biliary pathology Flashcards by Kayla Morales

acute cholecystitis

gallbladder inflammation
most common cause of increased wall thickness
stone in the neck or duct more common cause

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calculus chole

WITH STONES
more common in females

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acalculous chole

NO STONES
more common in mean by bile stasis

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Acute Cholecystitis
lab values

increased bilirubin , ALP, WBC ,LFT

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Acute Cholecystitis
can lead to

hydrops
perforation
gangrene
empyema
abscess

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Acute Cholecystitis
symptoms

murphy sign
fever
N & V

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other causes of GB wall thickening

CHF
renal failure
cirrhosis
hepatits

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Acute Cholecystitis
sono appearance

halo sign
wall thickening of >3 mm
peri fluid
positive murphy

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Chronic Cholecystitis

intermittent fever and RUQ pain
WBC may be normal
associated with porcelain GB

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Chronic Cholecystitis has production of

milk of calcium bile

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Chronic Cholecystitis sono appearance

small contracted GB
thick walls
stones
layering of sludge

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complications of cholecystitis

empyema
emphysematous cholecystitis
perforation
abscess

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GB empyema

pus
complete GB obstruction

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Emphysematous Cholecystitis is more common in

males and diabetics

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Emphysematous Cholecystitis sono

air in GB wall
enlarged GB
dirty shadowing

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Emphysematous Cholecystitis symptoms

RUQ pain
fever
leukocytosis

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GB perforation

leads to localized fluid in GB fossa

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GB perforation can cause

peritonitis and abscess

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porcelain GB

calcification of the GB wall
chronic and 95% of cases with stones

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porcelain GB increased risk of

GB carcinoma

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porcelain GB sono appearance

wall very echogenic
no WES sign

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Cholangitis causes

inflammation of bile ducts
MOST COMMON DUCTAL STONES
hiv
infection

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Cholangitis symptoms

ruq pain
fever chills
biliary colic
jaundice

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Cholangitis MOST COMMON TRIAD

fever
ruq pain
jaundice

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Cholangitis lab values

Lab Testing: - Increased direct bilirubin, alkaline phosphatase, and/or LFT - Amylase and lipase can be elevated if pancreatic ducts involved - Leukocytosis

Cholangitis sono appearance

thickened internal ductal wall layers with increased echogenicity dilated intra and extra hepatic ducts up to 3-4 cm

abnormal ductal wall thickness

over 2mm

sludge

precursor to stones stagnation of bile

sludge related to

poor or absent GB function alcohol pregnancy fasting low fat diet

tumefactive sludge

balls of sludge

sono appearance of sludge

lumen filled with echoes move with position of patient DOES NOT SHADOW

CHOLELITHIASIS risk factors

- obesity - oral contraceptives - estrogen therapy - pregnancy - Impaired gallbladder function - prolonged fasting - diabetes - high cholesterol - Crohn disease - hemolytic disorders (like sickle cell anemia)

Cholelithiasis symptoms

- RUQ pain - pain has sudden onset and lasts 1-3 hours - nausea/vomiting

Cholelithiasis labs

increased ALP and bilirubin

sono of cholelithiasis

- Wall - Echo - Shadow - also called double arc shadow sign * mass is mobile with change in patient position, unless it is impacted at the neck * posterior shadowing from the reflective stone * vary in size and number * dilated ducts would be found proximal to the level of a complete obstruction * dilated ducts can exhibit posterior enhancement

normal CBD

less than 8mm

mirizzi syndrome

stone in cystic duct causing compression of the common hepatic duct

mirizzi symptoms

elevated direct bilirubin pain and jaundice

Courvoisier GB

enlarged non diseased GB due to mechanical obstruction of the CBD

Courvoisier GB tranverse diameter

greater than 5 cm

Courvoisier GB associated w/

pancreatic head mass or obstruction at ampulla of vater

Choledocholithiasis

stone in ductal system

most common Choledocholithiasis

secondary: stones pass from GB pass into ductal system

Choledocholithiasis sono appearance

foci in ductal system PARALLEL CHANNEL SIGN DILATED CBD

Adenoma/Polyp greater than 10 mm indicates

strong suspicion of cancer

Adenoma/Polyp

do not move with position change overgrowth of GB lining usually asymptomatic

Adenoma/Polyp sono appearance

protrusion into the gallbladder lumen * attached to the wall, non-mobile * usually isoechoic to the gallbladder wall, may be hypoechoic * non-shadowing