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MIDS 127 > Biliary System > Flashcards

Biliary System Flashcards

1
Q

What is the gallbladder?

A

A pear shaped sac in the main lobar fissure (MLF) that stores bile

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2
Q

What are the dimensions of the gallbladder?

A

8 cm long
4-5 cm anterior-posterior and transverse
Normal wall thickness is less than 3 mm

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3
Q

Where does the gallbladder lie?

A

-Under the inferior surface of the liver
-Lateral to the 2nd part duodenum
-Anterior to R kidney and transverse colon

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4
Q

3 divisions of GB?

A

Neck - lies to R of porta hepatis (narrowest portion)
Body - central portion
Fundus - most inferior portion

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5
Q

4 layers of GB?

A
  1. Inner epithelial mucosa with folds
  2. Muscular layer
  3. Subserous layer
  4. Outer serosal surface
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6
Q

What is the heister valve?

A

-Valve that prevents kinking of the cystic duct
-Located in the neck
-Aids in the passage of bile to and from the GB

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7
Q

What do the intrahepatic bile ducts do?

A

-They carry bile inside the liver
-Run with the PVs and HAs
-Join to form the R and L main hepatic ducts
-The R and L main hepatic ducts unite at the porta hepatis and form the CHD

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8
Q

Measurement of intrahepatic bile ducts?

A

Less than 2 mm
(often can’t see IHD’s on ultrasound)

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9
Q

What does IHDD stand for?

A

Intrahepatic duct dilitation
(IHD greater than 2 mm)

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10
Q

Measurement of common hepatic duct?

A

Less than 6 mm

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11
Q

What does the CHD do?

A

Joins the cystic duct to form the CBD

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12
Q

What does the cystic duct do?

A

-Joins the CHD to form the CBD

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13
Q

Where is the cystic duct located?

A

Arises from the superior aspect of the GB neck

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14
Q

Measurement of CBD

A

7-8 mm

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15
Q

Measurement of CBD w/o GB

A

11 mm

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16
Q

What forms the CBD?

A

The cystic duct and CHD

(The CCH - cool, calm, happy. Stands for cystic, common hepatic ducts)

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17
Q

Location of CBD?

A

-Proximally lateral to HA
-Anterior to PV
-Goes inferiorly within hepatoduodenal lig
-To the 1st portion duodenum and into the head of pancreas

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18
Q

What is the mickey mouse sign?

A

MPV (head, big circle)
HA (L ear)
CBD (R ear)

In TRV plane

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19
Q

What is the ampulla of vater?

A

-A small opening at the duodenal wall where the CBD and main pancreatic duct join

(will never see on U/S because we can’t see bowel)

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20
Q

What is the sphincter of Oddi?

A

-Muscle surrounding the ampulla of vater
-It is the ends of the CBD and main pancreatic duct
-Forces bile into GB

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21
Q

What is the biliary system?

A

System that transports bile from liver (where it is produced) to the duodenum where it aids in digestion

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22
Q

What is in bile?

A

Bilirubin, bile acids, cholesterol, lecithin, mucin, etc.

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23
Q

What is the process of bile being released?

A
  1. Food into sm intestine
  2. Cholecystokinin (CCK) is a hormone secreted by the sm intestine
  3. GB contracts + sphincter of oddi relaxes/opens
  4. Bile released from GB into cystic duct
  5. Bile into CBD
  6. Bile into duodenum
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24
Q

What are the lab tests associated with the biliary system?

A

WBC: elevated w infection
AST & ALT: elevated w biliary obstruction
LDH: mildly elevated w obstructive jaundice
ALP: very elevated w obstructive jaundice
Bilirubin: direct/conjugated elevated w obstructive jaundice
Bilirubin: indirect/unconjugated elevated w liver disease

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25
Q

What is a cholecystectomy?

A

Removal of GB

(bowel may take place where GB would be if removed, sometimes can see clips or fluid where GB was removed)

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26
Q

How does the liver produce bile when the GB is removed?

A

-Bile salts from intestines stimulate the liver to produce more bile
-Bile flows freely into duodenum

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27
Q

What are the sonographic findings of a normal GB?

A

-Anechoic lumen
-Thin echogenic walls
-Posterior enhancement

-Evaluate GB in 2 positions (supine & LLD)

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28
Q

What are the sonographic findings of normal ducts?

A

-Anechoic lumen
-Normal measurements (inner-inner w/o wall)

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29
Q

What is the sonographic murphy sign?

A

-If positive the pt will have intense focal pain over their GB
-Only effective if pt is not on any pain medications

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30
Q

What is true about gallstones?

A

-They shadow
-May be mobile
-Check if stone is in the neck of GB (this can prevent the GB from releasing bile)

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31
Q

What is true about masses?

A

-They don’t shadow
-They aren’t mobile

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32
Q

What lab test is not elevated in obstructive jaundice

A

Indirect/unconjuated

33
Q

What is acute cholecystitis?

A

Inflammation of GB from stone in neck or cystic duct

(m/c women over 50)
(calculus and acalculus version)

34
Q

What is sludge?

A

Thick bile

35
Q

What is GB interposition?

A

When CHD and cystic duct are gone
(think of it as changing positions - gone now)

36
Q

What is caroli’s disease?

A

Ectasia (entirely dilated) of IHD’s

(type 5 of choledochal cyst)

37
Q

What is empyema cholecystitis?

A

Pus filled version of acute cholecystitis
(empyema means pus)

38
Q

What is gangrenous cholecystitis?

A

-GB full of gunk and absent blood supply
-High death rate

39
Q

What is chronic cholecystitis?

A

Recurrent attacks of acute cholecystitis

(common elderly women)

40
Q

What is porcelain GB?

A

Calcified GB (has echogenic line)

(common elderly women)

41
Q

What is GB perforation?

A

Life threatening hole in GB
(bile leaks into abdomen)

42
Q

What is bouveret syndrome/gallstone ileus?

A

Abnormal connection between GB and duodenum

(m/c women over 60)

43
Q

What is mirizzi syndrome?

A

Obstruction of CHD (an extrahepatic duct) due to stone in GB neck or cystic duct

44
Q

What does cholesterosis look like?

A

Strawberry GB

45
Q

What is courvoisier GB?

A

Obstructed CBD with mass in pancreatic head
(C in courvoisier - think C for CBD)

46
Q

What is hydropic GB?

A

Obstructed GB neck or cystic duct by gallstone

47
Q

What is GB torsion/volvulus?

A

GB blood supply cut off

48
Q

What is a biloma?

A

Collection of bile outside GB

49
Q

What is a polyp?

A

Non mobile, attached to GB wall, don’t shadow, hyperechoic

50
Q

What is a adenoma?

A

Hypoechoic, benign mass
(not as common as polyps)

51
Q

Most common GB carcinoma?

A

Majority adenocarcinomas

52
Q

Most common GB mestastases?

A

Melanoma (skin cancer)

53
Q

Cholecystokinin causes what to happen?

A

The liver to synthesize/create more bile

54
Q

What does adenomyomatosis look like?

A

-Comit tail/posterior shadowing
-Thickened wall
-RA sinuses
-Originates from anterior GB wall

55
Q

What is choledocholithiasis?

A

Stone in the bile duct
(may or may not cause dilation)

56
Q

What is cholangitis?

A

-Inflammation of biliary system
-PSC is idiopathic, within ductal system
-SSC is associated with biliary infection and caused by GB, not the ductal system

57
Q

What does cholangitis look like?

A

Proximally dilated ducts

58
Q

What is AIDS cholecystopathy?

A

-Secondary form of sclerosing cholangitis
-Increase ALP
(GB wall thickening, ductal dilation)

59
Q

What is cholangiocarcinoma?

A

Primary malignancy of bile duct

60
Q

What is cholangiocarcinoma: Intrahepatic?

A

-Least common location of cholangiocarcinoma

61
Q

What is cholangiocarcinoma: Hilar/Klatskin’s tumour?

A

-Most common location of cholangiocarcinoma
-Occurs at porta hepatis
-Looks like mass in between the ducts

62
Q

What is cholangiocarcinoma: Distal?

Describe the 2 types of masses involved.

A

-Sclerosing or polypoid (more common) tumour masses
(polypoid - well defined mass, no wall thickening)

(sclerosing - ill defined mass, wall thickening. think hardening)

63
Q

What is ascariasis?

A

Parasite worm that causes biliary obstruction

(think ascariasis - scary - tapeworm)

64
Q

What is pneumobilia?

A

-Air within biliary tree
-Looks like bright lines with shadow within the ducts
-Due to surgery/intervention

65
Q

What is hemobilia?

A

Blood in biliary tree

66
Q

What is biliary hamartomas/von Meyenburg complexes?

A

-Small clusters of dilated cystic bile ducts

67
Q

What is biliary atresia?

A

M/c type of obstructive biliary disease in infants + young children

(m/c males)

68
Q

Lightbulb for biliary atresia?

A

Jaundice
Young children
IHDD + can’t view CHD

(atresia means something is missing)

69
Q

What are choledochal cysts?

A

-Congenital dilation of biliary tree
-M/c in females + pediatric finding

(malignant potential)

70
Q

Which type of choledochal cyst is m/c?

A

Type 1 - fusiform dilation of CBD

71
Q

Who is more prone to getting Caroli’s disease?

A

Young adults or pediatrics

72
Q

What is slude a precursor to?

A

-Cholelithiasis (stones)
-Pregnancy

73
Q

SF of Caroli’s disease?

A

Multiple cysts near porta hepatis

74
Q

What are the 6 F’s?

A

Female, fat, fair, forty, fertile + flatulent

75
Q

What is the WES triad with cholelithiasis?

A

WES: wall-echo-shadow

76
Q

What is the m/c pathology of the biliary tract?

A

Choledocholithiasis (stone in BD)

77
Q

How to tell if bile duct obstruction is malignant or benign?

A

Benign - if the duct tapers at obstruction
Malignant - if the duct abruptly ends (due to a mass)

78
Q

Lightbulb sign for dilated bile ducts?

A

Parallel channel sign/double barreled shotgun sign

MIDS 127 (14 decks)

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