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Abdo Pathology > Lesson 2.1 - Biliary Path (part 1) > Flashcards

Lesson 2.1 - Biliary Path (part 1) Flashcards

1
Q

What is bilirubin

A

a product of the breakdown of hemoglobin in old RBC

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2
Q

elevation of direct/conjugated bilirubin associated with (4)

A

obstruction
hepatitis
cirrhosis
liver mets

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3
Q

elevation of indirect/unconjugated bilirubin is assoc with (1)

A

non obstructive conditions i.e. fatty liver

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4
Q

ALP elevation assoc with (1)*

A

obstructive jaundice

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5
Q

ALT elevation assoc with (4)*

A

cirrhosis
hepatitis
biliary obstruction

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6
Q

AST elevation assoc with (3)*

A

cirrhosis
hepatitis
mononucleosis

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7
Q

2 congenital variants

A

duplication - rare

multiseptated

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8
Q

what are risk factors for cholelithiasis (6)

A 
female
age (increasing)
pregnancy
fecundity (premenopausal women)
obesity
diabetes
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9
Q

what is the key feature of stones allowing differentiation from polyps

A

mobility

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10
Q

sono appearance of gallstone (1)

A

echogenic
shadowing
mobility

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11
Q

What is WES complex

A

wall-echo-shadow

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12
Q

what is milk of calcium bile, how is it caused?

A

GB filled with semisolid calcium carbonate caused by stasis

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13
Q

sono appearance of biliary sludge

A

amorphous low-level echoes with no acoustic shadowing

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14
Q

with biliary sludge, is there vascularity and are the GB walls normal?

A

lacks vascularity and normal GB wall

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15
Q

Acute cholecystitis s/s (3)

A

RUQ pain that is constant/epigastric pain
RUQ tenderness
Nausea/vomiting

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16
Q

Acute cholecystitis is caused by what in most patients?

A

stones

17
Q

acute cholecystitis most commonly affects (sex)

A

women 3x more <50 yrs

18
Q

impaction of stones in cystic duct or GB neck causes (8)

A 
bile flow obstruction (duct dilation)
luminal distension
ischemia
infection
necrosis
fever
leukocytosis
increased ALP &amp; bilirubin
19
Q

sono role for determining + murphys sign

A

pt in decub, slight/mod pressure over GB with probe (sag)

20
Q

Sono signs for acute cholecystitis (8)

A 
Thickening of GB wall >3mm
Edematous wall - can differentiate layers
Hyperemic wall
Percholecystic fluid collection
GB lumen distension >4cm transverse
Gallstones
\+ murphys
Duct dilation
21
Q

Gangrenous cholecystitis main sono finding *

A

Sloughing of wall into lumen

non layering bands echogenic tissue

22
Q

t/f Gangrenous cholecystitis shows a positive murphys sign

A

False - the nerves are necrosed in gangrenous cholecystitis so no + murphys sign

23
Q

focal defect in wall and deflation of GB in what pathology

A

GB perforation

24
Q

Pericholecystic fluid collection seen in what pathology

A

GB perforation (could also be acute cholecystitis)

25
Q

what pathology is frequently acalculus

A

Emphysematous cholecystitis

26
Q

(t/f) Emphysematous cholecystitis is most common in men

A

true

27
Q

Emphysematous cholecstitis appearance (2)

A

GAS IN LUMEN AND WALL
echogenic line, posterior dirty shadow
ring down artifact

28
Q

How is chronic cholecystitis differentiated from acute cholecystitis * (3)

A

Absence of the following:

  1. GB distension
    • murphys sign
  3. hyperemia of the wall
29
Q

what GB conditions do not show + murphys sign (2)

A

Gangrenous

chronic cholecystitis

30
Q

What GB pathology is common in the critically ill*, old, immunocompromised, diabetic?

A

acalculous cholecystitis

31
Q

Torsion of GB

A

GB lies in unusual horizontal position

32
Q

If torsion of GB exceeds 180 degrees what may occur?

A

Gangrene

33
Q

What might you expect if GB wall is thickly calcified with dense posterior acoustic shadowing

A

Porcelain GB

34
Q

Is adenomyomatosis benign/malignant and is it symptomatic?

A

benign and asymptomatic

35
Q

What is the key to diagnosing adenomyomatosis

A

thickening of adjacent GB wall

ring-down artifact from Rokitansky-Aschoff sinuses

36
Q

what may appear as twinkling

A

adenomyomatosis

37
Q

multiple polypoid masses characterizes benign or malignant

A

benign

Abdo Pathology (24 decks)

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