Biliary Flashcards
Name types of anatomical variants of gallbladder
Agenesis
Double
Phrygian cap
Left sided gallbladder
Name reasons for being unable to visualize the gallbladder
Surgery, no fasting, abnormal position, emphysema cholecystitis, filled with stones
Causes of sludge in gallbladder
Chronic fasting, critically ill, ceftriaxone, pregnancy
Ultrasound and CT findings of cholecystitis.
US :
Thickness wall more than 3mm
Gallbladder distention more than 5cm
Pericholecystic fluid
Wall striation
Wall hyperaemia on doppler
CT:
Wall thickening, subserosal odema, gallbladder distention, high density bile, pericholecystic fluid and inflammatory stranding in pericholecystic fat
Name other causes of gallbladder wall thickening.
Nonfasting, generalised odoema states, hepatitis, pancreatitis, gallbladder wall varices, adenomyomatosis and carcinoma
What are the 2 signs that a polyp might be invasive?
Diameter more than 10mm (usually 2-10mm)
Local disruption of adjacent gallbladder
What questions should be asked when assessing jaundice radiologically?
Is obstruction present? Intrahepatic less than 3mm centrally, peripherally smaller than portal vein branches. Commin duct less than 7mm
Anatomical level? Hilar/low/mid common duct
Cause? See next card
Malignant?
Evident of nonresectability?
If not for surgery, what procedure?
Name causes of major bile duct obstruction
Hilar - gallbladder ca, hepatocellular CA
Low/mid duct - pancreas cancer, ampullary CA, pancreatitis
Either - cholangioca, mets, lymphoma, biliary tumour, stones, mirizzi, post op strictures, PSC, heamobilia, parasites
What is the differential diagnosis of stones on ultrasound.
Gas, haemobilia, sludge, mets, parasites
What are the radiology signs of cholangiocarcinoma?
US - nodules or focal bile duct wall thickening, slightly hyperechoic
CT - isodense or slightly hypodense
MRI - hypointense in T1 and hyperintense on T2
