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KaBoom > Biliary System - Part 5 > Flashcards

Biliary System - Part 5 Flashcards

1
Q

Adenoma (polyp)

A

Benign epithelial tumour

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2
Q

What are the clinical findings of an adenoma? (3)

A
  1. Asymptomatic
  2. Dull RUQ pain
  3. Intolerance to fatty foods
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3
Q

What is the US appearance of an adenoma? (4)

A
  1. Echogenic intraluminal focus(i) 2. Immobile
  2. Non-shadowing
  3. Thickening of the GB wall
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4
Q

What are 3 differential diagnosis of an adenoma?

A
  1. Cholelithiasis
  2. Fold in the GB
  3. Carcinoma
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5
Q

Adenomyomatosis

A

Hyperplasia of the epithelial and muscle layers of the GB wall

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6
Q

What are the clinical findings of adenomyomatosis? (3)

A
  1. Asymptomatic
  2. Dull RUQ pain
  3. Intolerance to fatty foods
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7
Q

What is the US appearance of adenomyomatosis? (5)

A
  1. Echogenic intraluminal focus
  2. Diffuse comet-tail reverberation artifact
  3. Twinkling artifact on colour
  4. Doppler
  5. Immobile
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8
Q

What are 3 differential diagnosis of adenomyomatosis?

A
  1. Cholelithiasis
  2. Fold in the GB
  3. Carcinoma
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9
Q

What are the 2 types of cholesterolosis?

A
  1. Cholesterosis

2. Cholesterol polyps

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10
Q

What are the clinical findings of cholesterolosis? (2)

A
  1. Asymptomatic

2. Abdominal pain

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11
Q

What is the US appearance of cholesterolosis? (4)

A
  1. Echogenic intraluminal foci
  2. Non-shadowing
  3. Normal GB in the majority of cases
  4. Strawberry appearance with
    cholesterosis
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12
Q

What are 3 differential diagnosis of cholesterolosis?

A
  1. Cholelithiasis
  2. Carcinoma
  3. Fold in the GB
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13
Q

Cholelithiasis

A

Gallstones

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14
Q

What are the causes of cholelithiasis? (3)

A
  1. Abnormal bile composition
  2. Bile stasis
  3. Infection
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15
Q

What are the risk factors of cholelithiasis? (5)

A
  1. Family history
  2. Obesity
  3. Pregnancy
  4. Diabetes
  5. Female prevalence
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16
Q

What are the clinical findings of cholelithiasis? (8)

A
  1. Asymptomatic
  2. RUQ pain
  3. Epigastric pain
  4. Chest or shoulder pain
  5. Elevated LFTs
  6. Nausea/vomiting
  7. Postprandial pain
  8. Fatty food intolerance
17
Q

What is the US appearance of cholelithiasis? (4)

A
  1. Hyper echoic intraluminal focus(i)
  2. Posterior acoustic shadowing
  3. Mobile
    - need to flip the patient to prove this
  4. Wall-echo-shadow (WES)
18
Q

What are 5 differential diagnosis of cholelithiasis?

A
  1. Intestinal air
  2. Adenomyomatosis
  3. Polyp
  4. Fold in the GB
  5. Surgical clip
19
Q

Are gallstones more common in male or females?

A

Females

- 4:1

20
Q

Porcelain GB

A

Is a calcification of the gallbladder

21
Q

What are the causes of a porcelain GB? (3)

A
  1. Decrease in vascular supply to the GB
  2. Cystic duct obstruction causing bile stasis
  3. Chronic low-grade infection
22
Q

Is a porcelain GB more common in male or females?

A

Females

23
Q

What are the clinical findings of a porcelain GB? (2)

A
  1. Asymptomatic

2. Vague RUQ pain

24
Q

What is the US appearance of a porcelain GB? (4)

A
  1. Gallstones
    - 95%
  2. Hyper echoic wall
  3. Marked posterior acoustic shadowing 4. Diffuse or localized
25
Q

What are 3 differential diagnosis of a porcelain GB?

A
  1. Contracted GB with stones
    - WES complex
  2. Intestinal air
  3. Adenomyomatosis
26
Q

Mirizzi syndrome

A

Common hepatic duct obstruction

27
Q

What are the causes of Mirizzi syndrome? (2)

A
  1. Impacted stone in the cystic duct or GB neck

2. Obstruction of the CHD

28
Q

What are the clinical findings of Mirizzi syndrome? (4)

A
  1. RUQ pain
  2. Jaundice
  3. Elevated bilirubin and alkaline phosphatase
  4. Increase AST and ALT levels
29
Q

What is the US appearance of Mirizzi syndrome? (3)

A
  1. Immobile calculus in the cystic duct or neck of the GB
  2. Dilatation of the intrahepatic and CHDs
  3. Normal CBD
30
Q

What is a differential diagnosis of Mirizzi syndrome?

A

Choledocholithiasis

- CBD stones

31
Q

What are the causes of sludge? (5)

A
  1. Prolonged fasting
  2. Biliary stasis
  3. Biliary obstruction
  4. Cholecystitis
  5. Sickle cell anemia
32
Q

What are the clinical findings of sludge? (3)

A
  1. Asymptomatic
  2. RUQ pain
  3. Nausea/vomiting
33
Q

What is the US appearance of sludge? (5)

A
  1. Non-shadowing low amplitude echoes layering in the dependent portion of the GB
  2. Echoes move slowly with position change
  3. May fill entire GB
  4. May demonstrate fluid-fluid levels
34
Q

What are 4 differential diagnosis of sludge?

A
  1. Technical factors
  2. Intestinal air
  3. Carcinoma
  4. Hematobilia

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