 In today's talk on sergiocondition that we fortunately don't see very often and those are tumors of the Biliri tree. Now we see patients that are slightly older and we do have a male predominance and they present to us by and large with painless jaundice. But you've got to think of the anatomy of the Biliri tree and I'll link to some images in the description below. Just always think of the anatomy. We divide the Biliri tree usually in thirds when it comes to tumors of the Biliri tree. We have the lower third, we have the middle third and then we have the upper third which is really by the hyalum and the left and right hepatic ducts as they start going into or at least into the liver. Now the ones in the lower third and the middle third they present more common. They'll make up more than half of the cases and upper third will be less than half of the cases. The ones that are in the lower third and the middle third and specifically those that develop below where the common hepatic duct and the cystic duct combine to form the common bile duct. The tumors below that we are going to see the stention of the gallbladder and that has a name. It's called Kovosius sign where we have this painless distented gallbladder in a patient with jaundice. Now these patients have nausea, they have all patients really with cholangococinoma can have weight loss. They do feel unwell and they have proritus and then they have obviously this deepening jaundice. It is an obstructive jaundice so they are going to have dark urine and pale stools as we see with chilodocolathiasis as an obstructive cause of jaundice. So these patients with the bile ducts they really need confirmation of the disease and delineating the anatomy. When it comes to the tumors in the upper third we do have a bit of a classification for them. You might be asked about those. We have a type 1, type 2, 3 and 4 and really type 3 and 4 those are inside of the liver secondary bile ducts. 2 is will be above the hyalum and 1 will really be at the common level of the common hepatic duct. And remember that's above the level where the cystic duct is going to enter the biliary tree so you're not going to have this Kovosius sign with this large palpable gallbladder that we do see. Remember there's a special tumor we call it a clatskin tumor. That's really for tumors around the bifurcation where the left and right hepatic ducts combine to form the common hepatic duct. So it is all about imaging then. We will do CD scans, we will do MRIs, MRCPs, just to delineate the anatomy. And it is about receptability in these instances. So these patients really have to be referred to unit that deals with these sections. They are bigger sections if we're talking the lower third. We are talking pancreatic or diodelectomies if we're talking the upper third tumors. The problem is these might involve large liver sections or liver sections with maintenance of some form of intrapacted bile duct system still to maintain. And you have to hook up again, remember the hepatic ducts with the enteric system so that there is flow of bile into the bowel. So these are really bigger sections and they have to be done or you have to refer these patients as soon as possible. The prognosis is not so good. The further distal these tumors are, the easier they are picked up and the better the prognosis is and the easier it is to get resection. So it is all about resection with clear margins. That is the treatment for these patients. You have to get resection with clear margins so receptability is very important. These tumors remember they invade locally and they spread via the lymphatics. Many units will do a laparoscopy initially after deciding, after imaging, after delineating the anatomy with an ERCP, MRCP. Finding out exactly what is going on, looking at the reserve of these patients. Can they go through this major surgery? We'll add to that a laparoscopy just to finally determine whether the receptability is possible. And in some instances you might find deposits in the peritoneal cavity or other local invasions that were not seen on preoperative investigations. And that idea of going into the abdomen then for primary resection, that management plan is aborted at that time. So fortunately tumors that we see really, you must know something about it. It's very easy to answer questions on carcinomas of the bilirity to think about the anatomy.