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Miranda's Flash Cards > ABD Board-Biliary Tract > Flashcards

ABD Board-Biliary Tract Flashcards

1
Q

intrahepatic ducts converge to form

A

lt and rt hepatic ducts

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2
Q

cystic duct joint the CHD to form the

A

CBD

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3
Q

the CBD and the main panc duct join to form the

A

ampulla of vater

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4
Q

folds which control bile flow in the cystic duct

A

valve of heister

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5
Q

diverticulum of the gb

A

hartmans pouch

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6
Q

fold between the body and neck of gb

A

junctional fold

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7
Q

fold between the body and fundus of gb

A

phrygian cap

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8
Q

the cbd passes _______ to the first part of the duodenum and panc head joining the _______ at the ampulla of vater

A

posterior

main panc duct (duct of wirsung)

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9
Q

gb wall thickness less than ____ is normal

A

3mm

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10
Q

most common cause of gb wall thickening

A

cholecystitis

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11
Q

other causes of gb wall thickening

A 
hypoalbuminemia
ascites
hepatitis
congestive heart failure
pancreatitis
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12
Q

pre hepatic causes of jaundice

A

hemolysis

ineffective erythropoiesis (over production of heoglobin)

absorption of large amounts of heoglobin (internal bleeding)

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13
Q

hepatic causes of jaundice

A

acute liver inflammation (reduces the liver ability to conjugate)

chronic liver disease

infiltrative liver disease (metastaatic, heochromatosis, alpha 1 antitrypsin deficiency, wilsons disease)

inflammation of bile ducts (primary biliary cirrhosis, sclerosing cholangitis)

genetic disorders (gilberts syndrome, crigler najjar syndrome)

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14
Q

post hepatic reasons for jaundace

A

obstruction of biliary tree (anything that blocks bile ducts, causes pale still and dark urine)

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15
Q

calcium bilirubinate granules and cholesterol cyrstals

A

sludge

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16
Q

sludge associated with biliary statsis and secondary to

A

prolonged fasting

parenternal nutrition (intravenous feeding)

hemolysis

cystic duct obstruction

cholecystitis

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17
Q

gallstones are composed of

A

cholsterol

calcium bilirubinate

calcium carbonate

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18
Q

cystjic duct obstruction may result in

A

acute cholecystitis

empyema (collection of puss)

gb perforation

pericholecystic abscess

bile peritonitis

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19
Q

WES AKA

A

double arc

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20
Q

amylase elevation suggests

A

obstruction at the level of the ampulla of vater

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21
Q

acute cholecystitis due to gb wall ischemia (lack of blood) and infection

A

emphysematous cholecystitis

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22
Q

emphysematous cholecystitis

A

occurs more in diabetic men gas produced by aneorbic bacteria (clostridium, e coli)

gas found in gb wall, lumen, or biliary tree.

comet tail or rind down (reverberation) artifacts are seen due to the gas

higher rate of gangrene and perforation

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23
Q

causes of gas in the biliary system (pneumobilia)

A

ERCP

sphincter of oddi papilotomy

choledochojejunostomy

gb (biliary) fistula

emphysematous cholecystitis

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24
Q

symptoms are same as acute cholecystitis with addition to fever, atypical bile echoes, initiated w/ obstruction of cystic duct

A

empyema of GB (pus in GB)

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25
complication of acute cholecystitis locatlized fluid collection in the GB fossa complications are, peritonitis, pericholecystic abscess, and biliary fistula
GB perforation (like a dissection)
26
acute cholecystitis without the presence of gallstones
acalculous cholecystitis
27
acalculous cholecystitis is associated with
parenteral nutrition > 3 months abd surgerory trauma burns HIV/AIDS blood transfusion reaaction high dose opioid analgesics
28
causes and appearance of acalculous cholecystitis
bile stasis, decreased GB contraction, and infection wall thickening, murphy sign, and pericholecystic fluid
29
other causes of GB wall thickening
increased hypoalbuminemia causing ascites and congestive heart failure
30
sludge like material with a high concetration of calcium may be seen as layering of sludge that results in distal acoustic shadowing
milk of calcium bile (limy bile)
31
calcification of the GB wall associated with chronic cholecystitis
porcelain GB
32
_________ is frequently found in the porcelain GB
adenocarcinoma
33
mucocele of the GB AKA overdistended of GB filled with mucoid or clear watery contents
hydrops of the GB asymptomatic, palp mass, RUQ pain
34
abnormal measurment of anterior posterior trans diameter of GB
>5cm
35
polyps that measure
10mm (> 10mm suggest growth and malignancy)
36
appear as polyps and vary in size, can be as large as 1cm they are lipids (triglycerides and cholesterol) deposited in the GB was
cholesterolosis AKA strawberry GB
37
cholesterolosis appears like _______ without the reverberation artifact
adenomyomatosis
38
intraluminal mass asymmetric wall thickening mass that fills the GB (most common)
appearance of GB Carcinoma
39
associated findings with GB carcinoma
liver metastases lymphadenopathy bile duct dilation cholelithiasis porcelain GB
40
hyperplastic changes incolving the GB wall causing overgrowth of the mucosa, thickening of the GB wass, and formation of dicerticula
adenomyamatosis
41
dicerticula within GB wall AKA
rokitansky aschoff sinusus (RAS) often accumulate stones or sludge
42
appearance of adenomyomatosis
hyperechoic foci within the thickened GB wall comet tail (reverberation artifact) looks alot like cholesterolosis
43
in the majority of patients, biliary obstruction is due to pathology in the _____ -_____
distal CBD (will present with jaundice)
44
2 most common lesions causing biliary obstruction
gallstones carcinoma of the head of the pancreas
45
elevated labs for biliary obstruction
alkaline phosphatase (ALP) conjugated bilirubin gamma glutamyl transpeptidase (GGT)
46
common hepatic duct is measured _____ ___ at the point
lumen only where the rt hepatic artery courses between the portal vein and the biliary duct
47
size of extrahepatic bile duct is most sensitive of distinguishing
medical from surgical jaundice
48
common duct measurements
= or than 8mm increases 1mm per decade post cholecystectomy the duct is bile reservoir and may measure up to 1cm
49
parallel channel sign AKA shotgun sign
dilated hepatic duct adjacent to the portal vein
50
bile ducts are more ___ than portal vein
tortuous
51
bile ducts branch in a _____ shaped configuration
star
52
bile structures attenuate sound ____ than blood producing posterior acoustic enhancement
less
53
hormone that is released into the blood by the ingestion of fatty foods and causes GB contration
cholecystokinin
54
possitive result from administering a fatty meal
duct increases in size
55
most common location for an obstructing stone
distal common bile duct entire system distends including the GB
56
only the common hepatic duct and intrahepatic ducts with dilate and the GB will be contracted
common hepatic obstruction
57
only intrahepatic ducts dilate and the GB will be contracted
obstruction at the junction of the rt and lt hepatic ducts
58
most common cause of extrahepatic obstructive jaundice
choledocholithiasis
59
symptoms of choledocholithiasis
biliary colic (RUQ pain) and jaundice
60
increased lab values with choledocholithiasis
alkaline phosphatase (ALP) conjugulated bilirubin gamma glutamyl transpeptidase (GGT)
61
complications of choledocholithiasis
biliary cirrhosis cholangitis pancreatitis
62
extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct
mirizzi syndrome
63
associated findings with mirizzi syndrome
intrahepatic duct dilatation cystic duct stone curved segmental stenosis of CHD cholecystocholedochal fistula
64
bile duct carcinoma
cholangiocarcinoma
65
usually occur within extrahepatic bile ducts (CHD or CBD)
adenocarcinoms
66
cholangiocarcinoma located at the hepatic hilum (joint of rt and lt hepatic ducts) resulting in intrahepatic but not extrahepatic biliary dilation
klatskin tumor
67
predisposing condition for cholangiocarcinoma
primary sclerosing cholangitis (most common) carolis disease choledochal cyst parasitic infestation chemical toxins
68
most common finding and symptoms for cholangiocarcinoma
intrahepatic bile duct dilatation jaundice weight loss ABD pain
69
bacterial infection superimiposed on an obstruction of the biliary tree
cholangitis
70
most common cause of cholangitis
choledocholithiasis
71
symtpoms of cholangitis
RUQ pain fever jaundice
72
lab values for cholangitis
increased: conjugated bilirubin alkaline phosphatase (ALP) gamma glutamyl transpeptidase (GGT) amylase and lipase white blood cell count
73
suspected when jaundice (hyperbilirubinemia) persists beyond 14 days
biliary atresia | sugical drainage with the kasai portoenterostomy is most successful in treatment
74
air in the biliary tract
pneumobillia will have comet tail (reverberation) most commonly associated with ERCP (endoscopic retrograde cholangiopancreatogram)
75
congenital bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts
cholelochal cysts (5 classes) most common in Asia (33% in japan) syptems usually occur before age 10
76
most common choledochal cysts
type 1 saccular or fusiform incolves diatation of the CBD 2 cystic structures in the RUQ (GB and dilated CBD) intrahepatic bile duct dilatation (Other sources say normal intrahepatic ducts with CBD dilation)
77
type V (5) choledochal cyst mulifocal segmental dilatation of the intrahepatic bile ducts
carolis disease multiple cystic structures converging toward the porta hepatis
78
most common cause of malignant neoplasm obstructing the biliary tree
pancreatic adenocarcinoma
79
pacreatic adenocarcinoma at the head usually causes
courvoisier GB enlarged non diseased due to mechanical obstruction of the CBD
80
inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts
primary sclerosing cholangitis (hardening or thickening) associated with inflammatory bowel disease (ulcerative colitis), ERCP, and cholangiocarcinoma
81
chronic and progressive cholestatsis due to destruction of the small intrahepatic bile ducts leading to end stage liver disease
priimary biliary cirrhosis
82
end product of heoglobin breakdown
bilirubin
83
process of removing protein (albumin) from unconjucated bilirubin making it soluble. Important for bilrubin disposal. Makes pigment exretable by the liver and detoxifies the waste product.
conjugation
84
presence of bilrubin in urine indicates
conjugated hyperbilirubinemia cause kidneys do not filter unconjugated bilirubin as they are boind to albumin
85
enzyme that is concentrated in the bile ducts found in bone, liver, and placenta. increases with bile duct obstruction, bone growth, and pregnancy
alkkaline phosphatase (ALP)

Miranda's Flash Cards (14 decks)

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