Biliary Notes Flashcards
1
Q
What is an adenoma? What is it similar to? How common is this neoplasm?
A
- A benign epithelial tumor
- Histologically similar to a bowel wall polyp
- Most common benign neoplasm.
2
Q
What is adenomyomatosis? What kind of mass is this? How can this happen in the gallbladder?
A
- Hyperplasia of epithelial and muscle layers in the gallbladder wall
- A small polypoid mass of the gallbladder wall
- Diverticulosis of the gallbladder.
3
Q
What is the ampulla of Vater?
A
Opening in the duodenum for the entrance of the common bile duct.
4
Q
What is ascariasis?
A
Infection by a roundworm that may result in abdominal cramping or obstruction.
5
Q
Bile is a fluid secreted by what organ? Where is it concentrated in? And where is it poured into? What does it play a role in?
A
- A fluid secreted by the liver, concentrated in the gallbladder, and poured into the small intestine via the bile ducts
- Plays a role in emulsification, absorption, and digestion of fats.
6
Q
What is bilirubin?
A
Yellow pigment in bile formed by the breakdown of red blood cells.
7
Q
What is biliary atresia?
A
Partial or complete absence of the biliary system.
8
Q
What is biliary colic? What is it also called?
A
Visceral pain associated with passing of stone(s) through the bile ducts; also called cholecystalgia.
9
Q
What is biloma? What is it formed by?
A
An extrahepatic collection of extravasated bile from trauma, surgery, or gallbladder disease.
10
Q
What is Bouveret syndrome?
A
Gastric outlet obstruction caused by duodenal impaction of a large stone that has migrated through a cholecystoduodenal fistula.
11
Q
What is Caroli disease?
A
A segmental, saccular, or beaded appearance to the intrahepatic biliary ducts.
12
Q
What is Charcot triad?
A
Fever, chills, and jaundice.
13
Q
What is cholangitis?
A
Inflammation of a bile duct.
14
Q
What is cholangiocarcinoma?
A
Carcinoma of a bile duct.
15
Q
What is cholecystitis?
A
Inflammation of the gallbladder.
16
Q
What is cholecystokinin?
A
A hormone secreted in the small intestine that stimulates gallbladder contraction and secretion of pancreatic enzymes; stimulation occurs after food reaches the duodenum.
17
Q
What is a choledochal cyst?
A
Cystic dilatation of the common bile duct.
18
Q
What is choledocholithiasis?
A
Calculus in the common duct; stones contain bile pigments, bile calcium salts, and cholesterol.
19
Q
What is cholelithiasis?
A
The presence or formation of gallstones; stones contain cholesterol, calcium bilirubinate, and calcium carbonate.
20
Q
What is cholesterolosis?
A
A form of hyperplastic cholecystosis caused by the accumulation of triglycerides and esterified sterols in the macrophage of the gallbladder wall.
21
Q
What is cholesterosis appearance?
A
Type of cholesterolosis associated with a strawberry appearance to the gallbladder.
22
Q
What is chronic cholecystitis?
A
Recurrent attacks of acute cholecystitis.
23
Q
What is clonorchiasis?
A
Parasite that typically resides in the intrahepatic ducts; the gallbladder and pancreas may also be affected.
24
Q
What is the common duct?
A
Term used to include the extrahepatic common hepatic duct and common bile duct.
25
What is the Courvoisier sign? What is it caused by?
1. Painless jaundice associated with an enlarged gallbladder
2. Caused by the obstruction of the distal common bile duct by an external mass (typically adenocarcinoma of the pancreatic head).
26
What is the cystic duct? What does it drain into?
Small duct that drains the gallbladder.
27
What is emphysematous cholecystitis?
Gas in the gallbladder wall or lumen.
28
What is empyema?
Pus in the gallbladder.
29
What is hematobilia? What three things is it assocaited with?
1. Bleeding into the biliary tree
2. Associated with
- Liver Biopsy,
- Blunt trauma
- Rupture of a hepatic artery aneurysm.
30
What is Hartmann pouch?
Small posterior pouch near the gallbladder neck.
31
What is jaundice?
Yellowish discoloration of the skin or sclera related to an increased level of bilirubin in the blood.
32
What is the junctional fold?
Fold or septation of the gallbladder at the junction of the neck and body.
33
What is a Klatskin tumor?
Carcinoma located at the junction of the right and left hepatic ducts.
34
What is the main lobar fissure?
A hyperechoic line extending from the right portal vein to the gallbladder fossa; a boundary between the left and right lobes of the liver.
35
What is Mirizzi syndrome? What does it cause? (5)
1. Impacted stone in the cystic duct
2. Causing compression on the common hepatic duct resulting in
— Jaundice
— Recurrent cholangitis
— Formation of biliary fistulas,
— Cholangitis
— Cirrhosis.
36
What is parallel channeling?
Condition in biliary obstruction representing imaging of the dilated hepatic duct and adjacent portal vein.
37
What is a phrygian cap?
Fold in the gallbladder fundus.
38
What is pneumobilia?
Air in the biliary tree.
39
What is a polyp?
A soft tissue mass protruding from the gallbladder wall.
40
What is a porcelain gallbladder?
Complete or partial calcification of the gallbladder wall.
41
What is a positive Murphy sign?
Severe pain when pressure is increased over the gallbladder.
42
What is sludge?
Echogenic viscous bile associated with biliary stasis.
43
What is a sludgeball?
Mobile, echogenic, nonshadowing mass in the dependent portion of the gallbladder.
44
What is tumefactive sludge? What does it resemble?
Echogenic bile that does not layer evenly; resembles a polypoid mass.
45
What is the WES sign?
Wall-echo-shadow sign; 'double arc' sign; seen with a stone-filled gallbladder.
46
What are the functions of the biliary system? 3
• Transport bile to the gallbladder through the bile ducts.
• Store and concentrate bile in the gallbladder.
• Transport bile through the bile ducts to the duodenum.
47
What is the anatomy of the biliary system? (Where does it originate from? What is it subdivided into?)
• The biliary system originates in the liver as a series of ductules coursing between the liver cells.
• Biliary ducts are subdivided into intrahepatic and extrahepatic ducts.
48
What forms the common hepatic duct?
The right and left hepatic ducts join near the level of the porta hepatis, forming the common hepatic duct (CHD).
49
What is the cystic duct's average length?
An average length of 4 cm has been reported at surgery.
50
What is the common bile duct?
The CHD is joined by the cystic duct to form the CBD.
51
What is the average intraluminal diameter of the common bile duct in adults?
6 mm in diameter or less.
52
What is the normal fasting adult gallbladder size?
Approximately 8 to 12 cm in length and 3 to 4 cm in diameter.
53
What is the sonographic appearance of a normal fasting gallbladder?
An ellipsoid anechoic structure located in the gallbladder fossa demonstrating posterior acoustic enhancement.
54
What are reasons for nonvisualization of the gallbladder? 3
• Nonfasting patient.
• Surgically absent.
• Obliteration of the gallbladder lumen by intestinal air or gallstones.
55
What are noninflammatory causes of gallbladder wall thickening? 3
• Nonfasting patient.
• Ascites.
• Cirrhosis.
56
What is the recommended fasting duration for adults before a gallbladder ultrasound?
6 to 8 hours.
57
What transducer frequency is recommended for adults?
3.0 to 5.0 MHz.
58
What is the examination protocol for gallbladder imaging?
Systematic approach in the sagittal and transverse planes carefully examining and imaging all portions of the gallbladder and biliary tree.
59
What should be documented during gallbladder examination?
Abnormalities should be documented and when applicable measured in two imaging planes.
60
What is the purpose of color and/or spectral Doppler evaluation in gallbladder examination?
To include and document the flow type and direction of the main portal vein.
61
What is the use of harmonic imaging in biliary tree evaluation?
To evaluate and document the biliary tree.
62
What is the appearance of the normal gallbladder on ultrasound?
The normal gallbladder appears as an anechoic ovoid structure.
63
Where should focal zones be placed during ultrasound?
Focal zone(s) should be placed at or below the area of interest.
64
What effect does using multiple focal zones have on ultrasound imaging?
It increases detail resolution and decreases temporal resolution.
65
What imaging technique should be used to evaluate the biliary tree?
Harmonic imaging should be used to evaluate and document the biliary tree.
66
How can artifactual echoes within the gallbladder lumen be reduced?
Decreasing system compression (dynamic range) can reduce artifactual echoes.
67
What is the benefit of spatial compounding in ultrasound?
Spatial compounding can improve visualization of structures posterior to highly attenuating structures.
68
How should Doppler settings be adjusted for ultrasound?
Doppler settings should be adjusted for a slow flow rate.
69
What can improve visualization of the gallbladder and common ducts? (What can we get the patient to do)
The use of deep inspiration may improve visualization.
70
What is a helpful hint for visualizing the main lobar fissure?
The main lobar fissure is best visualized in the sagittal oblique plane.
71
What positions may aid in visualization of the cystic duct?
Trendelenburg and right posterior oblique positions may aid in visualization.
72
What are common indications for ultrasound examination of the biliary system? 7
1. RUQ pain
2. Increase in liver function tests,
3. Intolerance to fatty foods
4. Postprandial pain,
5. Jaundice.
6. Nausea/vomiting
7. Positive Murphy sign
73
What is the normal adult range for alkaline phosphatase (ALP)?
Normal adult range for ALP is 45 to 115 U/L.
74
What does an elevation in alkaline phosphatase indicate?
It is the most specific indicator of biliary obstruction and may signal bone and liver abnormalities.
75
What is the normal adult range for alanine aminotransferase (ALT)?
Normal adult range for ALT is 7 to 55 U/L.
76
What does an elevation in ALT indicate?
Elevation is associated with hepatocellular disease, biliary tract obstruction, pancreatitis, and fatty infiltration.
77
What is the normal adult range for aspartate aminotransferase (AST)?
Normal adult range for AST is 8 to 48 U/L.
78
What does an elevation in AST indicate?
Elevation is associated with cirrhosis, hepatitis, mononucleosis, fatty infiltration, myocardial infarction, muscle disease, and cholestasis.
79
What is the normal adult total bilirubin level?
Normal adult total bilirubin is ≤ 1.1 mg/dL.
80
What can cause elevated bilirubin levels?
Elevated by excessive red blood cell destruction, malfunction of liver cells, or blockage of ducts.
81
What is the normal serum leukocyte count (WBC)?
Normal serum levels are 4500 to 11,000 mm3.
82
What does an increase in WBC count indicate?
It reflects the severity of inflammation and is associated with acute and chronic cholecystitis.
83
What are the sonographic findings of biliary dilatation? What enzymes are typically elevated?
1. Dilated intrahepatic and/or extrahepatic bile ducts
2. Elevated direct bilirubin and alkaline phosphatase.
84
What is the most common biliary malignancy?
Gallbladder carcinoma is the most common biliary malignancy.
85
What are the clinical findings of acute cholecystitis? 4 (s/s)
1. Acute RUQ pain
2. Nausea/vomiting
3. Fever/chills
4. Positive Murphy sign.
86
What is the sonographic finding of gallbladder hydrops?
Diffuse gallbladder wall thickening greater than 3 mm in diameter.
87
What is the risk factor for gallbladder carcinoma? 3
Risk factors include:
1. Cholelithiasis
2. Porcelain gallbladder
3. Female prevalence.
88
What is the appearance of gallstones on ultrasound?
Gallstones appear as hyperechoic intraluminal focus with posterior acoustic shadowing.
89
What is the significance of the Murphy sign?
A positive Murphy sign indicates gallbladder inflammation or cholecystitis.
90
What is a common finding in acute cholecystitis? 2
1. Thick,
2. Edematous gallbladder wall; 'halo sign'
## Footnote
Indicates inflammation of the gallbladder.
91
What is the most common cause of cholecystitis?
Cholelithiasis (90% of cases)
## Footnote
Presence of gallstones.
92
What laboratory finding is associated with acute cholecystitis?
Leukocytosis
## Footnote
Elevated white blood cell count.
93
What sign is positive in acute cholecystitis?
Positive Murphy sign
## Footnote
Pain upon palpation of the right upper quadrant.
94
What imaging finding can indicate acute cholecystitis?
Peripheral hyperemia on color Doppler
## Footnote
Increased blood flow to the gallbladder.
95
What are common symptoms of acute cholecystitis? 3
1. RUQ pain
2. Nausea/vomiting
3. Fever
## Footnote
Classic presentation of acute cholecystitis.
96
What is emphysematous cholecystitis?
A form of cholecystitis associated with gas-forming bacteria
## Footnote
Can lead to gallbladder perforation.
97
What are risk factors for acute cholecystitis? 3
1. Diabetes
2. Older adult
3. Male prevalence
## Footnote
Increased likelihood of developing the condition.
98
What is a potential complication of chronic cholecystitis?
Gallbladder carcinoma
## Footnote
Long-standing inflammation can lead to cancer.
99
What is the significance of a porcelain gallbladder?
It indicates chronic cholecystitis and increased cancer risk
## Footnote
Calcification of the gallbladder wall.
100
What is a common finding in chronic cholecystitis?
Asymptomatic or vague RUQ pain
## Footnote
Symptoms may be mild or absent.
101
What imaging finding suggests gallbladder obstruction?
Enlargement of gallbladder transverse diameter exceeding 4 cm
## Footnote
Indicates potential obstruction or disease.
102
What is Mirizzi syndrome?
Obstruction of the cystic duct leading to jaundice
## Footnote
Caused by a gallstone impacted in the cystic duct.
103
What is a common presentation of gallbladder varices?
Multiple tortuous tubular structures in the gallbladder periphery
## Footnote
Associated with portal hypertension.
104
What is a common symptom of gallbladder disease?
Fatty food intolerance
## Footnote
Often leads to discomfort after meals.
