Biliary system Flashcards
(39 cards)
the anatomy of the biliary system?
- right hepatic duct+ left hepatic duct= common hepatic duct
- common hepatic duct+ cystic duct = common bile duct
- common bile duct + Main pancreatic duct = common hepatopancreatic duct
- The common hepatopancreatic duct is inserted in the major duodenal papilla (the ampulla of Vater)
- The minor duodenal papilla : insertion the accessory pancreatic duct
the imaging thechniques?
- US
- CT
- Cholangio or Biliary MRI
- cholongiography: x ray with contrast inside the biliary tract
the uses of X-ray?
- Calcifications: rarely visible; transparent not like in uro
- pneumobilia: air
normal ultrasound of biliary system?
- first line examination
- Gallblader:
- Anechoic : purely liquid
- With posterior enhancement
- Thin wall < 3mm
- Main bile duct:
- Thin < 6mm
- In front of the portal vein.
- Intrahepatic biliary ducts: invisible
the role of CT scan?
- Without contrast
- Spontaneous density
- Biliary lithiasis ( not always calcic)- might be transparent
- With injection : Tumors
Indications of MRI?
- second line of examination
- Cholestatic jaundice
- Biliary duct dilatation without a visible obstacle
- u can see the intrahepatic ducts
what are the techniques of the cholangiography?
- Biliary ducts opacification using the Kheir drain: residual lithiasis
- Endoscopic retrograde cholangiography (ERCP)
- Percutaneous hepatic cholangiographie (PCHC): therapatic use
What are the gallblader pathologies?
-Lithiasis
- Acute cholecystis
- cancer
the clinical signs of lithiasis?
- right hypochondriac pain and dyspepsia- indigestion
the diagnosis of the lithiasis?
- US
how the lithiasis would appear in the US?
–Stone : hyper-echoic with posterior shadow
- Single or multiple (multi-lithiasis gallbladder)
- Mobile, they are not if there is inflammation and fibrosis
Acute complications of lithiasis- Microcalcification?
- Gallbladder hydrops
- Acute cholecystitis
- Acute cholangitis
- Acute pancreatitis
Chronic complications ofthe lithasis-Macrocalcifications?
- Chronic cholecystitis
- Gallbladder cancer
how the lithiasis appears in the MRI?
- all lithiasis even if it is cholesterolic < hyposignal
- the fluid is hypersignal in T2 < contrast
what are the clinical signs of the acute cholecystitis?
- Right hypochondriac pain
- Fever
- Murphy sign
- Surgical emergency
The diagnosis of the acute cholecystis?
US
how the cholecystitis appears in the US?
- Thick wall >4mm
when to do the CT in case of acute cholecystitis?
assess the complications
the characteristics imaging of the acute cholecystitis?
- Thickening of the wall
- Adjacent fat infiltration
- peri-vesicular effusion
what are the complications of the acute cholecystitis?
- Perforation
- Peri-vesicular abscess
- Bilio enteric fistula (pneumobilia)
- Emphysematous cholecystitis: surinfection with anaerobic germs give air inside the gallbladder or in the wall. Also we can have gangrenous
cholystitis with necrosis
what is the type of gallblader cancer
calculous cancer= gallblader carcinoma
frequent in female
how the gallblader cancer appears in the US?
- Irregular thickening of the wall
- heteregoneous echogenic mass
- lithiasis
- changement in the content of the gallblader- no more bile
how the gallbladder appears in the CT and MRI?
- Irregular thickening of the gallbladder wall
- Gallbladder mass
- stagging
what to look for staggng the gallbladder cancer
liver: invasion very quickly, poor prognosis
, pedicle, lymphadenopathy, peritoneal carcinomatosis
