Biliary System - Part 4 Flashcards
Biloma
Collection of bile within the abdominal cavity
What are the causes of a biloma? (3)
- Surgery
- Trauma
- GB disease
What are the clinical findings of a biloma?
RUQ pain
What is the US appearance of a biloma? (3)
- Anechoic fluid collection near the porta hepatis
- Fluid may demonstrate mobility with changes in patient position
- Check pelvis and paracolic gutters for free fluid
What are 3 differential diagnosis for a biloma?
- Seroma
- Fluid in the stomach or intestines
- Ascites
Cholangitis
Inflammation of the bile duct
What causes cholangitis? (6)
- Congenital or acquired stricture
- Infection
- Parasitic infestation
- Biliary stasis
- Ulcerative colitis 6. Autoimmune deficiency syndrome (AIDS)
What are the clinical findings for cholangitis? (6)
- Abdominal pain
- Fever
- Leukocytosis
- Jaundice
- Mild elevation in
AST and ALT levels 6. Marked elevation in bilirubin and alkaline phosphatase levels
What is the US appearance for cholangitis? (5)
- Biliary dilatation
- Thickening of the bile duct walls
- Pneumobilia
- GB hydrops
- Brightly echogenic portal
triad
What are 2 differential diagnosis for cholangitis?
- Biliary obstruction
2. Caroli disease
Cholangiocarcinoma
Cancer of the bile ducts
What are the risk factors for cholangiocarcinoma? (6)
- Ulcerative colitis 2. Cholangitis
- Choledochal cyst
- Chronic biliary stasis
- Caroli disease
- Male prevalence
What are the clinical findings for cholangiocarcinoma? (7)
- Jaundice
- Acute onset of abdominal pain
- Biliary colic
- Weight loss
- Fatigue
- Elevated bilirubin and alkaline phosphatase levels
- Mild increase in AST and ALT
What is the US appearance for cholangiocarcinoma? (6)
- Echogenic mass within a bile duct
- Dilatation of the intrahepatic and extrahepatic bile ducts
- GB hydrops
- Hepatomegaly
- Gallstones
- 30% of cases - Ascites
What are 5 differential diagnosis for cholangiocarcinoma?
- Artifact
- Portal vein thrombosis
- Lymphadenopathy 4. Choledocholithiasis 5. Pancreatic mass
Choledocholithiasis
Stones in the CBD
What are complications for choledocholithiasis? (3)
- Biliary obstruction
- Cholangitis
- Pancreatitis
What are the clinical findings for choledocholithiasis? (3)
- RUQ colicky pain
- Elevated bilirubin and
alkaline phosphatase - Mild increase in AST and ALT levels
What is the US appearance for choledocholithiasis? (4)
- Echogenic focus(i) within the common duct
- Posterior acoustic shadowing
- 60-80% of cases - Biliary dilatation 4. Hydropic GB
What are 5 differential diagnosis for choledocholithiasis?
- Surgical clip
- Tortuous bile duct
- Cystic duct remnant
- Intestinal air
- Intraductal tumour
What causes choledochal cyst? (2)
- Congenital weakness of the ductile wall
2. Reflux of pancreatic juices into the bile duct
What are the clinical findings for choledochal cyst? (4)
- Asymptomatic
- Jaundice
- RUQ mass
- RUQ pain
What is the US appearance for choledochal cyst? (3)
- Nonvascular cystic mass medial to the GB and lateral to the head of the pancreas
- Dilated CHD, CBD or cystic duct entering the cystic mass
- Dilated intrahepatic bile ducts
What are 4 differential diagnosis for choledochal cyst?
- Hepatic cyst
- Pancreas cyst
- Normal junction
of the common hepatic and cystic ducts - GB duplication
Ascariasis
Infection in the intestines with ascarids
What causes ascariasis?
Ingestion of contaminated water or food
What are the clinical findings of ascariasis? (4)
- Asymptomatic
- RUQ pain
- Fever
- Leukocytosis
What is the US appearance of ascariasis? (3)
- Spaghetti-like echogenic structure within a bile duct
- Non-shadowing
- Posterior acoustic
enhancement
What are 4 differential diagnosis for ascariasis?
- Stent
- Cholangitis
- Cholangiocarcinoma
- Choledocholithiasis
Where is ascariasis more common? (3)
- Africa
- Asia
- South America
