biliary pathology Flashcards
acute cholecystitis
gallbladder inflammation
most common cause of increased wall thickness
stone in the neck or duct more common cause
calculus chole
WITH STONES
more common in females
acalculous chole
NO STONES
more common in mean by bile stasis
Acute Cholecystitis
lab values
increased bilirubin , ALP, WBC ,LFT
Acute Cholecystitis
can lead to
hydrops
perforation
gangrene
empyema
abscess
Acute Cholecystitis
symptoms
murphy sign
fever
N & V
other causes of GB wall thickening
CHF
renal failure
cirrhosis
hepatits
Acute Cholecystitis
sono appearance
halo sign
wall thickening of >3 mm
peri fluid
positive murphy
Chronic Cholecystitis
intermittent fever and RUQ pain
WBC may be normal
associated with porcelain GB
Chronic Cholecystitis has production of
milk of calcium bile
Chronic Cholecystitis sono appearance
small contracted GB
thick walls
stones
layering of sludge
complications of cholecystitis
empyema
emphysematous cholecystitis
perforation
abscess
GB empyema
pus
complete GB obstruction
Emphysematous Cholecystitis is more common in
males and diabetics
Emphysematous Cholecystitis sono
air in GB wall
enlarged GB
dirty shadowing
Emphysematous Cholecystitis symptoms
RUQ pain
fever
leukocytosis
GB perforation
leads to localized fluid in GB fossa
GB perforation can cause
peritonitis and abscess
porcelain GB
calcification of the GB wall
chronic and 95% of cases with stones
porcelain GB increased risk of
GB carcinoma
porcelain GB sono appearance
wall very echogenic
no WES sign
Cholangitis causes
inflammation of bile ducts
MOST COMMON DUCTAL STONES
hiv
infection
Cholangitis symptoms
ruq pain
fever chills
biliary colic
jaundice
Cholangitis MOST COMMON TRIAD
fever
ruq pain
jaundice
Cholangitis lab values
Lab Testing:
- Increased direct bilirubin, alkaline phosphatase, and/or LFT
- Amylase and lipase can be elevated if pancreatic ducts involved
- Leukocytosis
Cholangitis sono appearance
thickened internal ductal wall layers with increased echogenicity
dilated intra and extra hepatic ducts up to 3-4 cm
abnormal ductal wall thickness
over 2mm
sludge
precursor to stones
stagnation of bile
sludge related to
poor or absent GB function
alcohol
pregnancy
fasting
low fat diet
tumefactive sludge
balls of sludge
sono appearance of sludge
lumen filled with echoes
move with position of patient
DOES NOT SHADOW
CHOLELITHIASIS risk factors
- obesity
- oral contraceptives
- estrogen therapy
- pregnancy
- Impaired gallbladder function
- prolonged fasting
- diabetes
- high cholesterol
- Crohn disease
- hemolytic disorders (like sickle cell
anemia)
Cholelithiasis symptoms
- RUQ pain
- pain has sudden onset and lasts 1-3 hours - nausea/vomiting
Cholelithiasis labs
increased ALP and bilirubin
sono of cholelithiasis
- 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
normal CBD
less than 8mm
mirizzi syndrome
stone in cystic duct causing compression of the common hepatic duct
mirizzi symptoms
elevated direct bilirubin
pain and jaundice
Courvoisier GB
enlarged non diseased GB due to mechanical obstruction of the CBD
Courvoisier GB tranverse diameter
greater than 5 cm
Courvoisier GB associated w/
pancreatic head mass or obstruction at ampulla of vater
Choledocholithiasis
stone in ductal system
most common Choledocholithiasis
secondary: stones pass from GB pass into ductal system
Choledocholithiasis sono appearance
foci in ductal system
PARALLEL CHANNEL SIGN DILATED CBD
Adenoma/Polyp
greater than 10 mm indicates
strong suspicion of cancer
Adenoma/Polyp
do not move with position change
overgrowth of GB lining
usually asymptomatic
Adenoma/Polyp
sono appearance
protrusion into the gallbladder lumen
* attached to the wall, non-mobile
* usually isoechoic to the gallbladder wall, may be hypoechoic * non-shadowing
Cholesterolosis/Strawberry GB
hyperplastic cholecystosis
cholesterol polyps on GB wall
does not cause wall thickening
Cholesterolosis/Strawberry GB sono appearance
Adenomyomatosis
GB sinuses or rokitsansky-aschoff filled with bile or cholesterol deposits
Adenomyomatosis sono appearance
diffuse or segmental thickening of GB wall
comet tail artifact
GB cancer
more common than ductal
more common in women over 60
GB cancer associated
w/ long standing cholecystitis
GB cancer lab testing
increased bilirubin
ALP
GB cancer sono appearance
GB wall thickening
solid mass in lumen
most commonly seen with stones
Cholangiocarcinoma most commonly occurs in
extrahepatic ducts
CHD or CBD
Cholangiocarcinoma symptoms
ruq pain
weight losss
jaundice
Cholangiocarcinoma lab values
increased bilirubin
ALP
AFP
Cholangiocarcinoma sono appearance
contiguous with biliary tree
dilated intra and extra hepatic ducts
klatskin tumor
most common type
found in hilum of right and left hepatic duct confluence
cbd usually normal
klatskin tumor symptoms
jaundice
pruritus
weight loss
pain
klatskin tumor lab values
AFP
ALP
bilirubin
GB metastasis
1 primary melanoma
usually no stones
gb metastasis sono
vascular flow in mass
focal wall thickening
