Bile Duct MCQs

The cystic duct is about 3 cm in length but the length is variable. The lumen is usually 1-3 mm in diameter. The mucosa of the cystic duct is arranged in spiral folds known as the valves of Heister and the wall is surrounded by a sphincteric structure called the sphincter of Lutkens . The cystic duct joins the supraduodenal segment of the common hepatic duct in 80% of cases, however the anatomy may vary and the junction may be much lower in the retroduodenal or even retropancreatic part of the bile duct. Occasionally, the cystic duct may join the right hepatic duct or even a right hepatic sectorial duct. Reference : Bailey & Love's short practice of surgery 27 th edition, Chapter 67, The gallbladder and bile ducts, Pg no: 1188

Benign tumours of the bile duct These are uncommon and may be an incidental finding. For symptomatic patients, the duration of symptoms may vary from a few days to months and their clinical presentation may in fact mimic conditions such as cholecystitis,choledocholithiasis, cholangiocarcinoma or pancreatic cancer. Benign neoplasms causing biliary obstruction may be classified as follows: papilloma and adenoma; multiple biliary papillomatosis; granular cell myoblastoma; neural tumours; leiomyoma; endocrine tumours. Reference : Bailey & Love's short practice of surgery 27 edition, Chapter 67, The gallbladder and bile ducts, Pg no: 1207

Investigations Biochemical investigations will confirm the presence of obstructive jaundice (elevated bilirubin, alkaline phosphatase and γ-glutamyl transferase) in case of cholangiocarcinoma. The tumour-marker CA 19-9 may also be elevated . Imaging studies such as ultrasound, MDR-CT and MRI/MRCP are essential for diagnosis and staging. These studies allow the level of biliary obstruction to be defined and determine the locoregional extent of disease and the presence of metastases. Reference : Bailey & Love's short practice of surgery 28 th Edition, Chapter 71 Gallbladder and bile ducts Pg no: 1256-1257.