Biliary System - Part 5 Flashcards
Adenoma (polyp)
Benign epithelial tumour
What are the clinical findings of an adenoma? (3)
- Asymptomatic
- Dull RUQ pain
- Intolerance to fatty foods
What is the US appearance of an adenoma? (4)
- Echogenic intraluminal focus(i) 2. Immobile
- Non-shadowing
- Thickening of the GB wall
What are 3 differential diagnosis of an adenoma?
- Cholelithiasis
- Fold in the GB
- Carcinoma
Adenomyomatosis
Hyperplasia of the epithelial and muscle layers of the GB wall
What are the clinical findings of adenomyomatosis? (3)
- Asymptomatic
- Dull RUQ pain
- Intolerance to fatty foods
What is the US appearance of adenomyomatosis? (5)
- Echogenic intraluminal focus
- Diffuse comet-tail reverberation artifact
- Twinkling artifact on colour
- Doppler
- Immobile
What are 3 differential diagnosis of adenomyomatosis?
- Cholelithiasis
- Fold in the GB
- Carcinoma
What are the 2 types of cholesterolosis?
- Cholesterosis
2. Cholesterol polyps
What are the clinical findings of cholesterolosis? (2)
- Asymptomatic
2. Abdominal pain
What is the US appearance of cholesterolosis? (4)
- Echogenic intraluminal foci
- Non-shadowing
- Normal GB in the majority of cases
- Strawberry appearance with
cholesterosis
What are 3 differential diagnosis of cholesterolosis?
- Cholelithiasis
- Carcinoma
- Fold in the GB
Cholelithiasis
Gallstones
What are the causes of cholelithiasis? (3)
- Abnormal bile composition
- Bile stasis
- Infection
What are the risk factors of cholelithiasis? (5)
- Family history
- Obesity
- Pregnancy
- Diabetes
- Female prevalence
What are the clinical findings of cholelithiasis? (8)
- Asymptomatic
- RUQ pain
- Epigastric pain
- Chest or shoulder pain
- Elevated LFTs
- Nausea/vomiting
- Postprandial pain
- Fatty food intolerance
What is the US appearance of cholelithiasis? (4)
- Hyper echoic intraluminal focus(i)
- Posterior acoustic shadowing
- Mobile
- need to flip the patient to prove this - Wall-echo-shadow (WES)
What are 5 differential diagnosis of cholelithiasis?
- Intestinal air
- Adenomyomatosis
- Polyp
- Fold in the GB
- Surgical clip
Are gallstones more common in male or females?
Females
- 4:1
Porcelain GB
Is a calcification of the gallbladder
What are the causes of a porcelain GB? (3)
- Decrease in vascular supply to the GB
- Cystic duct obstruction causing bile stasis
- Chronic low-grade infection
Is a porcelain GB more common in male or females?
Females
What are the clinical findings of a porcelain GB? (2)
- Asymptomatic
2. Vague RUQ pain
What is the US appearance of a porcelain GB? (4)
- Gallstones
- 95% - Hyper echoic wall
- Marked posterior acoustic shadowing 4. Diffuse or localized
What are 3 differential diagnosis of a porcelain GB?
- Contracted GB with stones
- WES complex - Intestinal air
- Adenomyomatosis
Mirizzi syndrome
Common hepatic duct obstruction
What are the causes of Mirizzi syndrome? (2)
- Impacted stone in the cystic duct or GB neck
2. Obstruction of the CHD
What are the clinical findings of Mirizzi syndrome? (4)
- RUQ pain
- Jaundice
- Elevated bilirubin and alkaline phosphatase
- Increase AST and ALT levels
What is the US appearance of Mirizzi syndrome? (3)
- Immobile calculus in the cystic duct or neck of the GB
- Dilatation of the intrahepatic and CHDs
- Normal CBD
What is a differential diagnosis of Mirizzi syndrome?
Choledocholithiasis
- CBD stones
What are the causes of sludge? (5)
- Prolonged fasting
- Biliary stasis
- Biliary obstruction
- Cholecystitis
- Sickle cell anemia
What are the clinical findings of sludge? (3)
- Asymptomatic
- RUQ pain
- Nausea/vomiting
What is the US appearance of sludge? (5)
- Non-shadowing low amplitude echoes layering in the dependent portion of the GB
- Echoes move slowly with position change
- May fill entire GB
- May demonstrate fluid-fluid levels
What are 4 differential diagnosis of sludge?
- Technical factors
- Intestinal air
- Carcinoma
- Hematobilia