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MIDS 127 > Biliary System > Flashcards

Biliary System Flashcards

1
Q

What is the gallbladder?

A

A pear shaped sac in the main lobar fissure (MLF) that stores bile

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2
Q

What are the dimensions of the gallbladder?

A

8 cm long
4-5 cm anterior-posterior and transverse
Normal wall thickness is less than 3 mm

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3
Q

Where does the gallbladder lie?

A

-Under the inferior surface of the liver
-Lateral to the 2nd part duodenum
-Anterior to R kidney and transverse colon

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4
Q

3 divisions of GB?

A

Neck - lies to R of porta hepatis (narrowest portion)
Body - central portion
Fundus - most inferior portion

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5
Q

4 layers of GB?

A
  1. Inner epithelial mucosa with folds
  2. Muscular layer
  3. Subserous layer
  4. Outer serosal surface
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6
Q

What is the heister valve?

A

-Valve that prevents kinking of the cystic duct
-Located in the neck
-Aids in the passage of bile to and from the GB

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7
Q

What do the intrahepatic bile ducts do?

A

-They carry bile inside the liver
-Run with the PVs and HAs
-Join to form the R and L main hepatic ducts
-The R and L main hepatic ducts unite at the porta hepatis and form the CHD

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8
Q

Measurement of intrahepatic bile ducts?

A

Less than 2 mm
(often can’t see IHD’s on ultrasound)

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9
Q

What does IHDD stand for?

A

Intrahepatic duct dilitation
(IHD greater than 2 mm)

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10
Q

Measurement of common hepatic duct?

A

Less than 6 mm

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11
Q

What does the CHD do?

A

Joins the cystic duct to form the CBD

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12
Q

What does the cystic duct do?

A

-Joins the CHD to form the CBD

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13
Q

Where is the cystic duct located?

A

Arises from the superior aspect of the GB neck

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14
Q

Measurement of CBD

A

7-8 mm

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15
Q

Measurement of CBD w/o GB

A

11 mm

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16
Q

What forms the CBD?

A

The cystic duct and CHD

(The CCH - cool, calm, happy. Stands for cystic, common hepatic ducts)

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17
Q

Location of CBD?

A

-Proximally lateral to HA
-Anterior to PV
-Goes inferiorly within hepatoduodenal lig
-To the 1st portion duodenum and into the head of pancreas

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18
Q

What is the mickey mouse sign?

A

MPV (head, big circle)
HA (L ear)
CBD (R ear)

In TRV plane

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19
Q

What is the ampulla of vater?

A

-A small opening at the duodenal wall where the CBD and main pancreatic duct join

(will never see on U/S because we can’t see bowel)

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20
Q

What is the sphincter of Oddi?

A

-Muscle surrounding the ampulla of vater
-It is the ends of the CBD and main pancreatic duct
-Forces bile into GB

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21
Q

What is the biliary system?

A

System that transports bile from liver (where it is produced) to the duodenum where it aids in digestion

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22
Q

What is in bile?

A

Bilirubin, bile acids, cholesterol, lecithin, mucin, etc.

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23
Q

What is the process of bile being released?

A
  1. Food into sm intestine
  2. Cholecystokinin (CCK) is a hormone secreted by the sm intestine
  3. GB contracts + sphincter of oddi relaxes/opens
  4. Bile released from GB into cystic duct
  5. Bile into CBD
  6. Bile into duodenum
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24
Q

What are the lab tests associated with the biliary system?

A

WBC: elevated w infection
AST & ALT: elevated w biliary obstruction
LDH: mildly elevated w obstructive jaundice
ALP: very elevated w obstructive jaundice
Bilirubin: direct/conjugated elevated w obstructive jaundice
Bilirubin: indirect/unconjugated elevated w liver disease

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25
What is a cholecystectomy?
Removal of GB (bowel may take place where GB would be if removed, sometimes can see clips or fluid where GB was removed)
26
How does the liver produce bile when the GB is removed?
-Bile salts from intestines stimulate the liver to produce more bile -Bile flows freely into duodenum
27
What are the sonographic findings of a normal GB?
-Anechoic lumen -Thin echogenic walls -Posterior enhancement -Evaluate GB in 2 positions (supine & LLD)
28
What are the sonographic findings of normal ducts?
-Anechoic lumen -Normal measurements (inner-inner w/o wall)
29
What is the sonographic murphy sign?
-If positive the pt will have intense focal pain over their GB -Only effective if pt is not on any pain medications
30
What is true about gallstones?
-They shadow -May be mobile -Check if stone is in the neck of GB (this can prevent the GB from releasing bile)
31
What is true about masses?
-They don't shadow -They aren't mobile
32
What lab test is not elevated in obstructive jaundice
Indirect/unconjuated
33
What is acute cholecystitis?
Inflammation of GB from stone in neck or cystic duct (m/c women over 50) (calculus and acalculus version)
34
What is sludge?
Thick bile
35
What is GB interposition?
When CHD and cystic duct are gone (think of it as changing positions - gone now)
36
What is caroli's disease?
Ectasia (entirely dilated) of IHD's (type 5 of choledochal cyst)
37
What is empyema cholecystitis?
Pus filled version of acute cholecystitis (empyema means pus)
38
What is gangrenous cholecystitis?
-GB full of gunk and absent blood supply -High death rate
39
What is chronic cholecystitis?
Recurrent attacks of acute cholecystitis (common elderly women)
40
What is porcelain GB?
Calcified GB (has echogenic line) (common elderly women)
41
What is GB perforation?
Life threatening hole in GB (bile leaks into abdomen)
42
What is bouveret syndrome/gallstone ileus?
Abnormal connection between GB and duodenum (m/c women over 60)
43
What is mirizzi syndrome?
Obstruction of CHD (an extrahepatic duct) due to stone in GB neck or cystic duct
44
What does cholesterosis look like?
Strawberry GB
45
What is courvoisier GB?
Obstructed CBD with mass in pancreatic head (C in courvoisier - think C for CBD)
46
What is hydropic GB?
Obstructed GB neck or cystic duct by gallstone
47
What is GB torsion/volvulus?
GB blood supply cut off
48
What is a biloma?
Collection of bile outside GB
49
What is a polyp?
Non mobile, attached to GB wall, don't shadow, hyperechoic
50
What is a adenoma?
Hypoechoic, benign mass (not as common as polyps)
51
Most common GB carcinoma?
Majority adenocarcinomas
52
Most common GB mestastases?
Melanoma (skin cancer)
53
Cholecystokinin causes what to happen?
The liver to synthesize/create more bile
54
What does adenomyomatosis look like?
-Comit tail/posterior shadowing -Thickened wall -RA sinuses -Originates from anterior GB wall
55
What is choledocholithiasis?
Stone in the bile duct (may or may not cause dilation)
56
What is cholangitis?
-Inflammation of biliary system -PSC is idiopathic, within ductal system -SSC is associated with biliary infection and caused by GB, not the ductal system
57
What does cholangitis look like?
Proximally dilated ducts
58
What is AIDS cholecystopathy?
-Secondary form of sclerosing cholangitis -Increase ALP (GB wall thickening, ductal dilation)
59
What is cholangiocarcinoma?
Primary malignancy of bile duct
60
What is cholangiocarcinoma: Intrahepatic?
-Least common location of cholangiocarcinoma
61
What is cholangiocarcinoma: Hilar/Klatskin's tumour?
-Most common location of cholangiocarcinoma -Occurs at porta hepatis -Looks like mass in between the ducts
62
What is cholangiocarcinoma: Distal? Describe the 2 types of masses involved.
-Sclerosing or polypoid (more common) tumour masses (polypoid - well defined mass, no wall thickening) (sclerosing - ill defined mass, wall thickening. think hardening)
63
What is ascariasis?
Parasite worm that causes biliary obstruction (think ascariasis - scary - tapeworm)
64
What is pneumobilia?
-Air within biliary tree -Looks like bright lines with shadow within the ducts -Due to surgery/intervention
65
What is hemobilia?
Blood in biliary tree
66
What is biliary hamartomas/von Meyenburg complexes?
-Small clusters of dilated cystic bile ducts
67
What is biliary atresia?
M/c type of obstructive biliary disease in infants + young children (m/c males)
68
Lightbulb for biliary atresia?
Jaundice Young children IHDD + can't view CHD (atresia means something is missing)
69
What are choledochal cysts?
-Congenital dilation of biliary tree -M/c in females + pediatric finding (malignant potential)
70
Which type of choledochal cyst is m/c?
Type 1 - fusiform dilation of CBD
71
Who is more prone to getting Caroli's disease?
Young adults or pediatrics
72
What is slude a precursor to?
-Cholelithiasis (stones) -Pregnancy
73
SF of Caroli's disease?
Multiple cysts near porta hepatis
74
What are the 6 F's?
Female, fat, fair, forty, fertile + flatulent
75
What is the WES triad with cholelithiasis?
WES: wall-echo-shadow
76
What is the m/c pathology of the biliary tract?
Choledocholithiasis (stone in BD)
77
How to tell if bile duct obstruction is malignant or benign?
Benign - if the duct tapers at obstruction Malignant - if the duct abruptly ends (due to a mass)
78
Lightbulb sign for dilated bile ducts?
Parallel channel sign/double barreled shotgun sign

MIDS 127 (14 decks)

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