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KaBoom > Biliary System - Part 4 > Flashcards

Biliary System - Part 4 Flashcards

1
Q

Biloma

A

Collection of bile within the abdominal cavity

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2
Q

What are the causes of a biloma? (3)

A
  1. Surgery
  2. Trauma
  3. GB disease
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3
Q

What are the clinical findings of a biloma?

A

RUQ pain

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4
Q

What is the US appearance of a biloma? (3)

A
  1. Anechoic fluid collection near the porta hepatis
  2. Fluid may demonstrate mobility with changes in patient position
  3. Check pelvis and paracolic gutters for free fluid
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5
Q

What are 3 differential diagnosis for a biloma?

A
  1. Seroma
  2. Fluid in the stomach or intestines
  3. Ascites
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6
Q

Cholangitis

A

Inflammation of the bile duct

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7
Q

What causes cholangitis? (6)

A
  1. Congenital or acquired stricture
  2. Infection
  3. Parasitic infestation
  4. Biliary stasis
  5. Ulcerative colitis 6. Autoimmune deficiency syndrome (AIDS)
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8
Q

What are the clinical findings for cholangitis? (6)

A
  1. Abdominal pain
  2. Fever
  3. Leukocytosis
  4. Jaundice
  5. Mild elevation in
    AST and ALT levels 6. Marked elevation in bilirubin and alkaline phosphatase levels
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9
Q

What is the US appearance for cholangitis? (5)

A
  1. Biliary dilatation
  2. Thickening of the bile duct walls
  3. Pneumobilia
  4. GB hydrops
  5. Brightly echogenic portal
    triad
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10
Q

What are 2 differential diagnosis for cholangitis?

A
  1. Biliary obstruction

2. Caroli disease

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11
Q

Cholangiocarcinoma

A

Cancer of the bile ducts

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12
Q

What are the risk factors for cholangiocarcinoma? (6)

A
  1. Ulcerative colitis 2. Cholangitis
  2. Choledochal cyst
  3. Chronic biliary stasis
  4. Caroli disease
  5. Male prevalence
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13
Q

What are the clinical findings for cholangiocarcinoma? (7)

A
  1. Jaundice
  2. Acute onset of abdominal pain
  3. Biliary colic
  4. Weight loss
  5. Fatigue
  6. Elevated bilirubin and alkaline phosphatase levels
  7. Mild increase in AST and ALT
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14
Q

What is the US appearance for cholangiocarcinoma? (6)

A
  1. Echogenic mass within a bile duct
  2. Dilatation of the intrahepatic and extrahepatic bile ducts
  3. GB hydrops
  4. Hepatomegaly
  5. Gallstones
    - 30% of cases
  6. Ascites
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15
Q

What are 5 differential diagnosis for cholangiocarcinoma?

A
  1. Artifact
  2. Portal vein thrombosis
  3. Lymphadenopathy 4. Choledocholithiasis 5. Pancreatic mass
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16
Q

Choledocholithiasis

A

Stones in the CBD

17
Q

What are complications for choledocholithiasis? (3)

A
  1. Biliary obstruction
  2. Cholangitis
  3. Pancreatitis
18
Q

What are the clinical findings for choledocholithiasis? (3)

A
  1. RUQ colicky pain
  2. Elevated bilirubin and
    alkaline phosphatase
  3. Mild increase in AST and ALT levels
19
Q

What is the US appearance for choledocholithiasis? (4)

A
  1. Echogenic focus(i) within the common duct
  2. Posterior acoustic shadowing
    - 60-80% of cases
  3. Biliary dilatation 4. Hydropic GB
20
Q

What are 5 differential diagnosis for choledocholithiasis?

A
  1. Surgical clip
  2. Tortuous bile duct
  3. Cystic duct remnant
  4. Intestinal air
  5. Intraductal tumour
21
Q

What causes choledochal cyst? (2)

A
  1. Congenital weakness of the ductile wall

2. Reflux of pancreatic juices into the bile duct

22
Q

What are the clinical findings for choledochal cyst? (4)

A
  1. Asymptomatic
  2. Jaundice
  3. RUQ mass
  4. RUQ pain
23
Q

What is the US appearance for choledochal cyst? (3)

A
  1. Nonvascular cystic mass medial to the GB and lateral to the head of the pancreas
  2. Dilated CHD, CBD or cystic duct entering the cystic mass
  3. Dilated intrahepatic bile ducts
24
Q

What are 4 differential diagnosis for choledochal cyst?

A
  1. Hepatic cyst
  2. Pancreas cyst
  3. Normal junction
    of the common hepatic and cystic ducts
  4. GB duplication
25
Q

Ascariasis

A

Infection in the intestines with ascarids

26
Q

What causes ascariasis?

A

Ingestion of contaminated water or food

27
Q

What are the clinical findings of ascariasis? (4)

A
  1. Asymptomatic
  2. RUQ pain
  3. Fever
  4. Leukocytosis
28
Q

What is the US appearance of ascariasis? (3)

A
  1. Spaghetti-like echogenic structure within a bile duct
  2. Non-shadowing
  3. Posterior acoustic
    enhancement
29
Q

What are 4 differential diagnosis for ascariasis?

A
  1. Stent
  2. Cholangitis
  3. Cholangiocarcinoma
  4. Choledocholithiasis
30
Q

Where is ascariasis more common? (3)

A
  1. Africa
  2. Asia
  3. South America

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