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KaBoom > Biliary System - Part 5 > Flashcards

Biliary System - Part 5 Flashcards

1
Q

Adenoma (polyp)

A

Benign epithelial tumour

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2
Q

What are the clinical findings of an adenoma? (3)

A
  1. Asymptomatic
  2. Dull RUQ pain
  3. Intolerance to fatty foods
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3
Q

What is the US appearance of an adenoma? (4)

A
  1. Echogenic intraluminal focus(i) 2. Immobile
  2. Non-shadowing
  3. Thickening of the GB wall
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4
Q

What are 3 differential diagnosis of an adenoma?

A
  1. Cholelithiasis
  2. Fold in the GB
  3. Carcinoma
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5
Q

Adenomyomatosis

A

Hyperplasia of the epithelial and muscle layers of the GB wall

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6
Q

What are the clinical findings of adenomyomatosis? (3)

A
  1. Asymptomatic
  2. Dull RUQ pain
  3. Intolerance to fatty foods
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7
Q

What is the US appearance of adenomyomatosis? (5)

A
  1. Echogenic intraluminal focus
  2. Diffuse comet-tail reverberation artifact
  3. Twinkling artifact on colour
  4. Doppler
  5. Immobile
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8
Q

What are 3 differential diagnosis of adenomyomatosis?

A
  1. Cholelithiasis
  2. Fold in the GB
  3. Carcinoma
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9
Q

What are the 2 types of cholesterolosis?

A
  1. Cholesterosis

2. Cholesterol polyps

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10
Q

What are the clinical findings of cholesterolosis? (2)

A
  1. Asymptomatic

2. Abdominal pain

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11
Q

What is the US appearance of cholesterolosis? (4)

A
  1. Echogenic intraluminal foci
  2. Non-shadowing
  3. Normal GB in the majority of cases
  4. Strawberry appearance with
    cholesterosis
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12
Q

What are 3 differential diagnosis of cholesterolosis?

A
  1. Cholelithiasis
  2. Carcinoma
  3. Fold in the GB
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13
Q

Cholelithiasis

A

Gallstones

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14
Q

What are the causes of cholelithiasis? (3)

A
  1. Abnormal bile composition
  2. Bile stasis
  3. Infection
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15
Q

What are the risk factors of cholelithiasis? (5)

A
  1. Family history
  2. Obesity
  3. Pregnancy
  4. Diabetes
  5. Female prevalence
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16
Q

What are the clinical findings of cholelithiasis? (8)

A
  1. Asymptomatic
  2. RUQ pain
  3. Epigastric pain
  4. Chest or shoulder pain
  5. Elevated LFTs
  6. Nausea/vomiting
  7. Postprandial pain
  8. Fatty food intolerance
17
Q

What is the US appearance of cholelithiasis? (4)

A
  1. Hyper echoic intraluminal focus(i)
  2. Posterior acoustic shadowing
  3. Mobile
    - need to flip the patient to prove this
  4. Wall-echo-shadow (WES)
18
Q

What are 5 differential diagnosis of cholelithiasis?

A
  1. Intestinal air
  2. Adenomyomatosis
  3. Polyp
  4. Fold in the GB
  5. Surgical clip
19
Q

Are gallstones more common in male or females?

A

Females

- 4:1

20
Q

Porcelain GB

A

Is a calcification of the gallbladder

21
Q

What are the causes of a porcelain GB? (3)

A
  1. Decrease in vascular supply to the GB
  2. Cystic duct obstruction causing bile stasis
  3. Chronic low-grade infection
22
Q

Is a porcelain GB more common in male or females?

23
Q

What are the clinical findings of a porcelain GB? (2)

A
  1. Asymptomatic

2. Vague RUQ pain

24
Q

What is the US appearance of a porcelain GB? (4)

A
  1. Gallstones
    - 95%
  2. Hyper echoic wall
  3. Marked posterior acoustic shadowing 4. Diffuse or localized
25
What are 3 differential diagnosis of a porcelain GB?
1. Contracted GB with stones - WES complex 2. Intestinal air 3. Adenomyomatosis
26
Mirizzi syndrome
Common hepatic duct obstruction
27
What are the causes of Mirizzi syndrome? (2)
1. Impacted stone in the cystic duct or GB neck | 2. Obstruction of the CHD
28
What are the clinical findings of Mirizzi syndrome? (4)
1. RUQ pain 2. Jaundice 3. Elevated bilirubin and alkaline phosphatase 4. Increase AST and ALT levels
29
What is the US appearance of Mirizzi syndrome? (3)
1. Immobile calculus in the cystic duct or neck of the GB 2. Dilatation of the intrahepatic and CHDs 3. Normal CBD
30
What is a differential diagnosis of Mirizzi syndrome?
Choledocholithiasis | - CBD stones
31
What are the causes of sludge? (5)
1. Prolonged fasting 2. Biliary stasis 3. Biliary obstruction 4. Cholecystitis 5. Sickle cell anemia
32
What are the clinical findings of sludge? (3)
1. Asymptomatic 2. RUQ pain 3. Nausea/vomiting
33
What is the US appearance of sludge? (5)
1. Non-shadowing low amplitude echoes layering in the dependent portion of the GB 2. Echoes move slowly with position change 3. May fill entire GB 4. May demonstrate fluid-fluid levels
34
What are 4 differential diagnosis of sludge?
1. Technical factors 2. Intestinal air 3. Carcinoma 4. Hematobilia

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