Lesson 2.1 - Biliary Path (part 1)

Question 1

What is bilirubin

Answer 1

a product of the breakdown of hemoglobin in old RBC

Question 2

elevation of direct/conjugated bilirubin associated with (4)

Answer 2

obstruction
hepatitis
cirrhosis
liver mets

Question 3

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

Answer 3

non obstructive conditions i.e. fatty liver

Question 4

ALP elevation assoc with (1)*

Answer 4

obstructive jaundice

Question 5

ALT elevation assoc with (4)*

Answer 5

cirrhosis
hepatitis
biliary obstruction

Question 6

AST elevation assoc with (3)*

Answer 6

cirrhosis
hepatitis
mononucleosis

Question 7

2 congenital variants

Answer 7

duplication - rare

multiseptated

Question 8

what are risk factors for cholelithiasis (6)

Answer 8

female
age (increasing)
pregnancy
fecundity (premenopausal women)
obesity
diabetes

Question 9

what is the key feature of stones allowing differentiation from polyps

Answer 9

mobility

Question 10

sono appearance of gallstone (1)

Answer 10

echogenic
shadowing
mobility

Question 11

What is WES complex

Answer 11

wall-echo-shadow

Question 12

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

Answer 12

GB filled with semisolid calcium carbonate caused by stasis

Question 13

sono appearance of biliary sludge

Answer 13

amorphous low-level echoes with no acoustic shadowing

Question 14

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

Answer 14

lacks vascularity and normal GB wall

Question 15

Acute cholecystitis s/s (3)

Answer 15

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

Question 16

Acute cholecystitis is caused by what in most patients?

Answer 16

stones

Question 17

acute cholecystitis most commonly affects (sex)

Answer 17

women 3x more <50 yrs

Question 18

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

Answer 18

bile flow obstruction (duct dilation)
luminal distension
ischemia
infection
necrosis
fever
leukocytosis
increased ALP & bilirubin

Question 19

sono role for determining + murphys sign

Answer 19

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

Question 20

Sono signs for acute cholecystitis (8)

Answer 20

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

Question 21

Gangrenous cholecystitis main sono finding *

Answer 21

Sloughing of wall into lumen

non layering bands echogenic tissue

Question 22

t/f Gangrenous cholecystitis shows a positive murphys sign

Answer 22

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

Question 23

focal defect in wall and deflation of GB in what pathology

Answer 23

GB perforation

Question 24

Pericholecystic fluid collection seen in what pathology

Answer 24

GB perforation (could also be acute cholecystitis)

Question 25

what pathology is frequently acalculus

Answer 25

Emphysematous cholecystitis

Question 26

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

Answer 26

true

Question 27

Emphysematous cholecstitis appearance (2)

Answer 27

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

Question 28

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

Answer 28

Absence of the following: 1. GB distension 2. + murphys sign 3. hyperemia of the wall

Question 29

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

Answer 29

Gangrenous | chronic cholecystitis

Question 30

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

Answer 30

acalculous cholecystitis

Question 31

Torsion of GB

Answer 31

GB lies in unusual horizontal position

Question 32

If torsion of GB exceeds 180 degrees what may occur?

Answer 32

Gangrene

Question 33

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

Answer 33

Porcelain GB

Question 34

Is adenomyomatosis benign/malignant and is it symptomatic?

Answer 34

benign and asymptomatic

Question 35

What is the key to diagnosing adenomyomatosis

Answer 35

thickening of adjacent GB wall | ring-down artifact from Rokitansky-Aschoff sinuses

Question 36

what may appear as twinkling

Answer 36

adenomyomatosis

Question 37

multiple polypoid masses characterizes benign or malignant

Answer 37

benign