CBD 31-40

Questions 1-6

Questions 7-11

Questions 18-20 

Questions 21-25

Q 26-30

Q 31-40

Q31 ) Choledochal cyst III, treatment (MCH GI 2019) 

A) Partial hepatic resection
B) Choledochojejunostomy
C) Transduodenal excision
D) Endoscopic drainage

Ans 31) d

Type III cysts are uncommon and may be approached transduodenally. Because the pathogenesis of type III cysts is not clear and may not involve APBJ, endoscopic drainage may suffice. In the setting of duodenal or biliary obstruction, transduodenal excision or sphincteroplasty can be performed.

Sabiston page 1511

Q32) False about management of cholangiocarcinoma?

a) Resection can be done in  absence of histological diagnosis
b) External  radiotherapy better than brachytherapy
c) Lobar hepatectomy can be done

d) None

Ans d , ALL are true

In tumors of the upper third of the extrahepatic biliary tree, to achieve R0 resection  partial hepatectomy with or without caudate lobectomy is recommeneded.  In some cases extended right hepatectomy that includes segment IV has to be done provided the Future liver remnant is adequate

Histological diagnosis is often not required and most of these lesions turn out to be malignant. Both ERCP and PTC have a sensitivity and specificity of approximately 70% for obtaining a tissue diagnosis However, a tissue diagnosis is not mandatory before proceeding with attempted resection for cholangiocarcinoma ( BG 821) 

None of the studies, isolated brachytherapy is given, its either EBRT or combined