Biliary Notes Flashcards

1
Q

What is an adenoma? What is it similar to? How common is this neoplasm?

A
  1. A benign epithelial tumor
  2. Histologically similar to a bowel wall polyp
  3. Most common benign neoplasm.
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2
Q

What is adenomyomatosis? What kind of mass is this? How can this happen in the gallbladder?

A
  1. Hyperplasia of epithelial and muscle layers in the gallbladder wall
  2. A small polypoid mass of the gallbladder wall
  3. Diverticulosis of the gallbladder.
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3
Q

What is the ampulla of Vater?

A

Opening in the duodenum for the entrance of the common bile duct.

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4
Q

What is ascariasis?

A

Infection by a roundworm that may result in abdominal cramping or obstruction.

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5
Q

Bile is a fluid secreted by what organ? Where is it concentrated in? And where is it poured into? What does it play a role in?

A
  1. A fluid secreted by the liver, concentrated in the gallbladder, and poured into the small intestine via the bile ducts
  2. Plays a role in emulsification, absorption, and digestion of fats.
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6
Q

What is bilirubin?

A

Yellow pigment in bile formed by the breakdown of red blood cells.

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7
Q

What is biliary atresia?

A

Partial or complete absence of the biliary system.

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8
Q

What is biliary colic? What is it also called?

A

Visceral pain associated with passing of stone(s) through the bile ducts; also called cholecystalgia.

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9
Q

What is biloma? What is it formed by?

A

An extrahepatic collection of extravasated bile from trauma, surgery, or gallbladder disease.

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10
Q

What is Bouveret syndrome?

A

Gastric outlet obstruction caused by duodenal impaction of a large stone that has migrated through a cholecystoduodenal fistula.

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11
Q

What is Caroli disease?

A

A segmental, saccular, or beaded appearance to the intrahepatic biliary ducts.

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12
Q

What is Charcot triad?

A

Fever, chills, and jaundice.

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13
Q

What is cholangitis?

A

Inflammation of a bile duct.

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14
Q

What is cholangiocarcinoma?

A

Carcinoma of a bile duct.

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15
Q

What is cholecystitis?

A

Inflammation of the gallbladder.

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16
Q

What is cholecystokinin?

A

A hormone secreted in the small intestine that stimulates gallbladder contraction and secretion of pancreatic enzymes; stimulation occurs after food reaches the duodenum.

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17
Q

What is a choledochal cyst?

A

Cystic dilatation of the common bile duct.

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18
Q

What is choledocholithiasis?

A

Calculus in the common duct; stones contain bile pigments, bile calcium salts, and cholesterol.

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19
Q

What is cholelithiasis?

A

The presence or formation of gallstones; stones contain cholesterol, calcium bilirubinate, and calcium carbonate.

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20
Q

What is cholesterolosis?

A

A form of hyperplastic cholecystosis caused by the accumulation of triglycerides and esterified sterols in the macrophage of the gallbladder wall.

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21
Q

What is cholesterosis appearance?

A

Type of cholesterolosis associated with a strawberry appearance to the gallbladder.

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22
Q

What is chronic cholecystitis?

A

Recurrent attacks of acute cholecystitis.

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23
Q

What is clonorchiasis?

A

Parasite that typically resides in the intrahepatic ducts; the gallbladder and pancreas may also be affected.

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24
Q

What is the common duct?

A

Term used to include the extrahepatic common hepatic duct and common bile duct.

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25
Q

What is the Courvoisier sign? What is it caused by?

A
  1. Painless jaundice associated with an enlarged gallbladder
  2. Caused by the obstruction of the distal common bile duct by an external mass (typically adenocarcinoma of the pancreatic head).
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26
Q

What is the cystic duct? What does it drain into?

A

Small duct that drains the gallbladder.

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27
Q

What is emphysematous cholecystitis?

A

Gas in the gallbladder wall or lumen.

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28
Q

What is empyema?

A

Pus in the gallbladder.

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29
Q

What is hematobilia? What three things is it assocaited with?

A
  1. Bleeding into the biliary tree
  2. Associated with
    - Liver Biopsy,
    - Blunt trauma
    - Rupture of a hepatic artery aneurysm.
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30
Q

What is Hartmann pouch?

A

Small posterior pouch near the gallbladder neck.

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31
Q

What is jaundice?

A

Yellowish discoloration of the skin or sclera related to an increased level of bilirubin in the blood.

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32
Q

What is the junctional fold?

A

Fold or septation of the gallbladder at the junction of the neck and body.

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33
Q

What is a Klatskin tumor?

A

Carcinoma located at the junction of the right and left hepatic ducts.

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34
Q

What is the main lobar fissure?

A

A hyperechoic line extending from the right portal vein to the gallbladder fossa; a boundary between the left and right lobes of the liver.

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35
Q

What is Mirizzi syndrome? What does it cause? (5)

A
  1. Impacted stone in the cystic duct
  2. Causing compression on the common hepatic duct resulting in
    — Jaundice
    — Recurrent cholangitis
    — Formation of biliary fistulas,
    — Cholangitis
    — Cirrhosis.
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36
Q

What is parallel channeling?

A

Condition in biliary obstruction representing imaging of the dilated hepatic duct and adjacent portal vein.

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37
Q

What is a phrygian cap?

A

Fold in the gallbladder fundus.

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38
Q

What is pneumobilia?

A

Air in the biliary tree.

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39
Q

What is a polyp?

A

A soft tissue mass protruding from the gallbladder wall.

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40
Q

What is a porcelain gallbladder?

A

Complete or partial calcification of the gallbladder wall.

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41
Q

What is a positive Murphy sign?

A

Severe pain when pressure is increased over the gallbladder.

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42
Q

What is sludge?

A

Echogenic viscous bile associated with biliary stasis.

43
Q

What is a sludgeball?

A

Mobile, echogenic, nonshadowing mass in the dependent portion of the gallbladder.

44
Q

What is tumefactive sludge? What does it resemble?

A

Echogenic bile that does not layer evenly; resembles a polypoid mass.

45
Q

What is the WES sign?

A

Wall-echo-shadow sign; ‘double arc’ sign; seen with a stone-filled gallbladder.

46
Q

What are the functions of the biliary system? 3

A

• Transport bile to the gallbladder through the bile ducts.
• Store and concentrate bile in the gallbladder.
• Transport bile through the bile ducts to the duodenum.

47
Q

What is the anatomy of the biliary system? (Where does it originate from? What is it subdivided into?)

A

• The biliary system originates in the liver as a series of ductules coursing between the liver cells.
• Biliary ducts are subdivided into intrahepatic and extrahepatic ducts.

48
Q

What forms the common hepatic duct?

A

The right and left hepatic ducts join near the level of the porta hepatis, forming the common hepatic duct (CHD).

49
Q

What is the cystic duct’s average length?

A

An average length of 4 cm has been reported at surgery.

50
Q

What is the common bile duct?

A

The CHD is joined by the cystic duct to form the CBD.

51
Q

What is the average intraluminal diameter of the common bile duct in adults?

A

6 mm in diameter or less.

52
Q

What is the normal fasting adult gallbladder size?

A

Approximately 8 to 12 cm in length and 3 to 4 cm in diameter.

53
Q

What is the sonographic appearance of a normal fasting gallbladder?

A

An ellipsoid anechoic structure located in the gallbladder fossa demonstrating posterior acoustic enhancement.

54
Q

What are reasons for nonvisualization of the gallbladder? 3

A

• Nonfasting patient.
• Surgically absent.
• Obliteration of the gallbladder lumen by intestinal air or gallstones.

55
Q

What are noninflammatory causes of gallbladder wall thickening? 3

A

• Nonfasting patient.
• Ascites.
• Cirrhosis.

56
Q

What is the recommended fasting duration for adults before a gallbladder ultrasound?

A

6 to 8 hours.

57
Q

What transducer frequency is recommended for adults?

A

3.0 to 5.0 MHz.

58
Q

What is the examination protocol for gallbladder imaging?

A

Systematic approach in the sagittal and transverse planes carefully examining and imaging all portions of the gallbladder and biliary tree.

59
Q

What should be documented during gallbladder examination?

A

Abnormalities should be documented and when applicable measured in two imaging planes.

60
Q

What is the purpose of color and/or spectral Doppler evaluation in gallbladder examination?

A

To include and document the flow type and direction of the main portal vein.

61
Q

What is the use of harmonic imaging in biliary tree evaluation?

A

To evaluate and document the biliary tree.

62
Q

What is the appearance of the normal gallbladder on ultrasound?

A

The normal gallbladder appears as an anechoic ovoid structure.

63
Q

Where should focal zones be placed during ultrasound?

A

Focal zone(s) should be placed at or below the area of interest.

64
Q

What effect does using multiple focal zones have on ultrasound imaging?

A

It increases detail resolution and decreases temporal resolution.

65
Q

What imaging technique should be used to evaluate the biliary tree?

A

Harmonic imaging should be used to evaluate and document the biliary tree.

66
Q

How can artifactual echoes within the gallbladder lumen be reduced?

A

Decreasing system compression (dynamic range) can reduce artifactual echoes.

67
Q

What is the benefit of spatial compounding in ultrasound?

A

Spatial compounding can improve visualization of structures posterior to highly attenuating structures.

68
Q

How should Doppler settings be adjusted for ultrasound?

A

Doppler settings should be adjusted for a slow flow rate.

69
Q

What can improve visualization of the gallbladder and common ducts? (What can we get the patient to do)

A

The use of deep inspiration may improve visualization.

70
Q

What is a helpful hint for visualizing the main lobar fissure?

A

The main lobar fissure is best visualized in the sagittal oblique plane.

71
Q

What positions may aid in visualization of the cystic duct?

A

Trendelenburg and right posterior oblique positions may aid in visualization.

72
Q

What are common indications for ultrasound examination of the biliary system? 7

A
  1. RUQ pain
  2. Increase in liver function tests,
  3. Intolerance to fatty foods
  4. Postprandial pain,
  5. Jaundice.
  6. Nausea/vomiting
  7. Positive Murphy sign
73
Q

What is the normal adult range for alkaline phosphatase (ALP)?

A

Normal adult range for ALP is 45 to 115 U/L.

74
Q

What does an elevation in alkaline phosphatase indicate?

A

It is the most specific indicator of biliary obstruction and may signal bone and liver abnormalities.

75
Q

What is the normal adult range for alanine aminotransferase (ALT)?

A

Normal adult range for ALT is 7 to 55 U/L.

76
Q

What does an elevation in ALT indicate?

A

Elevation is associated with hepatocellular disease, biliary tract obstruction, pancreatitis, and fatty infiltration.

77
Q

What is the normal adult range for aspartate aminotransferase (AST)?

A

Normal adult range for AST is 8 to 48 U/L.

78
Q

What does an elevation in AST indicate?

A

Elevation is associated with cirrhosis, hepatitis, mononucleosis, fatty infiltration, myocardial infarction, muscle disease, and cholestasis.

79
Q

What is the normal adult total bilirubin level?

A

Normal adult total bilirubin is ≤ 1.1 mg/dL.

80
Q

What can cause elevated bilirubin levels?

A

Elevated by excessive red blood cell destruction, malfunction of liver cells, or blockage of ducts.

81
Q

What is the normal serum leukocyte count (WBC)?

A

Normal serum levels are 4500 to 11,000 mm3.

82
Q

What does an increase in WBC count indicate?

A

It reflects the severity of inflammation and is associated with acute and chronic cholecystitis.

83
Q

What are the sonographic findings of biliary dilatation?

A

Dilated intrahepatic and/or extrahepatic bile ducts with elevated direct bilirubin and alkaline phosphatase.

84
Q

What is the most common biliary malignancy?

A

Gallbladder carcinoma is the most common biliary malignancy.

85
Q

What are the clinical findings of acute cholecystitis? 4 (s/s)

A
  1. Acute RUQ pain
  2. Nausea/vomiting
  3. Fever/chills
  4. Positive Murphy sign.
86
Q

What is the sonographic finding of gallbladder hydrops?

A

Diffuse gallbladder wall thickening greater than 3 mm in diameter.

87
Q

What is the risk factor for gallbladder carcinoma? 3

A

Risk factors include:
1. Cholelithiasis
2. Porcelain gallbladder
3. Female prevalence.

88
Q

What is the appearance of gallstones on ultrasound?

A

Gallstones appear as hyperechoic intraluminal focus with posterior acoustic shadowing.

89
Q

What is the significance of the Murphy sign?

A

A positive Murphy sign indicates gallbladder inflammation or cholecystitis.

90
Q

What is a common finding in acute cholecystitis? 2

A
  1. Thick,
  2. Edematous gallbladder wall; ‘halo sign’

Indicates inflammation of the gallbladder.

91
Q

What is the most common cause of cholecystitis?

A

Cholelithiasis (90% of cases)

Presence of gallstones.

92
Q

What laboratory finding is associated with acute cholecystitis?

A

Leukocytosis

Elevated white blood cell count.

93
Q

What sign is positive in acute cholecystitis?

A

Positive Murphy sign

Pain upon palpation of the right upper quadrant.

94
Q

What imaging finding can indicate acute cholecystitis?

A

Peripheral hyperemia on color Doppler

Increased blood flow to the gallbladder.

95
Q

What are common symptoms of acute cholecystitis? 3

A
  1. RUQ pain
  2. Nausea/vomiting
  3. Fever

Classic presentation of acute cholecystitis.

96
Q

What is emphysematous cholecystitis?

A

A form of cholecystitis associated with gas-forming bacteria

Can lead to gallbladder perforation.

97
Q

What are risk factors for acute cholecystitis? 3

A
  1. Diabetes
  2. Older adult
  3. Male prevalence

Increased likelihood of developing the condition.

98
Q

What is a potential complication of chronic cholecystitis?

A

Gallbladder carcinoma

Long-standing inflammation can lead to cancer.

99
Q

What is the significance of a porcelain gallbladder?

A

It indicates chronic cholecystitis and increased cancer risk

Calcification of the gallbladder wall.

100
Q

What is a common finding in chronic cholecystitis?

A

Asymptomatic or vague RUQ pain

Symptoms may be mild or absent.

101
Q

What imaging finding suggests gallbladder obstruction?

A

Enlargement of gallbladder transverse diameter exceeding 4 cm

Indicates potential obstruction or disease.

102
Q

What is Mirizzi syndrome?

A

Obstruction of the cystic duct leading to jaundice

Caused by a gallstone impacted in the cystic duct.

103
Q

What is a common presentation of gallbladder varices?

A

Multiple tortuous tubular structures in the gallbladder periphery

Associated with portal hypertension.

104
Q

What is a common symptom of gallbladder disease?

A

Fatty food intolerance

Often leads to discomfort after meals.