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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
Q

complication of acute cholecystitis

locatlized fluid collection in the GB fossa

complications are, peritonitis, pericholecystic abscess, and biliary fistula

A

GB perforation (like a dissection)

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26
Q

acute cholecystitis without the presence of gallstones

A

acalculous cholecystitis

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27
Q

acalculous cholecystitis is associated with

A

parenteral nutrition > 3 months

abd surgerory

trauma

burns

HIV/AIDS

blood transfusion reaaction

high dose opioid analgesics

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28
Q

causes and appearance of acalculous cholecystitis

A

bile stasis, decreased GB contraction, and infection

wall thickening, murphy sign, and pericholecystic fluid

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29
Q

other causes of GB wall thickening

A

increased hypoalbuminemia causing ascites and congestive heart failure

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30
Q

sludge like material with a high concetration of calcium

may be seen as layering of sludge that results in distal acoustic shadowing

A

milk of calcium bile (limy bile)

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31
Q

calcification of the GB wall associated with chronic cholecystitis

A

porcelain GB

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32
Q

_________ is frequently found in the porcelain GB

A

adenocarcinoma

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33
Q

mucocele of the GB AKA

overdistended of GB filled with mucoid or clear watery contents

A

hydrops of the GB

asymptomatic, palp mass, RUQ pain

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34
Q

abnormal measurment of anterior posterior trans diameter of GB

A

> 5cm

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35
Q

polyps that measure

A

10mm (> 10mm suggest growth and malignancy)

36
Q

appear as polyps and vary in size, can be as large as 1cm

they are lipids (triglycerides and cholesterol) deposited in the GB was

A

cholesterolosis AKA strawberry GB

37
Q

cholesterolosis appears like _______ without the reverberation artifact

A

adenomyomatosis

38
Q

intraluminal mass

asymmetric wall thickening

mass that fills the GB (most common)

A

appearance of GB Carcinoma

39
Q

associated findings with GB carcinoma

A

liver metastases

lymphadenopathy

bile duct dilation

cholelithiasis

porcelain GB

40
Q

hyperplastic changes incolving the GB wall causing overgrowth of the mucosa, thickening of the GB wass, and formation of dicerticula

A

adenomyamatosis

41
Q

dicerticula within GB wall AKA

A

rokitansky aschoff sinusus (RAS)

often accumulate stones or sludge

42
Q

appearance of adenomyomatosis

A

hyperechoic foci within the thickened GB wall

comet tail (reverberation artifact)

looks alot like cholesterolosis

43
Q

in the majority of patients, biliary obstruction is due to pathology in the _____ -_____

A

distal CBD (will present with jaundice)

44
Q

2 most common lesions causing biliary obstruction

A

gallstones

carcinoma of the head of the pancreas

45
Q

elevated labs for biliary obstruction

A

alkaline phosphatase (ALP)

conjugated bilirubin

gamma glutamyl transpeptidase (GGT)

46
Q

common hepatic duct is measured _____ ___ at the point

A

lumen only

where the rt hepatic artery courses between the portal vein and the biliary duct

47
Q

size of extrahepatic bile duct is most sensitive of distinguishing

A

medical from surgical jaundice

48
Q

common duct measurements

A

= or than 8mm

increases 1mm per decade

post cholecystectomy the duct is bile reservoir and may measure up to 1cm

49
Q

parallel channel sign AKA shotgun sign

A

dilated hepatic duct adjacent to the portal vein

50
Q

bile ducts are more ___ than portal vein

A

tortuous

51
Q

bile ducts branch in a _____ shaped configuration

A

star

52
Q

bile structures attenuate sound ____ than blood producing posterior acoustic enhancement

A

less

53
Q

hormone that is released into the blood by the ingestion of fatty foods and causes GB contration

A

cholecystokinin

54
Q

possitive result from administering a fatty meal

A

duct increases in size

55
Q

most common location for an obstructing stone

A

distal common bile duct

entire system distends including the GB

56
Q

only the common hepatic duct and intrahepatic ducts with dilate and the GB will be contracted

A

common hepatic obstruction

57
Q

only intrahepatic ducts dilate and the GB will be contracted

A

obstruction at the junction of the rt and lt hepatic ducts

58
Q

most common cause of extrahepatic obstructive jaundice

A

choledocholithiasis

59
Q

symptoms of choledocholithiasis

A

biliary colic (RUQ pain) and jaundice

60
Q

increased lab values with choledocholithiasis

A

alkaline phosphatase (ALP)

conjugulated bilirubin

gamma glutamyl transpeptidase (GGT)

61
Q

complications of choledocholithiasis

A

biliary cirrhosis

cholangitis

pancreatitis

62
Q

extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct

A

mirizzi syndrome

63
Q

associated findings with mirizzi syndrome

A

intrahepatic duct dilatation

cystic duct stone

curved segmental stenosis of CHD

cholecystocholedochal fistula

64
Q

bile duct carcinoma

A

cholangiocarcinoma

65
Q

usually occur within extrahepatic bile ducts (CHD or CBD)

A

adenocarcinoms

66
Q

cholangiocarcinoma located at the hepatic hilum (joint of rt and lt hepatic ducts) resulting in intrahepatic but not extrahepatic biliary dilation

A

klatskin tumor

67
Q

predisposing condition for cholangiocarcinoma

A

primary sclerosing cholangitis (most common)

carolis disease

choledochal cyst

parasitic infestation

chemical toxins

68
Q

most common finding and symptoms for cholangiocarcinoma

A

intrahepatic bile duct dilatation

jaundice

weight loss

ABD pain

69
Q

bacterial infection superimiposed on an obstruction of the biliary tree

A

cholangitis

70
Q

most common cause of cholangitis

A

choledocholithiasis

71
Q

symtpoms of cholangitis

A

RUQ pain

fever

jaundice

72
Q

lab values for cholangitis

A

increased:

conjugated bilirubin

alkaline phosphatase (ALP)

gamma glutamyl transpeptidase (GGT)

amylase and lipase

white blood cell count

73
Q

suspected when jaundice (hyperbilirubinemia) persists beyond 14 days

A

biliary atresia

sugical drainage with the kasai portoenterostomy is most successful in treatment

74
Q

air in the biliary tract

A

pneumobillia

will have comet tail (reverberation)

most commonly associated with ERCP (endoscopic retrograde cholangiopancreatogram)

75
Q

congenital bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts

A

cholelochal cysts (5 classes)

most common in Asia (33% in japan)

syptems usually occur before age 10

76
Q

most common choledochal cysts

A

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
Q

type V (5) choledochal cyst

mulifocal segmental dilatation of the intrahepatic bile ducts

A

carolis disease

multiple cystic structures converging toward the porta hepatis

78
Q

most common cause of malignant neoplasm obstructing the biliary tree

A

pancreatic adenocarcinoma

79
Q

pacreatic adenocarcinoma at the head usually causes

A

courvoisier GB

enlarged non diseased due to mechanical obstruction of the CBD

80
Q

inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts

A

primary sclerosing cholangitis (hardening or thickening)

associated with inflammatory bowel disease (ulcerative colitis), ERCP, and cholangiocarcinoma

81
Q

chronic and progressive cholestatsis due to destruction of the small intrahepatic bile ducts leading to end stage liver disease

A

priimary biliary cirrhosis

82
Q

end product of heoglobin breakdown

A

bilirubin

83
Q

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.

A

conjugation

84
Q

presence of bilrubin in urine indicates

A

conjugated hyperbilirubinemia

cause kidneys do not filter unconjugated bilirubin as they are boind to albumin

85
Q

enzyme that is concentrated in the bile ducts found in bone, liver, and placenta. increases with bile duct obstruction, bone growth, and pregnancy

A

alkkaline phosphatase (ALP)

Miranda's Flash Cards (14 decks)

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