% saline = 300 g NaCl/litre) or 95% ethanol into the cyst, Reaspirate cyst contents after 30 minutes.
- Puncture cyst under USS or CT guidance, Aspirate ~50% of cyst fluid volume, Inject an equal volume of a scolicidal agent such as hypertonic saline (30% saline = 300 g NaCl/litre) or 95% ethanol into the cyst, Reaspirate cyst contents after 30 minutes.
Puncture cyst under USS or CT guidance, Aspirate ~30% of cyst fluid volume, Inject an equal volume of NSS, Reaspirate cyst contents after 30 minutes.
Puncture cyst under USS or CT guidance, Aspirate ~30% of cyst fluid volume, Inject an equal volume of a scolicidal agent such as hypertonic saline (30% saline = 300 g NaCl/litre) or 95% ethanol into the cyst, Reaspirate cyst contents after 15 minutes.
Surgical removal may be indicated for echinococcal granulosus liver cysts not amenable to the PAIR approach, especially if at risk of rupture or exerting pressure effects. Other indications are large cysts with multiple daughter cysts, cysts with biliary trees communication, and infected cysts. The principles of surgical management include:
Complete neutralization and removal of the parasite components, including the germinal membrane, scolices and brood capsules, prevention of contamination or spillage to prevent anaphylaxis or recurrence and management of the residual cavity.
No need to complete neutralization and removal of the parasite components, including the germinal membrane, scolices and brood capsules, prevention of contamination or spillage to prevent anaphylaxis or recurrence and management of the residual cavity.
Complete neutralization and removal of the parasite components, including the germinal membrane, scolices and brood capsules, prevention of contamination or spillage to prevent anaphylaxis or recurrence.
Complete neutralization and removal of the parasite components.
The treatment of echinococcal alveolaris liver cyst is
Liver transplantation
PAIR
Liver resection
Only antiparasitic drugs
Est ce qu’il y a de combien type de pancréatectomie caudale ?
2 types
3 types
4 types
Une patiente qui présente une tumeur probablement maligne à la queue du pancréas et aussi l’existent d’adénopathies manifestement métastatiques et autres exlorations ne trouvent pas de nodule de métastase hépatique ni de nodule de carcinose péritonéale. Laquelle est l’indication la plus idéale pour cette patiente?
Pancréatectomie caudale avec conservation splénique
Splénopancréatectomie gauche
Contre indication de chirurgie d’exérèse
Splénopancréatectomie gauche avec curage ganglionnaire
Concernant le technique de splénopancréatectomie gauche, laquelle est la proposition fausse?
Un décollement coloépiplooique afin d’ouvrir largement l’arrière- cavité des épiploons, ligature et section des vaisseaux courtes
L’exploration d’origine de l’artère splénique puis mise sur un lac et ensuite lié et sectionné
Décollement de la face postérieure du pancréas pour explorer l’origine de la veine splénique
Décollement de la queue et du corps du pancréas après section du péritoine pariétal postérieur au bord inférieur du pancréas
La veine splénique est liée et sectionnnée puis l’isthme du pancréas est sectionné par bistouri froid, ensuite fermeture la tranche de section du pancréas
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