Biliary tract Flashcards Preview

ABD Boards! > Biliary tract > Flashcards

Flashcards in Biliary tract Deck (69):
1

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

Common Hepatic Duct CHD

2

Where is the GB located?

Inferior end of MLF

3

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

1. cystic duct
2. CHD
3. CBD

4

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

Ampulla of Vater

5

What is consisted in the portal triad?

MPV
CHD
Hepatic Art.

6

What does the portal triad appear as?

"Mickey Mouse" sign

7

What are the segments are the GB?

Neck
Body
Fundus

8

Where are the Valves of Heister?

Spiral fold which controls bile flow in the cystic duct

9

What is a Hartmann's pouch?

abnormal diverticulum of the neck of the GB

10

What is a pharygian cap?

Fold between body and the fundus of GB

11

What is a junctional fold?

Fold between the body and neck of the GB

12

What does the CBD pass posterior to?

Duodenum and Pancreatic head

13

What is the Ampulla of Vater controlled by?

Sphincter of Oddi

14

What is the normal GB wall thickness measurement?

3 mm

15

What is the most common cause of GB wall thickening?

Cholecystitis

16

What is sludge composed of?

Calcium bilirubinate granules and cholesterol crystals

17

What does sludge appear as?

Nonshadowing, echogenic material which layers and shifts with patients position

18

What are some sonograph criteria for Cholelithiasis?

Mobile
Echogenic
Shadowing

19

What are gallstones composed of?

Cholesterol
Calcium Bilirubinate
Calcium Carbonate

20

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

- Wall-Echo-Shadow (WES sign)
- Double Arc

21

What is Acute Cholecystitis?

GB wall Inflammation due to cystic duct obstruction by a gallstone

22

What are the signs of acute cholecystitis?

- Gallstones
- Positive Murphy's sign
- Diffuse wall thickening
- GB dilatation
- Sludge

23

Explain what the Murphy's sign is....

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

24

What does a Amylase elevation suggest?

Obstruction in Ampulla of Vater

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...

Page 62 ESP