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radiology > Biliary system > Flashcards

Biliary system Flashcards

1
Q

the anatomy of the biliary system?

A
  • right hepatic duct+ left hepatic duct= common hepatic duct
  • common hepatic duct+ cystic duct = common bile duct
  • common bile duct + Main pancreatic duct = common hepatopancreatic duct
  • The common hepatopancreatic duct is inserted in the major duodenal papilla (the ampulla of Vater)
  • The minor duodenal papilla : insertion the accessory pancreatic duct
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2
Q

the imaging thechniques?

A
  • US
  • CT
  • Cholangio or Biliary MRI
  • cholongiography: x ray with contrast inside the biliary tract
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3
Q

the uses of X-ray?

A
  • Calcifications: rarely visible; transparent not like in uro
  • pneumobilia: air
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4
Q

normal ultrasound of biliary system?

A
  • first line examination
  • Gallblader:
  • Anechoic : purely liquid
  • With posterior enhancement
  • Thin wall < 3mm
  • Main bile duct:
  • Thin < 6mm
  • In front of the portal vein.
  • Intrahepatic biliary ducts: invisible
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5
Q

the role of CT scan?

A
  • Without contrast
  • Spontaneous density
  • Biliary lithiasis ( not always calcic)- might be transparent
  • With injection : Tumors
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6
Q

Indications of MRI?

A
  • second line of examination
  • Cholestatic jaundice
  • Biliary duct dilatation without a visible obstacle
  • u can see the intrahepatic ducts
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7
Q

what are the techniques of the cholangiography?

A
  • Biliary ducts opacification using the Kheir drain: residual lithiasis
  • Endoscopic retrograde cholangiography (ERCP)
  • Percutaneous hepatic cholangiographie (PCHC): therapatic use
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8
Q

What are the gallblader pathologies?

A

-Lithiasis
- Acute cholecystis
- cancer

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9
Q

the clinical signs of lithiasis?

A
  • right hypochondriac pain and dyspepsia- indigestion
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10
Q

the diagnosis of the lithiasis?

A
  • US
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11
Q

how the lithiasis would appear in the US?

A

–Stone : hyper-echoic with posterior shadow
- Single or multiple (multi-lithiasis gallbladder)
- Mobile, they are not if there is inflammation and fibrosis

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12
Q

Acute complications of lithiasis- Microcalcification?

A
  • Gallbladder hydrops
  • Acute cholecystitis
  • Acute cholangitis
  • Acute pancreatitis
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13
Q

Chronic complications ofthe lithasis-Macrocalcifications?

A
  • Chronic cholecystitis
  • Gallbladder cancer
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14
Q

how the lithiasis appears in the MRI?

A
  • all lithiasis even if it is cholesterolic < hyposignal
  • the fluid is hypersignal in T2 < contrast
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15
Q

what are the clinical signs of the acute cholecystitis?

A
  • Right hypochondriac pain
  • Fever
  • Murphy sign
  • Surgical emergency
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16
Q

The diagnosis of the acute cholecystis?

A

US

17
Q

how the cholecystitis appears in the US?

A
  • Thick wall >4mm
18
Q

when to do the CT in case of acute cholecystitis?

A

assess the complications

19
Q

the characteristics imaging of the acute cholecystitis?

A
  • Thickening of the wall
  • Adjacent fat infiltration
  • peri-vesicular effusion
20
Q

what are the complications of the acute cholecystitis?

A
  • Perforation
  • Peri-vesicular abscess
  • Bilio enteric fistula (pneumobilia)
  • Emphysematous cholecystitis: surinfection with anaerobic germs give air inside the gallbladder or in the wall. Also we can have gangrenous
    cholystitis with necrosis
21
Q

what is the type of gallblader cancer

A

calculous cancer= gallblader carcinoma
frequent in female

22
Q

how the gallblader cancer appears in the US?

A
  • Irregular thickening of the wall
  • heteregoneous echogenic mass
  • lithiasis
  • changement in the content of the gallblader- no more bile
23
Q

how the gallbladder appears in the CT and MRI?

A
  • Irregular thickening of the gallbladder wall
  • Gallbladder mass
  • stagging
24
Q

what to look for staggng the gallbladder cancer

A

liver: invasion very quickly, poor prognosis
, pedicle, lymphadenopathy, peritoneal carcinomatosis

25
Q

What are the other biliary tract pathologies?

A
  • Cholongitis/ angiocholitis
  • Main bile duct dilation
  • Intrahepatic bile duct dilation
  • lithiasis
  • tumor
  • Inflammation
  • Infection
  • Malformation
26
Q

What are the sign suggestive of the biliary duct pathology?

A
  • Retentional jaundice with signs of cholestasis
  • Acute presentation : angiocholitis
27
Q

what is the first to look for in biliary duct pathologies?

A
  • Dilation
28
Q

diagnosis of the main bile duct dialation?

A
  • US: Diameter > 8 mm
  • CT, MRI
29
Q

what are the clinical signs of the angiocholitis?

A
  • Pain in the right hypochondrium
    – Fever
    – Jaundice +++
    – Murphy’s signe
30
Q

what are of the imaging characteristics of the angiocholitis on Ultrasound?

A
  • Main biliary duct lithiasis
  • biliary duct dialation
  • thichening of the wall of the common bile duct
    in case of doubt < MRI
31
Q

what are the imaging charcteristics of the main bile duct tumor?

A
  • echogenic appearance without posterior shadowing
  • dilation of the intrahepatic and extrahepatic bile ducts
32
Q

what are the characteristics of the Hilum cholangiocarcinoma- onfluence of the right and left hepatic bile ducts on US?

A
  • pedicular infiltration
  • Dilation of the intrahepatic bile ducts
  • normal caliber common bile duct
33
Q

the signs of the inflammatory of the biliary system?

A
  • Sclerosing cholangitis: chronic < fibrosis, involvement of intrahepatic, and extrahepatic bile duct
  • Dilations and stenosis+++? irregularities
  • Thickening
  • stones
34
Q

what are some infectious causes of biliary system?

A
  • Ruptured hydatid cyst in the bile ducts
  • Ascariasis
    US,MRI
35
Q

what are some malformatives pathologies- Children+++?

A
  • Choledochal cyst: cystic dialation involves intrahepatic and extrahepatic
  • Caroli disease: dialation involve only the intrahepatique
  • Biliary atresia
    US; CT; MRI
36
Q

the probable diagnosis in case of Dilation of the intrahepatic bile ducts
with normal extrahepatic bile ducts?

A

Pedicle region+++
- Hilar tumor
- Bile duct cancer
- lithiasis
- Extrinsic compression

37
Q

the probable diagnosis in case of Dilation of the intrahepatic bile ducts
and the common bile duct?

A

Distal part
- Calculus or tumor, lithiasis at the
distal common bile duct
– Pancreatic head cancer
– Vater’s ampulla tumor

38
Q

CT scan role?

A
  • Location and nature of the obstruction
  • Staging of a tumor pathology
39
Q

Biliary MRI role?

A
  • morphological study
  • the etiological diagnosis of obstructive
  • malformative pathology of the bile ducts

radiology (3 decks)

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