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Biliary tract Flashcards

1
Q

What do the left and right hepatic ducts unite to form?

A

Common Hepatic Duct CHD

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2
Q

Where is the GB located?

A

Inferior end of MLF

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3
Q

GB neck tapers to form the 1) ______ which joins with the 2) _______ to form the 3)_________.

A
  1. cystic duct
  2. CHD
  3. CBD
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4
Q

What do the CBD and Duct of Wirsung join to form?

A

Ampulla of Vater

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5
Q

What is consisted in the portal triad?

A

MPV
CHD
Hepatic Art.

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6
Q

What does the portal triad appear as?

A

“Mickey Mouse” sign

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7
Q

What are the segments are the GB?

A

Neck
Body
Fundus

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8
Q

Where are the Valves of Heister?

A

Spiral fold which controls bile flow in the cystic duct

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9
Q

What is a Hartmann’s pouch?

A

abnormal diverticulum of the neck of the GB

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10
Q

What is a pharygian cap?

A

Fold between body and the fundus of GB

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11
Q

What is a junctional fold?

A

Fold between the body and neck of the GB

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12
Q

What does the CBD pass posterior to?

A

Duodenum and Pancreatic head

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13
Q

What is the Ampulla of Vater controlled by?

A

Sphincter of Oddi

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14
Q

What is the normal GB wall thickness measurement?

A

3 mm

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15
Q

What is the most common cause of GB wall thickening?

A

Cholecystitis

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16
Q

What is sludge composed of?

A

Calcium bilirubinate granules and cholesterol crystals

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17
Q

What does sludge appear as?

A

Nonshadowing, echogenic material which layers and shifts with patients position

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18
Q

What are some sonograph criteria for Cholelithiasis?

A

Mobile
Echogenic
Shadowing

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19
Q

What are gallstones composed of?

A

Cholesterol
Calcium Bilirubinate
Calcium Carbonate

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20
Q

What are the terms used for a GB filled with stones and you see a strong shadow in RUQ?

A
  • Wall-Echo-Shadow (WES sign)

- Double Arc

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21
Q

What is Acute Cholecystitis?

A

GB wall Inflammation due to cystic duct obstruction by a gallstone

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22
Q

What are the signs of acute cholecystitis?

A
  • Gallstones
  • Positive Murphy’s sign
  • Diffuse wall thickening
  • GB dilatation
  • Sludge
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23
Q

Explain what the Murphy’s sign is….

A

Intense point tenderness transducer pressure directly on the GB
90% sensitive and specific

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24
Q

What does a Amylase elevation suggest?

A

Obstruction in Ampulla of Vater

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25
What is Chronic Cholecystitis?
Chronic GB disease characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis
26
What is a Emphysematous GB?
Acute cholecystitis due to GB wall ischemia and infection - gas produced by aneorbic bacteria - Gas found in GB wall (Produce Ring down Artifact or Comet tail)
27
What is Empyema of the GB?
Purulent material within the GB due to bacterial- containing bile associated with acute cholecystitis
28
What is GB perforation?
- Complication of Acute cholecystitis | - Localized fluid collection in the GB fossa
29
What is Acalculous Cholecystitis?
Acute cholecystitis without the presence of Cholelithiasis.
30
What is Milk of Calcium Bile?
(Limy Bile) - Sludge like material with high concentration of calcium - Associated with chronic cholecystitis and GB obstruction in cystic duct
31
What is a Porcelain GB?
Calcification of GB wall associated with chronic cholecysitis
32
What is a Hydroptic GB?
- AKA mucocele of the GB | - overdistended GB filled with mucoid or clear watery contents
33
What is the measurement for a hydroptic GB?
5 cm
34
What is a hydroptic GB caused by?
Chronic cystic duct obstruction
35
Know about GB polyps....
- Less than 10 mm in diameter are less likely to be cancerous - Greater than 10 mm and demonstrate growth are most likely to be malignant
36
What is Cholesterolosis?
Lipids are deposited in the GB. Can look like polyps can be as large as 1 cm - "strawberry GB" due to golden yellow lipid deposits against red GB mucosa
37
What is GB carcinoma?
Can mimic cholecystitis - Intraluminal mass - Assymetric wall thickening - mass that fills the entire GB
38
What is Adenomymatosis?
Hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticulum - Comet tail artifact (Reverb)
39
What is Rokitansky- Aschoff sinuses? (RAS)
Diverticula within the GB wall that accumulates stones and sludge within them
40
What is the most common place to find biliary obstruction?
Distal CBD
41
What are the most common lesions?
Gallstones and Carcinoma of the Head of Pancreas
42
What labs will be elevated with biliary obstruction?
- Alkaline Phosphatase (ALP) - Conjugated Bilirubin - Gamma Glutamyl Transpeptidase (GGT)
43
How is the CBD measured?
Inner to inner
44
What is the normal measurement of the CBD?
- Normal: < 5 cm - Equivocal: 6 to 7 mm - Dilated: > 8 mm
45
In a postcholecystectomy patient, what is the normal measurement of the CBD?
Measure up to 10 mm
46
What does the "shotgun sign" refer to as?
Dilated hepatic ducts adjacent to the portal vein
47
What is a Stellate Confluence?
Bile ducts branch in a "star shaped" configuration
48
What is the hormone that is released when you eat?
Cholecystokinine | - causes GB to contract with ingestion of fatty foods
49
What is a Choledocholithiasis?
Formation or presence of calculi in the bile ducts | - most common cause of extrahepatic obstructive jaundice
50
What is Mirizzi Syndrome?
Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the CHD
51
Where does a Cholangiocarcinoma reside?
Originate within the extrahepatic bile ducts (CHD or CBD)
52
What is a Klatskin Tumor?
Cholangiocarcinoma located at the hepatic hilum (junction of left and right hepatic ducts) resulting in intrahepatic but not extrahepatic dilation
53
What is the most common finding with a Klatskin tumor?
Intrahepatic Bile Duct Dilatation
54
What is Cholangitis?
Bacterial infection imposed on an obstruction of the biliary tree.
55
What is the most common cause of Cholangitis?
Choledocholithiasis
56
What labs will be increases with Cholangitis?
- Bilirubin - ALP - GGT - Amylase - Lipase - White blood cells
57
What is Biliary Atresia?
- Absence of extrahepatic biles ducts (CHD and CBD)
58
What is the treatment for biliary atresia?
Kasai portoenterostomy is most successful treatment of biliary atresia if performed before 90 days of life. - Liver Transplant also considered
59
What is pneumobilia?
Air in the biliary tract | - commonly associated with ERCP (endoscopic retrograde cholangiopancreatogram)
60
What artifact goes with pneumobilia?
Comet tail or reverberation
61
What is a choledochal cyst?
Bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts
62
What is the most common type of choledochal cysts?
Dilatation of the CBD
63
Where is Choledochal cysts more prevelant?
Asia | - more than 33% of reported cases from Japan
64
What is Caroli's Disease?
- Type 5 choledochal cyst - Congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts
65
What is the most common cause of malignant neoplasm obstructing the biliary tree?
Pancreatic Adenocarcinoma | - causes Courvoisier GB ( enlarged non diseased GB due to obstruction of CBD)
66
What is Primary biliary cirrhosis?
Destruction of the small intrahepatic bile ducts leading to end stage liver disease - diagnosis confirmed by liver biopsy
67
What labs will be elevated with Biliary cirrhosis?
- ALT/AST - ALP - GGT - AMAs
68
What is Bilirubin?
End product of hemoglobin breakdown
69
More labs...
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