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let's shift gear and talk a little bit
about cola dose it's Cola dokgo cysts
are a congenital an abnormality that
cause abnormal enlargement of the bile
duct
this causes obstruction and hepatic
congestion and eventually liver failure
it's not that uncommon you can see a
here a picture of a patient with a gall
bladder and a large X ice-t-- excised
colloid ocol cyst happens about one in a
hundred thousand to one and a hundred
and fifty thousand patients so you'll
see one every several years of a large
birthing institution there are several
different types of cysts I don't think
it's likely that the test is going to
quiz you on which type of system is but
it's important to remember that there
are different types and so elucidating
what the type is may be beneficial in
terms of understanding exactly what's
going on with that patient by far the
most common is a cystic dilatation of
the peri
the extra hepatic biliary duct which you
can see here you can see here is on
their slide is a normal biliary tree and
then next to it in that common bile duct
there's just an outpouching or a cyst
that's formed along that duct
additionally patients can have an
abnormal pouch or a sac opening from the
duct this is a type 2 a type 3 is a cyst
which is located within the wall of the
actual duodenum a type 4 is when you
have swellings both in the intrahepatic
and extra hepatic biliary tracts so it's
inside the liver and just outside it and
type 5 is when there are multiple intra
fat exists this is the least common type
so key symptoms for any child with colla
do kosis is typically they will have
right upper quadrant pain now that's on
the test it's sometimes hard to truly
determine where the quadrant pain is in
an infant but you should see it but key
key and highly likely to
show up on your test these children will
have jaundice and they will have a colic
stools so they'll have a colic stools
again because that bile isn't getting
into the stools and their jaundice will
be from the hyper bilirubin emia which
is conjugated often they may have fever
or infection as a result of these cysts
being coming infected they may develop
pancreatitis and they often will have a
palpable mass in the right upper
quadrant you may be able to palpate this
cyst in general we'll get some labs
we'll get Billy Rubin which should be
elevated and should have a high
conjugated hyperbilirubinemia these
patients will often have elevated alq
foss ast alt and a high GG T as well
because again the Billy a tree isn't
biliary tree is involved as in other
things will get a coagulation profile a
PT PTT to assess the function of the
liver and see how badly off they're
doing and a CBC is often obtained as
well so the definitive diagnosis though
is made through an abdominal ultrasound
these cysts show up very nicely on
abdominal ultrasound rarely we may get
abdominal CT maybe an MRI instead the
MRI has the risk of needing sedation the
CT is a little bit quicker but has the
risk of radiation most centers are
moving more towards ultrasound however
sometimes the surgeons want a really
good idea what kind of Cola dokgo cyst
this is that they're dealing with and so
sometimes we'll get a magnetic remet
residence coley NGO pancreatic Rafi or
an MRCP to try and get a sense of
exactly what is the structure which type
of this is it is so the surgeons have an
idea of what they're getting into
treatment of the coaly Delco cyst is a
complete excision and a construction of
a biliary enteric and a stenosis
sometimes it's a Kasai procedure it
really depends on what the problem is
and this is what the surgeons are going
to look into after the imaging is done
so that is an assessment of the major
kinds of causes of conjugated
hyperbilirubinemia in young children
thanks for your time
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