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Biliary System Flashcards

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1
Q

What is cholelithiasis?

A

gallstones

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2
Q

What is cholelithiasis made up of?

A

Bilirubinate, cholesterol, calcium carbonate

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3
Q

Who gets cholelithiasis most commonly?

A

Five Fs: female, forty, fertile, fat, fair

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4
Q

What are risk factors for cholelithiasis?

A
  • obesity
  • diabetes
  • hx pancreatitis
  • hx parasitic disease
  • hx biliary tree infection
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5
Q

What are S&S of cholelithiasis?

A
  • asymptomatic
  • biliary colic
  • RUQ, Rt shoulder pain
  • jaundice
  • abn LFTs
  • fever, chills
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6
Q

What is the sono appearance of cholelithiasis?

A
  • hyperechoic, shadowing, mobile
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7
Q

What is WES?

A
  • Wall-echo-shadow
  • 2 echogenic lines with posterior shadowing, 1st line is wall 2nd is stone
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8
Q

What is sludge?

A

Echogenic or viscous bile, AKA biliary sand or microlithiasis

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9
Q

What causes sludge? What is it made up of?

A
  • bile stasis
  • calcium, bilirubinate, cholesterol crystals
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10
Q

What are S&S of sludge?

A

asymptomatic

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11
Q

What is the sono app of sludge?

A
  • homogenous, low level echoes
  • non shadowing
  • layering depending on pos
  • changes with position
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12
Q

What is a sludge ball called?

A

tumefactive sludge

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13
Q

What are polyps?

A

Benign wall growth, inflammatory, adenomatous, or cholesterol

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14
Q

What is a focal polyp?

A

Single polyp attached to GB by pedicle or stalk, more concerning

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15
Q

What are diffuse polyps?

A

Multiple in GB

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16
Q

What are S&S of polyps?

A
  • asymptomatic
  • dull epigastric pain
  • RUQ pain
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17
Q

What is sono app of polyps?

A
  • non-mobile echogenic foci
  • non-shadowing
  • usually near fundus
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18
Q

What is cholecystitis?

A

inflammation of the GB

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19
Q

What causes cholecystitis?

A

Usually obstruction, most commonly cholelithiasis

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20
Q

Who gets cholecystitis most commonly?

A

40-60 y.o. women

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21
Q

What is the sono app of cholecystitis?

A
  • dilation of GB
  • wall thickening & irregular walls
  • gallstone
  • pericholecystic fluid
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22
Q

What causes acute cholecystitis?

A

Inflammation and obstruction
- 90-95% calculous
- 5-10% acalculous, parasitic/bacterial involvement

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23
Q

What are S&S of acute cholecystitis?

A
  • RUQ, epi, back pain
  • pain post-prandial
  • abn LFTs
  • Murphy’s
  • increased serum amylase
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24
Q

What is emphysematous cholecystitis?

A

gas forming bacteria in GB wall/lumen

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25
What is gangrenous cholecystitis?
intermural hemorrhage and ulceration of mucosal surfaces
26
What two things indicate emergent cholecystitis?
Murphy's and wall >3 mm
27
What is chronic cholecystitis? What can it cause?
recurrent attacks of cholecystitis, can progress to carcinoma
28
What are S&S of chronic cholecystitis?
- asymptomatic - abn LFTs - increased serum amylase
29
What is the sono app of chronic cholecystitis?
- gallstones - small contracted GB - echogenic bile - wall thickening
30
What is hydrops of GB?
abnormal dilation of GB due to cystic duct obstruction, bile is reabsorbed and GB is filled with secretions from mucosa layer
31
What is the main cause of hydrops?
cholelithiasis
32
What is hydrops AKA?
mucocele
33
What are S&S of hydrops?
asymptomatic, palpable RUQ mass
34
What is the sono app of hydrops?
- round, distended - anechoic - non-inflamed
35
What is Courvoisier's law?
enlarged GB of a jaundiced patient is typically caused by obstruction of biliary duct
36
What is porcelain GB?
Calcification of GB wall
37
Who is porcelain GB most common in?
women over 60
38
What are S&S of porcelain GB?
- asymptomatic - associated with cholelithiasis - increased risk of GB carcinoma
39
What is the sono app of porcelain GB?
thickly calcified wall with shadowing
40
What is an adenoma?
Benign neoplasm that may be precancerous
41
What are S&S of an adenoma?
asymptomatic
42
What is the sono app of an adenoma?
- solitary - pedunculated - homogenous, hyper
43
What has a similar appearance to an adenoma?
a polyp
44
What is adenomyomatosis?
- excessive proliferation of the epithelial surface - gland-like formation and outpouchings of mucosa
45
What are S&S of adenomyomatosis?
asymptomatic
46
What is the sono app of adenomyomatosis?
- non-mobile echogenic foci along wall - comet tail artifact - single or in groups
47
What is cholesterolosis?
- excess lipids deposited within GB wall - polyps of triglycerides and cholesterol
48
What can the appearance of cholesterolosis be compared to?
strawberry: yellow cholesterol specks against red bile-stained mucosa
49
What are S&S of cholesterolosis?
- asymptomatic - dull epigastric pain - RUQ pain
50
What is the sono app of cholesterolosis?
- non-mobile, non-shadowing echogenic areas - variable size - unevenly distributed
51
What is primary GB carcinoma?
A rare, malignant neoplasm, most common biliary malignancy
52
What pathology is commonly associated with primary GB carcinoma?
porcelain GB
53
Who is primary GB carcinoma most common in?
females 50-80 y.o.
54
What are S&S of primary GB carcinoma?
- asymptomatic - weight/appetite loss - N/V - RUQ pain, mass - jaundice
55
What is the sono app of primary GB carcinoma?
- solid mass occupying GB lumen - thickened wall - echogenic mass with irregular borders
56
What is the most common primary cancer that metastasizes to GB?
melanoma
57
What are S&S of mets to GB?
- symptoms of cholecystitis - jaundice
58
What is the sono app of mets to GB?
- multiple hypo masses > 1 cm
59
What is jaundice?
Significantly abnormal bilirubin levels, caused by blockage along biliary tree
60
What is the most common cause of jaundice?
cholelithiasis
61
What are S&S of jaundice?
- yellow skin - pruritus - RUQ pain - weight loss - dark pain
62
What is the sono app of jaundice?
- dilated GB - hepatomegaly - CBD >7 mm - numerous visible tubes - double barrel sign - irregular biliary walls
63
What is ductal dilatation?
enlargement of the ducts which parallel the course of the portal veins
64
What is considered dilation of the intrahepatic ducts?
> 2 mm, not usually vis unless >4 mm
65
What is considered dilation of the common hepatic duct?
5 mm = borderline, 6mm enlarged
66
What is considered dilation of the CBD?
6 mm = borderline, 10 mm = enlarged
67
What is Mirrizi syndrome?
- extrahepatic biliary obstruction - gallstone impacted in neck of GB or cystic duct
68
What does Mirrizi syndrome cause?
Obstruction of the CHD due to stone in cystic duct pushing on CHD
69
What are S&S of Mirizzi syndrome?
- pain - fever - edema & inflammation
70
What is the sono app of Mirizzi syndrome?
- dilated duct above level of stone and normal duct below - cholecystitis - segmental stenosis of CHD
71
What is Caroli's disease?
- non-obstructive biliary dilation (no stone) - congenital abnormality, ducts have little pockets
72
What is Caroli's disease AKA?
communicating cavernous dilation
73
Who is Caroli's disease more common in?
People under 30, often diagnosed in childhood and early adulthood
74
What are S&S of Caroli's disease?
- RUQ pain - sepsis, cholangitis - stone formation, biliary stasis
75
What is the sono app of Caroli's disease?
- beaded, dilated appearance of biliary tree - irregularly dilated segmental portions of intrahepatic ducts - saccular, fusiform dilation - stones, sludge
76
What is biliary atresia?
- absence of extrahepatic biliary tree - bile is unable to pass from liver to GB and builds up within liver
77
What are S&S of biliary atresia?
- infants with jaundice and alcoholic stools - associated with situs inversus
78
What can develop as a result of biliary atresia?
Cirrhosis, can be fatal
79
What is the sono app of biliary atresia?
- two vessels seen in portal triad, missing CBD
80
What is choledocholithiasis?
- stones within bile duct - most common in distal CBD
81
What are S&S of choledocholithiasis?
- increased bilirubin, increased alkaline phosphatase, abn LFTs - leukocytosis
82
Who has an increased risk of choledocholithiasis?
older people, risk increases with age
83
What is the sono app of choledocholithiasis?
- echogenic foci in extrahepatic duct - ductal dilation depends on size and location of stone
84
What is choledochal cyst?
- cystic dilation of CBD/biliary tree - congenital, focal, or diffuse
85
Where is a choledochal cyst most common?
biliary tree
86
Who gets choledochal cysts most commonly?
~ 20 yo Asian females
87
What are S&S of choledochal cyst?
- asymptomatic - triad: jaundice, RUQ pain, RUQ mass - possible increased bilirubin
88
What is the sono app of choledochal cyst?
- anechoic mass adjacent to GB near porta hepatis - dilated CBD, hepatic duct - cystic duct may be seen entering mass - absent blood flow in mass
89
What is cholangitis?
- infection and inflammation of biliary ducts - caused by stone or interventional procedure
90
What are S&S of cholangitis?
- associated with IBS/UC - fever - abn LFTs - jaundice - RUQ pain
91
What is primary choledocholithiasis?
Stones form within the duct due to stasis
92
What is secondary choledocholithiasis?
Stones form within the GB and pass through GB via cystic duct
93
What is the sono app of cholangitis?
biliary wall thickening
94
What is ascariasis?
parasitic disease uncommon to US, AKA roundworm
95
How is ascariasis contracted?
ingestion of eggs via contaminated food/water
96
What are S&S of ascariasis?
- asymptomatic - abdominal discomfort - fever - NVD
97
What is the sono app of ascariasis?
- echogenic tubular structures with hypo center - motility
98
What is hemobilia?
blood within biliary tree
99
What are the causes of hemobilia?
most commonly interventional procedures, also: - vascular malformation - cholangitis, cholecystitis - malignancies
100
What are S&S of hemobilia?
- pain - bleeding (internal/external) - jaundice
101
What is the sono app of hemobilia?
- acute: low level echoes - chronic: hyperechoic
102
What is pneumobilia?
air within the biliary tree
103
What causes pneumobilia?
- biliary-enteric fistula - cholelithiasis - chronic cholecystitis
104
What are S&S of pneumobilia?
Caused by procedure: asymptomatic Caused by infection: RUQ pain, abd distention, fever
105
What is the sono app of pneumobilia?
- echogenic linear foci within intrahepatic tree - motion with patient position - shadowing - ring-down artifact
106
What is cholangiocarcinoma?
rare malignancy of bile ducts
107
Cholangiocarcinoma is usually a byproduct of what?
Adenocarcinoma: cancer of mucus secreting glands
108
Where is cholangiocarcinoma usually located?
CHD or CBD Intrahepatic, at porta hepatis, distal down CBD closer to duodenum
109
Who gets cholangiocarcinoma more commonly?
Japanese/Thai people
110
What are risk factors of cholangiocarcinoma?
- chronic biliary stasis - inflammation - infection - stones
111
What is the sono app of cholangiocarcinoma?
solid mass within biliary duct
112
What is Klatskins tumor?
Type of cholangiocarcinoma at hilar region of liver (porta hepatis)

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