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
31
What is the sonographic appearance of pneumobilia? (1)
1. Bright echogenic linear structures following portal triads
2. Reverberation ring down artifact
32
What are the causes of pneumobilia? (4)
1. Previous biliary intervention
- iatrogenic
2. Emphysematous cholecystitis
3. Choledochoduodenal fistula
4. Cholecystoenteric fistula
33
What is choledochoduodenal fistula caused by?
By stones in the CBD
- inflammation
34
Cholecystoenteric fistula
Prolonged acute cholecystitis erodes into an adjacent bowel loop
35
Gallstone ileus
Paralysis of the nerves
36
How do stones pass from the gallbladder into the bowel?
Cholecystoenteric fistula
37
What does gallstone ileus frequently involve? (2)
1. Duodenum
2. Transverse colon
38
