Biliary sytem

Question 1

Choledochal cysts

Answer 1

Heterogenous group of congenital diseases that may manifest as focal or diffuse cystic dilation of the biliary tree.
5 types
1. fusiform dilation of cbd
2. true diverticula of bile ducts
3. intraduodenal portion of CBD
4. multiple intrahepatic and extrahepatic biliary dilations
5. Caroli
US; cystic, internal sludge, stones or solid neoplasm

Question 2

Caroli disease

Answer 2

Congenital disorders of multifocal cystic dilation of segmental intrahepatic bile ducts.
Presentation: RUQ pain, recurrent cholelithiasis, cholangitis w fever and jaundice.

US appearance: dilated intrahepatic bile ducts, intraductal bridging, intraductal calculi, small portal venous branches partially or completely surrounded by dilated bile ducts
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Question 3

Choledocholithiasis

Answer 3

Primary: formation of stones
Secondary: migration of stones from GB to CBD

Stones are highly echogenic with posterior acoustic shadowing

Symptoms; acute pancreatitis, biliary colic, ascending cholangitis, obstructive jaundice

Question 4

Mirizzi Syndrome

Answer 4

Extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder.

Presentation: jaundice, cholangitis.

Appearance: Biliary obstruction with dilation of biliary ducts to the CHD is seen with acute or chronic cholecystitis.

Question 5

Hemobilia

Answer 5

Blood in the biliary tree.

Clinical presentation: melaena, jaundice, abdominal pain.

Appearance: echogenic material in the bile ducts and dilated gallbladder.

Question 6

Pneumobilia

Answer 6

Gas in the biliary tree.

Liver will have a striped appearance due to gas causing artifacts.

Question 7

Acute cholangitis

Answer 7

Acute bacterial infection of the biliary tree. Gram neg bac

Clinical presentation: RUQ pain, fever, jaundice.

US appearance: thickening of bile duct walls, calculi, debris or pus

Question 8

Cholangiocarcinoma

Answer 8

Malignant epithelial tumours arising from the biliary tree excluding the gallbladder or ampulla of Vater. Poor prognosis.

Painless jaundice

Appearance
Mass forming intrahepatic; homogenous mass of intermediate echogenicity with a peripheral hypoechoic halo of compressed liver parenchyma.

Periductal infiltrating intrahepatic: tumours typically are associated with altered calibre bile duct (narrowed or dilated) without a well-defined mass.

Intraductal: tumours are characterised by alterations in duct calibre, usually duct ectasia with or without a visible mass. If a polypoid mass is seen, it is usually hyperechoic compared to surrounding liver

Question 9

Biliary Sludge

Answer 9

A mixture of particulate matter and bile that occurs when solutes in bile precipitate.

Risk factors; rapid weight loss, pregnant, prolonged fasting

Appearance: amorphous, low level echoes within Gb

Question 10

Acute Cholecystitis

Answer 10

Acute inflammation of the gallbladder. Primary complication of cholelithiasis.

Presentation: RUQ pain that can radiate to the right shoulder.

Presentation: GB thickening > 3mm, sonographic murphy sign, gallstones, pericholecystic fluid collections, impacted stone in cystic duct or gallbladder neck ‘

Question 11

Gangrenous cholecystitis

Answer 11

When acute cholecystitis is prolonged, gallbladder may undergo necrosis.

US appearance; nonlayering bands of echogenic tissue within the lumen (sloughed membranes and blood). Irregular GB wall

Question 12

Perforated Gallbladder

Answer 12

Complication of acute cholecystitis. Pericholecystic fluid collection with layering of GB wall.

Question 13

Torsion of gb

Answer 13

Distended and inflamed GB lying in a horizontal position with long axis oriented in a left to right direction.

Question 14

Chronic Cholecystitis

Answer 14

Mere presence of gallstones, patients usually asymptomatic and have mild disease.

Wall thickening, fibrosis, gallstones

Question 15

Xanthogranulomatous cholecystitis

Answer 15

Collection of lipid- laden macrophages occur within grayish yellow nodules or streaks in the gallbladder wall.
Hypoechoic nodules or bands in thickened wall

Question 16

Porcelain gallbladder

Answer 16

Calcification of the gallbladder wall.

Hyperechoic semilunar line with dense posterior acoustic shadowing. Mild calcification appears as a echogenic line with variable degrees of posterior acoustic shadowing.

Question 17

Adenomyomatosis

Answer 17

Thickening of the gallbladder wall with internal cystic spaces.

Appearance: tiny echogenic foci that create comet tail artifact

Question 18

Cholesterol polyps

Answer 18

Usually 2-10mm, multiple ovoid, nonshadowing lesions attached to the gb wall.

Question 19

Adenomas

Answer 19

True benign neoplasms of the gallbladder. Represent less than 5% of gallbladder polyps.

Usually pedunculated, homogenously hyperechoic but more heterogenous as they increase in size. Sessile, polypoid lesion. Wall thickening next to adenoma could mean malignancy.

Question 20

Primary gallbladder adenocaricnomas

Answer 20

Polypoid mass, hyper echoic, broad-based polypoid lesions

Question 21

Gallbladder carcinoma

Answer 21

More common in females.
Immobile stone that is engrossed by the tumour, venous flow. Irregular wall with loss of normal layers, larger than 1cm, immobile.