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ARDMS ABD PATHOLOGY > Biliary System Pathology > Flashcards

Biliary System Pathology Flashcards

1
Q

sludge is also called ______ bile

A

inspissated bile

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2
Q

sludge occurs in patient with (5)

A
  1. prolonged fasting
  2. biliary obstruction
  3. receiving hyperalimentation
  4. coexisting gallstones or GB carcinoma
  5. acute or chronic cholecystitis
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3
Q

what is hepatization of GB?

A

sludge-filled GB that appears isoechoic to liver

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4
Q

ultrasound appearance of sludge (2)

A

low-level “sandy” echoes
moves slowly with patient repositioning

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5
Q

sludge balls are also called _________

A

tumefactive sludge

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6
Q

what is tumefactive sludge?

A

sludge balls

thick sludge that mimics an GB mass
occurs with long-duration obstruction

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7
Q

ultrasound appearance of sludge balls

A

avascular mass with low-level echoes

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8
Q

hemobilia is also called _____

A

hematobelia

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9
Q

what is hemobilia?

A

blood within the biliary system

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10
Q

signs/symptoms of hemobilia (3)

A

pain
bleeding
jaundice

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11
Q

ultrasound appearance of hematobelia (2)

A

new blood = anechoic
old blood = echogenic

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12
Q

what is acute cholecystitis?

A

sudden onset of GB inflammation

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13
Q

complications of acute cholecystitis (6)

A
  1. emphysematous cholecystitis
  2. gangrenous cholecystitis
  3. GB perforation
  4. pericholecystitic abscess
  5. emphyema
  6. cholangitis
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14
Q

strong indicator of acute cholecystitis

A

gallstone and + Murphy’s sign

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15
Q

what is acalculous cholecystitis?

A

acute cholecystitis without gallstones

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16
Q

acalculous cholecsystitis is common in (3)

A

children
immunocompromised
hospitalized

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17
Q

what is calculous cholecystitis?

A

acute cholecystitis caused by gallstones

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18
Q

what is emphysematous cholecystitis?

A

acute cholecystitis caused by gas-forming organism

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19
Q

the gas in emphysematous cholecystitis will create ____,____,_____ which is also termed the _____

A

dirty shadowing, reverberation, and ring down artifact

aka champagne sign

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20
Q

emphysematous cholecystitis is common in _____ and can be ____

A

common in diabetics
can be fatal

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21
Q

what is gangrenous cholecystitis?

A

progression of acute cholecystitis that leads to GB necrosis and perforation

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22
Q

2 main ultrasound appearances of gangrenous cholecytitis

A

GB wall tear
irregular GB shape

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23
Q

GB perforation is more common after _____

A

gangrenous cholecystitis

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24
Q

common site of GB perforation

A

fundus of GB

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25
Q

2 complications of GB perforation

A

peritonitis
pericholecystic abscess

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26
Q

ultrasound appearance of GB perforation

A

infected = poorly defined hypoechoic mass with low-level echoes

not infected = well defined band of low-level echoes

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27
Q

what is a pericholecystic abscess?

A

hypoechoic mass/area surrounding the GB

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28
Q

empyema is also called _____

A

pyogenic GB

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29
Q

what is empyema?

A

bacterial infection of bile

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30
Q

cholangitis is also called _____

A

primary sclerosing cholangitis (PSC)

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31
Q

what is cholangitis?

A

inflammation of biliary ducts

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32
Q

cholangitis should be suspected when bile duct wall thickness is greater than ____

A

5 mm

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33
Q

what are the 4 types of cholangitis?

A
  1. acute bacterial cholangitis
  2. AIDS cholangitis
  3. oriental cholangitis
  4. sclerosing cholangitis
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34
Q

what causes acute bacterial cholangitis?

A

bacterial accumulation secondary to obstruction

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35
Q

what is the charcot triad?

A

fever
RUQ pain
jaundice

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36
Q

AIDS cholangitis most often results from infection with _____ or ______

A

cryptosporidium
cytomegalovirus

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37
Q

sclerosing cholangitis is characterized by _____

A

fibrotic thickening of the bile ducts

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38
Q

sclerosing cholangitis is associated with (2)

A

inflammatory bowel disease
ulcerative colitis

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39
Q

what is used to diagnose primary sclerosing cholangitis?

A

ERCP = endoscopic retrograde cholangiopancreatography

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40
Q

patients with sclerosing cholangitis are at an increased risk for ____

A

cholangiocarcinoma

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41
Q

chronic cholecystitis results from ____

A

multiple bouts of acute cholecystitis with subsequent fibrosis of the GB wall

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42
Q

patients with chronic cholecystitis are at an increased risk for (3)

A
  1. porcelain GB
  2. stone formation
  3. adenocarcinoma of the GB
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43
Q

signs/symptoms of chronic cholecystitis (3)

A

intolerance to fatty foods
negative Murphy’s sign
RUQ pain

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44
Q

ultrasound appearance of chronic cholecystitis (4)

A
  1. thick GB wall
  2. WES sign
  3. contracted GB (<2cm)
  4. gallstones
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45
Q

what is cholelithiasis?

A

gallstones

46
Q

what are gallstones made of (3)

A

cholesterol
calcium bilirubinate
calcium carbonate

47
Q

risk factors for gallstones (5)

A
  1. obesity
  2. pregnancy
  3. diabetes
  4. oral contraceptives
  5. rapid weight loss
48
Q

what are the five F’s for cholelithiasis

A

female
fat
fertile
forty
fair

49
Q

pediatric patients who have _____ or _____ have higher risk for developing gallstones

A

hemolytic anemia (sickle cell)
Crohn disease

50
Q

T/F: patients with gallstones are usually asymptomatic

A

true

51
Q

signs/symptoms of gallstones (3)

A

RUQ pain the radiates to shoulders
intolerance to fatty foods
nausea and vomiting

52
Q

another name for milk of calcium bile

A

limey bile

53
Q

what is limey bile?

A

GB filled with calcium carbonate

54
Q

limey bile is associated with ____ and ____

A

GB stasis and chronic cholecystitis

55
Q

an enlarged GB can also be called a ___ or _____ GB

A

hydropic or mucocele GB

56
Q

what is the most common cause of an enlarged GB?

A

cystic duct obstruction

57
Q

what is Courvoisier GB?

A

enlarged GB caused by a pancreatic head mass that usually has painless jaundice

58
Q

GB hydrops in older infants and children’s may be associated with _____

A

Kawasaki disease

59
Q

what kind of GB polyps are the most common?

A

cholesterol polyps

60
Q

GB polyps measure less than ____

A

10mm

61
Q

rapid growing or large GB polyps can indicate ____

A

GB carcinoma

62
Q

used to describe GB polyps

A

“ball on the wall”

63
Q

what is strawberry GB?

A

abnormal cholesterol deposits within the GB wall
seen with cholesterolosis

64
Q

what is adenomyomatosis?

A

proliferation of epithelium and thickened muscular wall

65
Q

tiny pockets produced in adenomyomatosis are called _____

A

Rokitansky-Aschoff sinuses

66
Q

Rokintanksy-Aschoff sinuses contain _____ and produce ____

A

contain cholesterol crystals and produce comet tail artifact

67
Q

what is porcelain GB?

A

calcification of the GB wall

68
Q

porcelain GB is associated with (3)

A

GB carcinoma
cholelithiasis
chronic inflammation

69
Q

T/F: GB carcinoma is the most common cancer of the biliary tract

A

true

70
Q

adenocarcinoma of the GB has high association with ____

A

gallstones

71
Q

ultrasound appearance of GB carcinoma (3)

A

non mobile mass greater than 1 cm
thick GB wall
invasion of mass into surrounding tissue

72
Q

what is the most common metastatic disease of the GB?

A

malignant melanoma

73
Q

what is cholangiocarcinoma?

A

primary biliary tree cancer

74
Q

what is the most common risk factor of cholangiocarcinoma?

A

cholangitis

75
Q

what is the most common manifestation of cholangiocarcinoma?

A

Klatskin tumors

76
Q

Klatskin tumors are located at the junction of the ____

A

right and left hepatic ducts

77
Q

ultrasound appearance of cholangiocarcinoma

A

dilated intrahepatic ducts that abruptly terminate at the level of the tumor

78
Q

what lab values increase with cholangiocarcinoma? (2)

A

ALP and direct bilirubin

79
Q

biliary dilation will occur ____ to the level of obstruction

A

proximal

80
Q

what is the most common level for biliary obstruction?

A

distal CBD

81
Q

what are the most common causes for biliary obstruction? (3)

A

choledocholithiasis
pancreatitis
pancreatic carcinoma

82
Q

appearance of intrahepatic dilation (3)

A

parallel channel sign
antler branching pattern
too many tubes sign

83
Q

appearance of extrahepatic dilation (2)

A

“double barrel” shotgun sign
parallel tube sign

84
Q

what is choledocholithiasis?

A

gallstones within the bile ducts

85
Q

gallstones in the ____ is the most common cause of obstructive jaundice

A

CBD

86
Q

T/F: choledocholithiasis always has biliary dilation

A

FALSE- may have biliary dilation but not always

87
Q

what is Mirizzi syndrome?

A

when a gallstone blocks the cystic duct with subsequent compression of the CHD

88
Q

how is Mirizzi syndrome diagnosed? (2)

A

cholangiography or ERCP

89
Q

what is pneumobilia?

A

air or gas within the biliary tree

90
Q

pneumobilia produces what artifacts? (2)

A

ring down and dirty shadowing

91
Q

what is biliary atresia?

A

congenital disease
narrowing or obliteration of all or a portion of the biliary tree

92
Q

biliary anomaly is suspected when jaundice persists for more than _____ days after birth

A

14 days

93
Q

biliary atresia may show evidence of “triangular cord sign” which is an ____

A

avascular, echogenic, triangular or tubular structure anterior to the PV

94
Q

what does the “triangular cord sign” represent?

A

replacement of the extrahepatic duct with fibrous tissue in the porta hepatis

95
Q

what is a choledochal cyst?

A

congenital cystic dilation of the CBD

96
Q

choledochal cysts are confirmed with _____
aka _____ scans

A

hepatobiliary iminodiacetic acid (HIDA)
cholescintigraphy scans

97
Q

what is Caroli disease?

A

congenital disorder
segmental dilation of the intrahepatic ducts (beaded appearance)

98
Q

the “central dot sign” is an appearance of _____

A

Caroli disease

99
Q

what is endoscopic retrograde cholangiopancreatography (ERCP)?

A

endoscope with x-ray imaging
examine ducts that drain the liver, GB, and pancreas

100
Q

what is percutaneous transhepatic cholangiography (PTC)?

A

dye injected into bile ducts within the liver with subsequent x-ray imaging

101
Q

what is intraoperative cholangiography?

A

dye injected directly into the bile duct during GB operation

102
Q

other causes of GB wall thickening (5)

A

hypoalbuminemia
ascites
hepatitis
CHF
pancreatitis

103
Q

3 causes of jaundice

A

pre hepatic = excessive red cell breakdown causes unconjugated hyperbilirubinemia (Gilbert syndrome)

hepatic = dysfunction of the liver

post hepatic = obstruction of the biliary tree causes conjugated hyperbilirubinemia that results in pale stool and dark urine

104
Q

what is choledochojejunostomy?

A

procedure for creating an anastomosis of the CBD to the jejunum
relieve symptoms of biliary obstruction

105
Q

causes of gas in the biliary system (5)

A

ERCP
sphincter of oddi papilotomy
choledochojejunostomy
GB fistula
emphysematous cholecsytitis

106
Q

biliary dynamics, GB contractility, or obstruction can be assessed by

A

administering a fatty meal

107
Q

a Klatskin tumor is located at the ____ resulting in _____ but not _____ biliary dilation

A

located at the hepatic hilum
causes intrahepatic but NOT extrehapatic biliary diliation

108
Q

what is biliary ascariasis?

A

obstruction caused by parasitic worm (Ascaris lumbricoides)
common in the south-east asian countries

109
Q

Kasai portoenterostomy (KPE) is most successful in the treatment of ____ if performed before ____ days of life.

A

biliary atresia
90 days

110
Q

choledochal cysts are more prevalent in ____

A

female asians before puberty

111
Q

what is primary biliary cholangitis?

A

autoimmmune disorder resulting in cholestasis (reduced or stopped bile flow)
due to destruction of the small intrahepatic bile ducts

112
Q

elevated lab values of primary biliary cholangitis (5)

A

AST
ALT
ALP
GGT
AMAs

ARDMS ABD PATHOLOGY (13 decks)

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