Lesson 2A (Part 4) Flashcards
What are indications for a biliary US? (2)
- Patients have increased LFT’s
- Painless or painful jaundice
- acute obstruction or infection of biliary tree
What are you trying to rule out with a biliary US? (5)
- Obstruction of bile ducts
- are the ducts or gallbladder dilated
- if dilated, at what level - Stones
- Infection
- Neoplasms
- Extrinsic compression
Stasis
Bile has been sitting in the gallbladder for a long time without being excreted
When you lay down, where do the stones in a gallbladder normally fall to?
The neck
- gravity dependent
What happens in gangrenous cholecystitis?
The inner most layer of the wall becomes detached and ends up in the lumen
Acalculus
No stones
What kind of a disease is a choledochal cyst?
Congenital disease
What are type 1, 2 and 3 of choledochal cysts involved with?
Cystic dilation of the common bile duct
What type 4 of choledochal cysts involved with?
Intrahepatic ducts
What type 5 of choledochal cysts involved with?
Caroli’s disease
- not a true choledochal cyst
Carolis disease
Is a rare congenital disease that involves the intrahepatic biliary tree associated with medullary sponge kidneys
- usually diffuses
Who does caroli’s disease effect?
Men and women equally
What kind of complications can arise with caroli’s disease? (6)
- Biliary stasis
- Cholangitis
- Stones and sepsis
- Hepatic fibrosis
- Portal hypertension
- At risk for cholangiocarcinoma
Primary choledocholithiasis
Stones form within ducts related to diseases causing strictures or dilation of bile ducts resulting in stasis
What are the causes of primary choledocholithiasis? (5)
- Sclerosing cholangitis
- Caroli’s disease
- Parasitic infections of liver
- Chronic hemolytic disease
- sickle cell anemia - Prior biliary surgery
- enteric anastomosis
Secondary choledocholithiasis
Migration of stones from the gallbladder into the common bile duct
What symptoms do patients with secondary choledocholithiasis have?
Pain in the RUQ/epigastric region
What is the sonographic appearance of secondary choledocholithiasis? (4)
- Dilated common bile duct proximal to the stone
- Dilated Intrahepatic ducts
- Large stone shadow
- smaller stones may not shadow - GB distension
Where will the majority CBD stones be?
In the distal portion of the CBD at the ampulla of vater
What are potential differential diagnosis for CBD stones? (3)
- Blood clot
- hemobilia - Papillary tumor
- Biliary sludge
- None of these shadow
Hemobilia
Blood in the biliary
When are intrahepatic bile duct stones seen?
In patients with cystic fibrosis
What is a fistula?
Abnormal connection between an organ,vessel,intestine or other structure
What is a fistula usually a result of? (4)
- Injury
- Surgery
- Infection
- Inflammation
