Biliary System Flashcards
(38 cards)
What are the sonographic signs to look for with acute cholecystitis?
Gallstones Thickening of GB wall (>3mm) Edematous wall--differentiation of layers Distention of GB lumen (>4cm) Impacted stone in cystic duct/ GB neck Pericholecystic fluid collection Hyperemic wall \++ MS Intrahepatic duct/ CBD dilation
What are the sonographic findings for gangrenous cholecystitis?
Nonlayering bands of echogenic tissue within the lumen–sloughed membranes and blood
Irregular walls
Small collections within wall–abscesses or hemorrhage
– MS (nerves are necrosed)
What are the sonographic signs of GB perforation?
Focal wall defect and deflation of GB
Pericholecystic fluid collection
Perforation extends into adjacent liver parenchyma forming abscess
Cystic liver lesion around GB fossa suggests a pericholecystic abscess
What can arise from prolonged acute cholecystitis?
Gangrenous GB Perforation Rupture Emphysematous cholecystitis Empyema (pus) Gallstone ileus Cholecystoenteric fistula
What does emphysematous cholecystitis appear as?
Frequently acalculus
Gas forming bacteria after ischemic event appears as gas in lumen and wall
Echogenic line w/ posterior dirty shadow or ring down artifact
Pneumobilia
What are the sonographic signs for chronic cholecystitis?
Gallstones
Wall thickening
Fibrosis
What differentiates acute from chronic cholecystitis?
Absence of:
- distension
- ++ MS
- hyperemia of wall
Acalculous cholecystitis:
Common in critically ill
Those who’ve had a major surgery, trauma, sepsis, TPN, diabetes, atherosclerotic disease, HIV
Hard to assess
Porcelain GB:
Wall is calcified
Dense posterior shadowing
Stones
Female dominance
What are the sonographic signs of adenomyomatosis?
Invaginations of luminal epithelium Cystic spaces/echogenic foci with comet tail artifact Thickening of GB wall Focal (seen in fundus) or diffuse Hourglass appearance
Gallbladder carcinoma:
98% are adenocarcinoma
Associated with gallstones
Focal or diffuse polypoid mass arises from liver
Invades liver
What is the sonographic appearance of GB CA?
Absence of normal appearing GB with no history of cholecystectomy Immobile stone engrossed in tumor Arterial and venous flow Irregular wall thickening Intraluminal mass >1cm
What are complications of Caroli’s disease?
Biliary stasis Cholangitis Stones/sepsis Hepatic fibrosis Portal hypertension
What can occur from Caroli’s disease?
Cholangiocarcinoma
What can cause primary choledocholithiasis?
Caroli's disease Sclerosing cholangitis Parasites of liver Hemolytic disease Previous biliary surgery
What are the sonographic signs for choledocholithiasis?
Dilated CBD proximal to stone
Dilated intrahepatic ducts
Shadow or no shadowing
GB distension
The majority of CBD stones occur where?
Distal to ampulla of Vater
What’s a differential diagnosis of CBD stones?
Blood clot- hemobilia
Papillary tumor
Biliary sludge
(none of these shadow)
What are the signs of Mirizzi syndrome?
Painful jaundice
Fever
CHD obstruction
What is Mirizzi syndrome?
CHD obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the GB
Results in a fistula between cystic and CHD
What can cause hemobilia? (blood in bile)
Cholangitis Cholecystitis Vascular malformations Trauma Malignancies
What causes pneumobilia?
Emphysematous cholecystitis Choledochoduodenal fistula (caused by stone in CBD) Cholecystoenteric fistula (prolonged acute cholecystitis erodes into bowel)
What’s a good landmark for the GB?
Main lobar fissure
Trv PV
What is the normal CBD measurement?
<7mm (but why do I feel like we’ve also heard <6mm)
