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Abdominal Pathologies > Biliary Pathology > Flashcards

Biliary Pathology Flashcards

1
Q

What is a choledochal cyst?

A

a congenital, focal, or diffuse cystic dilation of the biliary tree

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2
Q

what are the risk factors of a choledochal cyst?

A
  • more common in men
  • increased incidents in infants
  • associated with gallstones, pancreatitis, and cirrhosis
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3
Q

what are the symptoms of a choledochal cyst?

A
  • abdominal mass
  • pain
  • fever
  • jaundice
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4
Q

sonographic appearance of a choledochal cyst

A

appear as cysts in an ultrasound
- anechoic
- echogenic walls
- posterior enhancement
- round

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5
Q

define Caroli’s Disease

A

a rare congenital abnormality most likely inherited in an autosomal recessive fashion.

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6
Q

what is Caroli’s Disease associated with?

A

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

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7
Q

symptoms of Caroli’s Disease

A
  • recurrent cramplike upper abd pain
  • secondary to biliary stasis
  • ductal stones
  • cholangitis
  • hepatic fibrosis
  • cystic disease of the kidneys (ADPKD)
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8
Q

what is considered a dilated duct?

A

where the CHD has an internal diameter of greater than 4mm

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9
Q

what is the most common cause of ductal dilation?

A

the presence of an obstruction like a tumor or thrombus within the ductal system

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10
Q

how does ductal dilation appear on US?

A

it appears as the “shotgun” symbol on US when the intrahepatic ducts are dilated

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11
Q

what can cause on obstruction of the distal CBD?

A

the most common cause is pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation

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12
Q

define cholangiocarcinoma

A

a rare malignancy that originates in the CBD or CHD.

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13
Q

where is cholangiocarcinoma usually located?

A

in the CBD or CHD

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14
Q

what is a specific type of cholangiocarcinoma that occurs in the CHD?

A

a Klatskin’s tumor is a specific type of cancer that occurs in the CHD.

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15
Q

appearance of a Klatskin’s tumor

A

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

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16
Q

define Mirizzi syndrome

A

Mirizzi syndrome is an uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct

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17
Q

what are the symptoms of Mirizzi syndrome?

A

painful jaundice

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18
Q

how does Mirizzi syndrome appear on US?

A

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

19
Q

define choledocholithiasis

A

choledocholithiasis is the formation of calcium stones in the bile duct

20
Q

what may cause a primary ductal stone?

A

primary ductal stones may be caused from disease, causing strictures or dilation of the bile ducts leading to stasis

21
Q

what is a secondary ductal stone?

A

a secondary ductal stone denotes the majority of stones in the CBD have migrated from the GB and are usually associated with calculus cholecystitis

22
Q

define hemobilia

A

bleeding in or around the biliary tract

23
Q

what are the causes of hemobilia?

A

the main cause of hemobilia is trauma, secondary to percutaneous biliary procedures or liver biopsies

24
Q

clinical symptoms of hemobilia

A
  • pain
  • bleeding
  • jaundice
25
Q

sonographic appearance of hemobilia

A

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

26
Q

define pneumobilia

A

air within the biliary tree secondary to biliary intervention, biliary-enteric anastomoses, or CBD stents

27
Q

what may cause pneumobilia?

A
  • Emphysematous cholecystitis
  • Inflammation from an impacted stone in the CBD
  • Prolonged acute cholecystitis, which may lead to erosion of the bowel
28
Q

sonographic appearance of pneumobilia

A
  • 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
29
Q

define cholangitis

A

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.

30
Q

symptoms of cholangitis

A
  • malaise
  • fever
  • sweating
  • shivering
  • RUQ pain
  • jaundice

in serious cases, patient is:
- lethargic
- prostrate
- in shock
- leukocytosis
- elevation of serum alkaline phosphatase and bilirubin

31
Q

define cystadenoma

A

a rare intrahepatic biliary tumor

32
Q

define cystadenocarcinoma

A

a rare intrahepatic biliary tumor

33
Q

risk factors of cystadenoma and cystadenocarcinoma

A

more common in middle-aged women whose clinical presentation includes:
- abd pain
- abd mass
- jaundice

34
Q

sonographic appearance of cystadenoma or cystadenocarcinoma

A

cystic mass with multiple septa and papillary excrescences

35
Q

define cholangiocarcinoma

A

cholangiocarcinoma is the second most common primary malignancy of the liver

36
Q

risk factors of cholangiocarcinoma

A

incidence of this tumor has risen, secondary to increasing number of patients with liver cirrhosis and hep C infection

37
Q

sonographic appearance of cholangiocarcinoma

A
  • large hepatic mass
  • hypoechoic to hyperechoic
  • heterogenous texture
38
Q

what cancer spread to biliary tree?

A

the most common tumor sites that can spread to the biliary tree are from the breast, colon, or melanoma

39
Q

what is the sonographic appearance of metastases?

A

the sonographic appearance of metastases is similar to that of cholangiocarcinoma

40
Q

define hydrops

A

hydrops is a distended non-inflammatory GB due to obstruction of the cystic duct

41
Q

symptoms of hydrops

A

hydrops is asymptomatic and appears as a palpable mass

42
Q

sonographic appearance of hydrops

A

the GB appears enlarged and measures as larger than the normal size

43
Q

define Courvoisier’s gallbladder

A

courvoisier’s gallbladder is a malignancy in the head of the pancreas with a dilated CBD
- symptoms include painless jaundice and RUQ palpable mass

Abdominal Pathologies (8 decks)

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