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Biliary System Flashcards

1
Q

What is cholelithiasis?

A

gallstones

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2
Q

What is cholelithiasis made up of?

A

Bilirubinate, cholesterol, calcium carbonate

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3
Q

Who gets cholelithiasis most commonly?

A

Five Fs: female, forty, fertile, fat, fair

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4
Q

What are risk factors for cholelithiasis?

A
  • obesity
  • diabetes
  • hx pancreatitis
  • hx parasitic disease
  • hx biliary tree infection
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5
Q

What are S&S of cholelithiasis?

A
  • asymptomatic
  • biliary colic
  • RUQ, Rt shoulder pain
  • jaundice
  • abn LFTs
  • fever, chills
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6
Q

What is the sono appearance of cholelithiasis?

A
  • hyperechoic, shadowing, mobile
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7
Q

What is WES?

A
  • Wall-echo-shadow
  • 2 echogenic lines with posterior shadowing, 1st line is wall 2nd is stone
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8
Q

What is sludge?

A

Echogenic or viscous bile, AKA biliary sand or microlithiasis

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9
Q

What causes sludge? What is it made up of?

A
  • bile stasis
  • calcium, bilirubinate, cholesterol crystals
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10
Q

What are S&S of sludge?

A

asymptomatic

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11
Q

What is the sono app of sludge?

A
  • homogenous, low level echoes
  • non shadowing
  • layering depending on pos
  • changes with position
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12
Q

What is a sludge ball called?

A

tumefactive sludge

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13
Q

What are polyps?

A

Benign wall growth, inflammatory, adenomatous, or cholesterol

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14
Q

What is a focal polyp?

A

Single polyp attached to GB by pedicle or stalk, more concerning

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15
Q

What are diffuse polyps?

A

Multiple in GB

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16
Q

What are S&S of polyps?

A
  • asymptomatic
  • dull epigastric pain
  • RUQ pain
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17
Q

What is sono app of polyps?

A
  • non-mobile echogenic foci
  • non-shadowing
  • usually near fundus
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18
Q

What is cholecystitis?

A

inflammation of the GB

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19
Q

What causes cholecystitis?

A

Usually obstruction, most commonly cholelithiasis

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20
Q

Who gets cholecystitis most commonly?

A

40-60 y.o. women

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21
Q

What is the sono app of cholecystitis?

A
  • dilation of GB
  • wall thickening & irregular walls
  • gallstone
  • pericholecystic fluid
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22
Q

What causes acute cholecystitis?

A

Inflammation and obstruction
- 90-95% calculous
- 5-10% acalculous, parasitic/bacterial involvement

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23
Q

What are S&S of acute cholecystitis?

A
  • RUQ, epi, back pain
  • pain post-prandial
  • abn LFTs
  • Murphy’s
  • increased serum amylase
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24
Q

What is emphysematous cholecystitis?

A

gas forming bacteria in GB wall/lumen

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25
Q

What is gangrenous cholecystitis?

A

intermural hemorrhage and ulceration of mucosal surfaces

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26
Q

What two things indicate emergent cholecystitis?

A

Murphy’s and wall >3 mm

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27
Q

What is chronic cholecystitis? What can it cause?

A

recurrent attacks of cholecystitis, can progress to carcinoma

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28
Q

What are S&S of chronic cholecystitis?

A
  • asymptomatic
  • abn LFTs
  • increased serum amylase
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29
Q

What is the sono app of chronic cholecystitis?

A
  • gallstones
  • small contracted GB
  • echogenic bile
  • wall thickening
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30
Q

What is hydrops of GB?

A

abnormal dilation of GB due to cystic duct obstruction, bile is reabsorbed and GB is filled with secretions from mucosa layer

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31
Q

What is the main cause of hydrops?

A

cholelithiasis

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32
Q

What is hydrops AKA?

A

mucocele

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33
Q

What are S&S of hydrops?

A

asymptomatic, palpable RUQ mass

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34
Q

What is the sono app of hydrops?

A
  • round, distended
  • anechoic
  • non-inflamed
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35
Q

What is Courvoisier’s law?

A

enlarged GB of a jaundiced patient is typically caused by obstruction of biliary duct

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36
Q

What is porcelain GB?

A

Calcification of GB wall

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37
Q

Who is porcelain GB most common in?

A

women over 60

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38
Q

What are S&S of porcelain GB?

A
  • asymptomatic
  • associated with cholelithiasis
  • increased risk of GB carcinoma
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39
Q

What is the sono app of porcelain GB?

A

thickly calcified wall with shadowing

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40
Q

What is an adenoma?

A

Benign neoplasm that may be precancerous

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41
Q

What are S&S of an adenoma?

A

asymptomatic

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42
Q

What is the sono app of an adenoma?

A
  • solitary
  • pedunculated
  • homogenous, hyper
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43
Q

What has a similar appearance to an adenoma?

A

a polyp

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44
Q

What is adenomyomatosis?

A
  • excessive proliferation of the epithelial surface
  • gland-like formation and outpouchings of mucosa
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45
Q

What are S&S of adenomyomatosis?

A

asymptomatic

46
Q

What is the sono app of adenomyomatosis?

A
  • non-mobile echogenic foci along wall
  • comet tail artifact
  • single or in groups
47
Q

What is cholesterolosis?

A
  • excess lipids deposited within GB wall
  • polyps of triglycerides and cholesterol
48
Q

What can the appearance of cholesterolosis be compared to?

A

strawberry: yellow cholesterol specks against red bile-stained mucosa

49
Q

What are S&S of cholesterolosis?

A
  • asymptomatic
  • dull epigastric pain
  • RUQ pain
50
Q

What is the sono app of cholesterolosis?

A
  • non-mobile, non-shadowing echogenic areas
  • variable size
  • unevenly distributed
51
Q

What is primary GB carcinoma?

A

A rare, malignant neoplasm, most common biliary malignancy

52
Q

What pathology is commonly associated with primary GB carcinoma?

A

porcelain GB

53
Q

Who is primary GB carcinoma most common in?

A

females 50-80 y.o.

54
Q

What are S&S of primary GB carcinoma?

A
  • asymptomatic
  • weight/appetite loss
  • N/V
  • RUQ pain, mass
  • jaundice
55
Q

What is the sono app of primary GB carcinoma?

A
  • solid mass occupying GB lumen
  • thickened wall
  • echogenic mass with irregular borders
56
Q

What is the most common primary cancer that metastasizes to GB?

57
Q

What are S&S of mets to GB?

A
  • symptoms of cholecystitis
  • jaundice
58
Q

What is the sono app of mets to GB?

A
  • multiple hypo masses > 1 cm
59
Q

What is jaundice?

A

Significantly abnormal bilirubin levels, caused by blockage along biliary tree

60
Q

What is the most common cause of jaundice?

A

cholelithiasis

61
Q

What are S&S of jaundice?

A
  • yellow skin
  • pruritus
  • RUQ pain
  • weight loss
  • dark pain
62
Q

What is the sono app of jaundice?

A
  • dilated GB
  • hepatomegaly
  • CBD >7 mm
  • numerous visible tubes
  • double barrel sign
  • irregular biliary walls
63
Q

What is ductal dilatation?

A

enlargement of the ducts which parallel the course of the portal veins

64
Q

What is considered dilation of the intrahepatic ducts?

A

> 2 mm, not usually vis unless >4 mm

65
Q

What is considered dilation of the common hepatic duct?

A

5 mm = borderline, 6mm enlarged

66
Q

What is considered dilation of the CBD?

A

6 mm = borderline, 10 mm = enlarged

67
Q

What is Mirrizi syndrome?

A
  • extrahepatic biliary obstruction
  • gallstone impacted in neck of GB or cystic duct
68
Q

What does Mirrizi syndrome cause?

A

Obstruction of the CHD due to stone in cystic duct pushing on CHD

69
Q

What are S&S of Mirizzi syndrome?

A
  • pain
  • fever
  • edema & inflammation
70
Q

What is the sono app of Mirizzi syndrome?

A
  • dilated duct above level of stone and normal duct below
  • cholecystitis
  • segmental stenosis of CHD
71
Q

What is Caroli’s disease?

A
  • non-obstructive biliary dilation (no stone)
  • congenital abnormality, ducts have little pockets
72
Q

What is Caroli’s disease AKA?

A

communicating cavernous dilation

73
Q

Who is Caroli’s disease more common in?

A

People under 30, often diagnosed in childhood and early adulthood

74
Q

What are S&S of Caroli’s disease?

A
  • RUQ pain
  • sepsis, cholangitis
  • stone formation, biliary stasis
75
Q

What is the sono app of Caroli’s disease?

A
  • beaded, dilated appearance of biliary tree
  • irregularly dilated segmental portions of intrahepatic ducts
  • saccular, fusiform dilation
  • stones, sludge
76
Q

What is biliary atresia?

A
  • absence of extrahepatic biliary tree
  • bile is unable to pass from liver to GB and builds up within liver
77
Q

What are S&S of biliary atresia?

A
  • infants with jaundice and alcoholic stools
  • associated with situs inversus
78
Q

What can develop as a result of biliary atresia?

A

Cirrhosis, can be fatal

79
Q

What is the sono app of biliary atresia?

A
  • two vessels seen in portal triad, missing CBD
80
Q

What is choledocholithiasis?

A
  • stones within bile duct
  • most common in distal CBD
81
Q

What are S&S of choledocholithiasis?

A
  • increased bilirubin, increased alkaline phosphatase, abn LFTs
  • leukocytosis
82
Q

Who has an increased risk of choledocholithiasis?

A

older people, risk increases with age

83
Q

What is the sono app of choledocholithiasis?

A
  • echogenic foci in extrahepatic duct
  • ductal dilation depends on size and location of stone
84
Q

What is choledochal cyst?

A
  • cystic dilation of CBD/biliary tree
  • congenital, focal, or diffuse
85
Q

Where is a choledochal cyst most common?

A

biliary tree

86
Q

Who gets choledochal cysts most commonly?

A

~ 20 yo Asian females

87
Q

What are S&S of choledochal cyst?

A
  • asymptomatic
  • triad: jaundice, RUQ pain, RUQ mass
  • possible increased bilirubin
88
Q

What is the sono app of choledochal cyst?

A
  • anechoic mass adjacent to GB near porta hepatis
  • dilated CBD, hepatic duct
  • cystic duct may be seen entering mass
  • absent blood flow in mass
89
Q

What is cholangitis?

A
  • infection and inflammation of biliary ducts
  • caused by stone or interventional procedure
90
Q

What are S&S of cholangitis?

A
  • associated with IBS/UC
  • fever
  • abn LFTs
  • jaundice
  • RUQ pain
91
Q

What is primary choledocholithiasis?

A

Stones form within the duct due to stasis

92
Q

What is secondary choledocholithiasis?

A

Stones form within the GB and pass through GB via cystic duct

93
Q

What is the sono app of cholangitis?

A

biliary wall thickening

94
Q

What is ascariasis?

A

parasitic disease uncommon to US, AKA roundworm

95
Q

How is ascariasis contracted?

A

ingestion of eggs via contaminated food/water

96
Q

What are S&S of ascariasis?

A
  • asymptomatic
  • abdominal discomfort
  • fever
  • NVD
97
Q

What is the sono app of ascariasis?

A
  • echogenic tubular structures with hypo center
  • motility
98
Q

What is hemobilia?

A

blood within biliary tree

99
Q

What are the causes of hemobilia?

A

most commonly interventional procedures, also:
- vascular malformation
- cholangitis, cholecystitis
- malignancies

100
Q

What are S&S of hemobilia?

A
  • pain
  • bleeding (internal/external)
  • jaundice
101
Q

What is the sono app of hemobilia?

A
  • acute: low level echoes
  • chronic: hyperechoic
102
Q

What is pneumobilia?

A

air within the biliary tree

103
Q

What causes pneumobilia?

A
  • biliary-enteric fistula
  • cholelithiasis
  • chronic cholecystitis
104
Q

What are S&S of pneumobilia?

A

Caused by procedure: asymptomatic
Caused by infection: RUQ pain, abd distention, fever

105
Q

What is the sono app of pneumobilia?

A
  • echogenic linear foci within intrahepatic tree
  • motion with patient position
  • shadowing
  • ring-down artifact
106
Q

What is cholangiocarcinoma?

A

rare malignancy of bile ducts

107
Q

Cholangiocarcinoma is usually a byproduct of what?

A

Adenocarcinoma: cancer of mucus secreting glands

108
Q

Where is cholangiocarcinoma usually located?

A

CHD or CBD
Intrahepatic, at porta hepatis, distal down CBD closer to duodenum

109
Q

Who gets cholangiocarcinoma more commonly?

A

Japanese/Thai people

110
Q

What are risk factors of cholangiocarcinoma?

A
  • chronic biliary stasis
  • inflammation
  • infection
  • stones
111
Q

What is the sono app of cholangiocarcinoma?

A

solid mass within biliary duct

112
Q

What is Klatskins tumor?

A

Type of cholangiocarcinoma at hilar region of liver (porta hepatis)

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