How do you approach the management of patients with bile duct strictures?

Sample interview questions: How do you approach the management of patients with bile duct strictures?

Sample answer:

• History and Physical Examination:

  • Obtain a detailed history, including the nature of the stricture (e.g., benign or malignant), its location, and the presence of associated symptoms (e.g., jaundice, abdominal pain, cholangitis).
  • Perform a physical examination to assess for signs of cholestasis (e.g., jaundice, scleral icterus, dark urine, pale stools) and any associated abdominal masses or tenderness.

• Laboratory and Imaging Studies:

  • Order laboratory tests to evaluate liver function (e.g., bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase) and to rule out infection (e.g., complete blood count, C-reactive protein).
  • Perform imaging studies to visualize the biliary tree and identify the location and extent of the stricture. Magnetic resonance cholangiopancreatography (MRCP) is typically the first-line imaging modality, followed by endoscopic retrograde cholangiopancreatography (ERCP) if further evaluation is needed.

• Endoscopic Management:

  • ERCP is the preferred initial treatment modality for most bile duct strictures. During ERCP, a stent can be placed across the stricture to relieve biliary obstruction and improve bile flow.
  • Balloon dilation can also be performed during ERCP to widen the stricture and facilitate the passage of bile.

• Surgical Management:

  • Surgical intervention may be necessary if endoscopic management is unsuccessful or if the stricture is malignant. Surgical options include:
    • Stricturoplasty: Surgical repair of the stricture to restore normal bile flow.
    • Hepaticojejunostomy: Creation of a new connection between the bile duct and the small intestine to bypass the stricture.
    • Liver transplantation: In cases of unresectable malignant strictures, liver transplantation may be considered…. Read full answer

      Source: https://hireabo.com/job/2_1_11/Gastroenterologist