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ABDOMINAL Liver/billiary/panc > biliary pathology > Flashcards

biliary pathology Flashcards

1
Q

acute cholecystitis

A

gallbladder inflammation
most common cause of increased wall thickness
stone in the neck or duct more common cause

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2
Q

calculus chole

A

WITH STONES
more common in females

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3
Q

acalculous chole

A

NO STONES
more common in mean by bile stasis

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4
Q

Acute Cholecystitis
lab values

A

increased bilirubin , ALP, WBC ,LFT

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5
Q

Acute Cholecystitis
can lead to

A

hydrops
perforation
gangrene
empyema
abscess

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6
Q

Acute Cholecystitis
symptoms

A

murphy sign
fever
N & V

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7
Q

other causes of GB wall thickening

A

CHF
renal failure
cirrhosis
hepatits

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8
Q

Acute Cholecystitis
sono appearance

A

halo sign
wall thickening of >3 mm
peri fluid
positive murphy

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9
Q

Chronic Cholecystitis

A

intermittent fever and RUQ pain
WBC may be normal
associated with porcelain GB

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10
Q

Chronic Cholecystitis has production of

A

milk of calcium bile

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11
Q

Chronic Cholecystitis sono appearance

A

small contracted GB
thick walls
stones
layering of sludge

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12
Q

complications of cholecystitis

A

empyema
emphysematous cholecystitis
perforation
abscess

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13
Q

GB empyema

A

pus
complete GB obstruction

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14
Q

Emphysematous Cholecystitis is more common in

A

males and diabetics

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15
Q

Emphysematous Cholecystitis sono

A

air in GB wall
enlarged GB
dirty shadowing

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16
Q

Emphysematous Cholecystitis symptoms

A

RUQ pain
fever
leukocytosis

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17
Q

GB perforation

A

leads to localized fluid in GB fossa

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18
Q

GB perforation can cause

A

peritonitis and abscess

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19
Q

porcelain GB

A

calcification of the GB wall
chronic and 95% of cases with stones

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20
Q

porcelain GB increased risk of

A

GB carcinoma

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21
Q

porcelain GB sono appearance

A

wall very echogenic
no WES sign

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22
Q

Cholangitis causes

A

inflammation of bile ducts
MOST COMMON DUCTAL STONES
hiv
infection

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23
Q

Cholangitis symptoms

A

ruq pain
fever chills
biliary colic
jaundice

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24
Q

Cholangitis MOST COMMON TRIAD

A

fever
ruq pain
jaundice

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25
Q

Cholangitis lab values

A

Lab Testing:
- Increased direct bilirubin, alkaline phosphatase, and/or LFT
- Amylase and lipase can be elevated if pancreatic ducts involved
- Leukocytosis

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26
Q

Cholangitis sono appearance

A

thickened internal ductal wall layers with increased echogenicity
dilated intra and extra hepatic ducts up to 3-4 cm

27
Q

abnormal ductal wall thickness

A

over 2mm

28
Q

sludge

A

precursor to stones
stagnation of bile

29
Q

sludge related to

A

poor or absent GB function
alcohol
pregnancy
fasting
low fat diet

30
Q

tumefactive sludge

A

balls of sludge

31
Q

sono appearance of sludge

A

lumen filled with echoes
move with position of patient
DOES NOT SHADOW

32
Q

CHOLELITHIASIS risk factors

A
  • obesity
  • oral contraceptives
  • estrogen therapy
  • pregnancy
  • Impaired gallbladder function
  • prolonged fasting
  • diabetes
  • high cholesterol
  • Crohn disease
  • hemolytic disorders (like sickle cell
    anemia)
33
Q

Cholelithiasis symptoms

A
  • RUQ pain
  • pain has sudden onset and lasts 1-3 hours - nausea/vomiting
34
Q

Cholelithiasis labs

A

increased ALP and bilirubin

35
Q

sono of cholelithiasis

A
  • Wall - Echo - Shadow
  • also called double arc shadow sign
  • mass is mobile with change in patient position, unless it is impacted at the neck
  • posterior shadowing from the reflective stone
  • vary in size and number
  • dilated ducts would be found proximal to the level of a complete obstruction
  • dilated ducts can exhibit posterior enhancement
36
Q

normal CBD

A

less than 8mm

37
Q

mirizzi syndrome

A

stone in cystic duct causing compression of the common hepatic duct

38
Q

mirizzi symptoms

A

elevated direct bilirubin
pain and jaundice

39
Q

Courvoisier GB

A

enlarged non diseased GB due to mechanical obstruction of the CBD

40
Q

Courvoisier GB tranverse diameter

A

greater than 5 cm

41
Q

Courvoisier GB associated w/

A

pancreatic head mass or obstruction at ampulla of vater

42
Q

Choledocholithiasis

A

stone in ductal system

43
Q

most common Choledocholithiasis

A

secondary: stones pass from GB pass into ductal system

44
Q

Choledocholithiasis sono appearance

A

foci in ductal system
PARALLEL CHANNEL SIGN DILATED CBD

45
Q

Adenoma/Polyp
greater than 10 mm indicates

A

strong suspicion of cancer

46
Q

Adenoma/Polyp

A

do not move with position change
overgrowth of GB lining
usually asymptomatic

47
Q

Adenoma/Polyp
sono appearance

A

protrusion into the gallbladder lumen
* attached to the wall, non-mobile
* usually isoechoic to the gallbladder wall, may be hypoechoic * non-shadowing

48
Q

Cholesterolosis/Strawberry GB

A

hyperplastic cholecystosis
cholesterol polyps on GB wall
does not cause wall thickening

49
Q

Cholesterolosis/Strawberry GB sono appearance

A
50
Q

Adenomyomatosis

A

GB sinuses or rokitsansky-aschoff filled with bile or cholesterol deposits

51
Q

Adenomyomatosis sono appearance

A

diffuse or segmental thickening of GB wall
comet tail artifact

52
Q

GB cancer

A

more common than ductal
more common in women over 60

53
Q

GB cancer associated

A

w/ long standing cholecystitis

54
Q

GB cancer lab testing

A

increased bilirubin
ALP

55
Q

GB cancer sono appearance

A

GB wall thickening
solid mass in lumen
most commonly seen with stones

56
Q

Cholangiocarcinoma most commonly occurs in

A

extrahepatic ducts
CHD or CBD

57
Q

Cholangiocarcinoma symptoms

A

ruq pain
weight losss
jaundice

58
Q

Cholangiocarcinoma lab values

A

increased bilirubin
ALP
AFP

59
Q

Cholangiocarcinoma sono appearance

A

contiguous with biliary tree
dilated intra and extra hepatic ducts

60
Q

klatskin tumor

A

most common type
found in hilum of right and left hepatic duct confluence
cbd usually normal

61
Q

klatskin tumor symptoms

A

jaundice
pruritus
weight loss
pain

62
Q

klatskin tumor lab values

A

AFP
ALP
bilirubin

63
Q

GB metastasis

A

1 primary melanoma

usually no stones

64
Q

gb metastasis sono

A

vascular flow in mass
focal wall thickening

ABDOMINAL Liver/billiary/panc (5 decks)

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