Biliary Pathology Flashcards
What is a choledochal cyst?
a congenital, focal, or diffuse cystic dilation of the biliary tree
what are the risk factors of a choledochal cyst?
- more common in men
- increased incidents in infants
- associated with gallstones, pancreatitis, and cirrhosis
what are the symptoms of a choledochal cyst?
- abdominal mass
- pain
- fever
- jaundice
sonographic appearance of a choledochal cyst
appear as cysts in an ultrasound
- anechoic
- echogenic walls
- posterior enhancement
- round
define Caroli’s Disease
a rare congenital abnormality most likely inherited in an autosomal recessive fashion.
what is Caroli’s Disease associated with?
characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts
- usually found in young adults or pediatric patients
- renal disease
- congenital hepatic fibrosis
symptoms of Caroli’s Disease
- recurrent cramplike upper abd pain
- secondary to biliary stasis
- ductal stones
- cholangitis
- hepatic fibrosis
- cystic disease of the kidneys (ADPKD)
what is considered a dilated duct?
where the CHD has an internal diameter of greater than 4mm
what is the most common cause of ductal dilation?
the presence of an obstruction like a tumor or thrombus within the ductal system
how does ductal dilation appear on US?
it appears as the “shotgun” symbol on US when the intrahepatic ducts are dilated
what can cause on obstruction of the distal CBD?
the most common cause is pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation
define cholangiocarcinoma
a rare malignancy that originates in the CBD or CHD.
where is cholangiocarcinoma usually located?
in the CBD or CHD
what is a specific type of cholangiocarcinoma that occurs in the CHD?
a Klatskin’s tumor is a specific type of cancer that occurs in the CHD.
appearance of a Klatskin’s tumor
although the mass may not show up on ultrasound, a nonunion of the right and left hepatic ducts is a characteristic of a Klatskin’s tumor
define Mirizzi syndrome
Mirizzi syndrome is an uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct
what are the symptoms of Mirizzi syndrome?
painful jaundice
how does Mirizzi syndrome appear on US?
an intrahepatic ductal dilation is seen with a normal size common duct and a large stone in the cystic duct or the neck of the gallbladder
define choledocholithiasis
choledocholithiasis is the formation of calcium stones in the bile duct
what may cause a primary ductal stone?
primary ductal stones may be caused from disease, causing strictures or dilation of the bile ducts leading to stasis
what is a secondary ductal stone?
a secondary ductal stone denotes the majority of stones in the CBD have migrated from the GB and are usually associated with calculus cholecystitis
define hemobilia
bleeding in or around the biliary tract
what are the causes of hemobilia?
the main cause of hemobilia is trauma, secondary to percutaneous biliary procedures or liver biopsies
clinical symptoms of hemobilia
- pain
- bleeding
- jaundice
sonographic appearance of hemobilia
depends on how long the blood has been there
- if it is an acute hemorrhage, it will appear as fluid with low-level internal echoes
define pneumobilia
air within the biliary tree secondary to biliary intervention, biliary-enteric anastomoses, or CBD stents
what may cause pneumobilia?
- Emphysematous cholecystitis
- Inflammation from an impacted stone in the CBD
- Prolonged acute cholecystitis, which may lead to erosion of the bowel
sonographic appearance of pneumobilia
- The air in the bile ducts appears as bright, echogenic linear structures that follow the portal triads
- The posterior dirty shadow and reverberation artifact are seen
- Movement of tiny air bubbles with a change in the patient’s position should be noted
define cholangitis
cholangitis is a serious infection in the bile ducts. this can occur when a stone blocks the normal passage of bile. this causes the fluid to back up, which can cause an infection to occur.
symptoms of cholangitis
- malaise
- fever
- sweating
- shivering
- RUQ pain
- jaundice
in serious cases, patient is:
- lethargic
- prostrate
- in shock
- leukocytosis
- elevation of serum alkaline phosphatase and bilirubin
define cystadenoma
a rare intrahepatic biliary tumor
define cystadenocarcinoma
a rare intrahepatic biliary tumor
risk factors of cystadenoma and cystadenocarcinoma
more common in middle-aged women whose clinical presentation includes:
- abd pain
- abd mass
- jaundice
sonographic appearance of cystadenoma or cystadenocarcinoma
cystic mass with multiple septa and papillary excrescences
define cholangiocarcinoma
cholangiocarcinoma is the second most common primary malignancy of the liver
risk factors of cholangiocarcinoma
incidence of this tumor has risen, secondary to increasing number of patients with liver cirrhosis and hep C infection
sonographic appearance of cholangiocarcinoma
- large hepatic mass
- hypoechoic to hyperechoic
- heterogenous texture
what cancer spread to biliary tree?
the most common tumor sites that can spread to the biliary tree are from the breast, colon, or melanoma
what is the sonographic appearance of metastases?
the sonographic appearance of metastases is similar to that of cholangiocarcinoma
define hydrops
hydrops is a distended non-inflammatory GB due to obstruction of the cystic duct
symptoms of hydrops
hydrops is asymptomatic and appears as a palpable mass
sonographic appearance of hydrops
the GB appears enlarged and measures as larger than the normal size
define Courvoisier’s gallbladder
courvoisier’s gallbladder is a malignancy in the head of the pancreas with a dilated CBD
- symptoms include painless jaundice and RUQ palpable mass
