Biliary system

Question 1

Answer 1

todani I

Ultrasound study shows a cystic mass between the pancreatic head and the gallbladder. Smooth wall and homogeneous anechoic content were detected.

The study is compatible with dilatation of entire extrahepatic bile duct, that’s also known as a true choledochal cyst. Is the type 1 of Todani classification of bile duct cysts.

Question 2

todani type I

Answer 2

fusiform common bile duct dilation

Question 3

most common choledochal cyst

Answer 3

tondani type I = fusiform dilation of the CBD

Question 4

Answer 4

todani type III = choledococele at the intraduodenal bile duct

“cobra head”

Question 5

Answer 5

todani type I

Question 6

Answer 6

type ii

Question 7

Answer 7

todani type iii

Question 8

Answer 8

todani type IV

both extra and intra hepatic bile ducts

Question 9

Answer 9

Caroli disease (todani type V) plus ADPKD

Caroli’s is associated with medullary sponge kidney and ADPKD and ARPKD

https://radiopaedia.org/cases/caroli-syndrome-and-autosomal-recessive-polycystic-kidney-disease?lang=us

Question 10

Answer 10

caroli disease (todani type V)

Question 11

Answer 11

Question 12

Answer 12

Question 13

mesh of small bile ducts in the liver parenchyma draining into gallbladder

Answer 13

subvesicle bile duct –> can lead to persistent bile leak after cholecystectomy

Question 14

what can lead to inadvertent common duct ligation in a cholecystectomy?

Answer 14

low insertion of the CBD

Question 15

Charcot’s triad

Answer 15

fever, abdominal pain, jaundice

Question 16

parasite associated with recurrent pyogenic cholangitis

Answer 16

Clonorchis sinesis

Question 17

HIV, CD4 counts < 130

Answer 17

AIDS cholangiopathy

Characterized by multiple irregular strictures essentially indistinguishable from primary sclerosing cholangitis (PSC).

No definite organism is identified in up to half of the patients. It typically affects patients with low CD4 counts (<135/mm3).

Question 18

Answer 18

Recurrent pyogenic cholangitis (oriental cholangiohepatitis)

“ducts full of stones”

• pigment stone formation, biliary stasis, and cholangitis
• caused by the parasite Clonorchis sinensis
• ncreased risk of cholangiocarcinoma.

Imaging triad of:

1) Pneumobilia.
2) Lamellated bile duct filling defects.
3) Intrahepatic and extrahepatic bile duct dilation and strictures

Question 19

Answer 19

biliary cystadenoma

• benign cystic neoplasm,
• middle-aged women
• does not communicate with the biliary system

Question 20

most common met to the GB

Answer 20

melanoma

Question 21

middle age woman with pruitis and fatigue

Answer 21

PBC

T2: if parenchymal lace-like fibrosis and periportal halo sign are seen together the sensitivity for PBC can approach 70%

Presentation: The typical patient is a middle-aged woman presenting with symptoms of fatigue and pruritus and laboratory test evidence of cholestasis.