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ABD Pathology > Bile Ducts > Flashcards

Bile Ducts Flashcards

1
Q

Intrahepatic duct dilatation

A

CHD
RHD
LHD

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2
Q

Extrahepatic duct dilatation includes:

A

Cystic duct

CBD

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3
Q

Risk factors for biliary dilatation

A

Mirizzi syndrome
Choledocholithiasis
Cholangiocarcinoma
Mets

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4
Q

Clinical Presentation of biliary dilatation

A

RUQ pain
Jaundice
Elevated LFTS

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5
Q

Double barrel shotgun sign

A

AKA parallel channel sign

Dilated intrahepatic ducts adjacent to normal portal vein

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6
Q

Flashlight sign

A

Peripheral anechoic areas in liver that cause acoustic enhancement

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7
Q

anechoic tubular structure in liver that has antler or stellate branching pattern converging near porta hepatis

A

Sonographic sign of biliary dilatation

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8
Q

Dilated CBD

A

> =8 mm

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9
Q

Dilated CHD

A

> 5mm

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10
Q

What occurs when dilatation of biliary tree progresses?

A

Portal system becomes flattened

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11
Q

Normal CBD for adults older than 60

A

Add 1 mm to normal for each decade over

Ex: 80 years will measure 8 mm

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12
Q

Normal CBD for neonates

A

<1mm

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13
Q

Normal CBD for infants to 1 year

A

<2 mm

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14
Q

Normal CBD for older children (2-10)

A

<4 mm

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15
Q

Choledocholithiasis

A

Complete/partial obstruction of bile ducts by stones

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16
Q

Incidence of Choledocholithiasis

A

Greatest at time of cholecystectomy
3-4% of post cholecystectomy PTs
Ductal stones found in 75% of chronic bile duct obstructions

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17
Q

Risk factors for Choledocholithiasis

A 
Cholelithiasis
Sclerosing cholangitis
Caroli’s disease 
Parasitic infection of liver
Chronic hemolytic diseases 
Prior biliary surgery
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18
Q

Clinical presentation of Choledocholithiasis

A

Biliary colic
Jaundice
Elevated ALP, direct bilirubin, AST and ALT

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19
Q

Sonographic findings of Choledocholithiasis

A

Hyperechoic shadowing foci within CBD that MUST be demonstrated in orthogonal views

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20
Q

Structures that appear similar to Choledocholithiasis

A 
Air or stool in adjacent bowel
RHA crossing CHD and indenting it
Refraction of beam 
Post op cholecystectomy clips
Cystic duct impression on CBD
Pneumobilia
Mucous plug
Calcification in pancreas head
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21
Q

Cholangitis

A

Inflammation of bile duct walls

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22
Q

Types of cholangitis

A

Acute bacterial
Recurrent pyogenic
HIV cholangiopathy
sclerosing

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23
Q

Incidence of recurrent pyogenic cholangitis

A

Affects male and female with equal frequency

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24
Q

Incidence of primary sclerosing cholangitis

A

Affects males more frequently than females (7:3)

25
Q

Majority older than 45 years of age for cholangitis

T/F

A

False, less than 45 years old

26
Q

What is the Charcot triad?

A

Fever, chills, and jaundice

27
Q

Lab findings with cholangitis

A

Marked elevation of bilirubin and ALP with sclerosing cholangitis
Increased AST and ALT
Elevated WBC

28
Q

Differential Diagnoses for cholangitis

A

Biliary obstruction

Caroli’s disease

29
Q

Infection of ascariasis lumbricoides incidence

A

More frequent in children due to poor hygiene
More frequent in southern and gulf coast states in US
Most prevalent in Africa, Asia, and South America

30
Q

Sonographic findings for cholangitis may include:

A

Thickening of bile duct walls with mild dilatation
Brightly echogenic portal triad
Thickened GB wall
Dilated ducts as large as 3-4cm
Sludge or pus in ducts
Dilatation of extrahepatic ducts packed with stones
Hydropic GB in 30% of cases
Pneumobilia
Hepatic abscess
Portal hypertension with liver damage and cirrhosis changes

31
Q

Hemobilia

A

Blood in biliary tree

32
Q

Hemobilia causes

A 
65% caused by percutaneous biliary procedures and liver biopsies
Infection
Vascular malformation
Trauma 
Malignancy
33
Q

Blood and thrombus common in gallbladder with Hemobilia

T/F

34
Q

Pneumobilia

A

Air in biliary tree

35
Q

Risk factors for Pneumobilia

A 
Incompetent sphincter of Oddi
Post sphincter of Oddie sphincterotomy
Gallstone ileus
Emphysematous cholecystitis
Trauma
Duodenal ulcer perforating into CBD
Post op
Post ERCP
36
Q

Sonographic findings of Pneumobilia

A

Hyperechoic collections of “dirty” shadowing within extrahepatic biliary ducts or GB

37
Q

Cholangiocarcinoma

A

Primary cancer of the biliary ducts

Typically Adenocarcinoma arising from epithelial layer

38
Q

Cholangiocarcinoma incidence

A

1/3 of all malignancies in liver
More common in males
50-60 years
Location of tumors: 1) CBD (esp. distal), 2) hepatic ducts, 3) cystic duct

39
Q

Risk factors for cholangiocarcinoma

A 
Primary sclerosing cholangitis
Cholangitis
Chronic biliary stasis
Caroli’s disease 
Choledochal cysts
Pancreatitis
Ulcerative colitis
40
Q

Hilar cholangiocarcinoma

A

Klatskins tumor

41
Q

Types of cholangiocarcinoma

A

Intrahepatic
Hilar
Distal
Extrahepatic

42
Q

Lab findings for cholangiocarcinoma

A

Elevated ALP and bilirubin

43
Q

Diff Dx for cholangiocarcinoma

A

small pancreatic or ampullary carcinoma

Lymphadenopathy

44
Q

Sonographic findings of cholangiocarcinoma

A

Normal pancreas, marked biliary obstruction
Mass involving bile duct
Echogenic bands across lumen
Hepatomegaly and ascites

45
Q

Biliary atresia

A

Fibrotic obliteration of biliary tree

46
Q

Biliary atresia most commonly affects:

A

Extrahepatic ducts

47
Q

Incidence of biliary atresia

A

Neonates
Males (2:1)
Rare

48
Q

Differentiating biliary atresia from ________________ is critical and difficult.

A

Neonatal hepatitis

49
Q

Triangular cord

A

Sclerotic ductal remnant visualized at porta hepatis

50
Q

Two signs that are pathognomonic for biliary atresia in a fasting infant

A

Triangular cord and small GB

51
Q

What is the Kasai procedure?

A

Portoenterostomy

52
Q

Roux-en-Y procedure

A

Choledochojejunostomy

53
Q

Caroli’s disease

A

Congenital communicating cavernous ectasia of intrahepatic bile ducts

54
Q

Incidence of Caroli’s disease

A

Affects males and females equally

Typically identified in childhood through 20’s

55
Q

Sonographic findings in Caroli’s disease

A

Multiple cystic structures within liver that communicate with biliary tree
Stones and sludge may be seen in dilated ducts
Doppler of cystic structures demonstrated absence of flow
Central dot sign

56
Q

Choledochal cysts

A

Congenital focal or diffuse cystic dilation of extrahepatic biliary tree

57
Q

Incidence of Choledochal cyst

A

More common in East Asian populations
More common in females (4:1)
Typically identified in kids less than 10 yrs of age

58
Q

Large, cystic mass in porta hepatitis separate from GB measures:

ABD Pathology (5 decks)

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