Lesson 2A (Part 4) Flashcards Preview

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Flashcards in Lesson 2A (Part 4) Deck (38)
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1

What are indications for a biliary US? (2)

1. Patients have increased LFT’s
2. Painless or painful jaundice
- acute obstruction or infection of biliary tree

2

What are you trying to rule out with a biliary US? (5)

1. Obstruction of bile ducts
- are the ducts or gallbladder dilated
- if dilated, at what level
2. Stones
3. Infection
4. Neoplasms
5. Extrinsic compression

3

Stasis

Bile has been sitting in the gallbladder for a long time without being excreted

4

When you lay down, where do the stones in a gallbladder normally fall to?

The neck
- gravity dependent

5

What happens in gangrenous cholecystitis?

The inner most layer of the wall becomes detached and ends up in the lumen

6

Acalculus

No stones

7

What kind of a disease is a choledochal cyst?

Congenital disease

8

What are type 1, 2 and 3 of choledochal cysts involved with?

Cystic dilation of the common bile duct

9

What type 4 of choledochal cysts involved with?

Intrahepatic ducts

10

What type 5 of choledochal cysts involved with?

Caroli's disease
- not a true choledochal cyst

11

Carolis disease

Is a rare congenital disease that involves the intrahepatic biliary tree associated with medullary sponge kidneys
- usually diffuses

12

Who does caroli's disease effect?

Men and women equally

13

What kind of complications can arise with caroli's disease? (6)

1. Biliary stasis
2. Cholangitis
3. Stones and sepsis
4. Hepatic fibrosis
5. Portal hypertension
6. At risk for cholangiocarcinoma

14

Primary choledocholithiasis

Stones form within ducts related to diseases causing strictures or dilation of bile ducts resulting in stasis

15

What are the causes of primary choledocholithiasis? (5)

1. Sclerosing cholangitis
2. Caroli’s disease
3. Parasitic infections of liver
4. Chronic hemolytic disease
- sickle cell anemia
5. Prior biliary surgery
- enteric anastomosis

16

Secondary choledocholithiasis

Migration of stones from the gallbladder into the common bile duct

17

What symptoms do patients with secondary choledocholithiasis have?

Pain in the RUQ/epigastric region

18

What is the sonographic appearance of secondary choledocholithiasis? (4)

1. Dilated common bile duct proximal to the stone
2. Dilated Intrahepatic ducts
3. Large stone shadow
- smaller stones may not shadow
4. GB distension

19

Where will the majority CBD stones be?

In the distal portion of the CBD at the ampulla of vater

20

What are potential differential diagnosis for CBD stones? (3)

1. Blood clot
- hemobilia
2. Papillary tumor
3. Biliary sludge

- None of these shadow

21

Hemobilia

Blood in the biliary

22

When are intrahepatic bile duct stones seen?

In patients with cystic fibrosis

23

What is a fistula?

Abnormal connection between an organ,vessel,intestine or other structure

24

What is a fistula usually a result of? (4)

1. Injury
2. Surgery
3. Infection
4. Inflammation

25

What is hemobilia caused by?

1. Percutaneous biliary procedures(ERCP)
2. Liver biopsies
3. Cholangitis/cholecystitis
4. Vascular malformations
5. Trauma
6. Malignancies

26

What occurs with hemobilia? (3)

1. Pain
2. Bleeding
3. Increased bilirubin

27

What is essential in the diagnosis of hemobilia?

Clinical history

28

How does hemobilia appear?

As blood clot within biliary tree

29

What is the sonographic appearance of hemobilia? (3)

1. Echogenic
2. Mixed echogenicity
3. Conforms to shape of the duct

30

Pneumobilia

The presence of gas in the biliary system