BILIARY TRACT Flashcards by Carissa Levake

the right and left hepatic ducts join to form the _______

CHD

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the GB is located at the _______ end of the main lobar fissure

inferior

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the gallbladder neck tapers to form the _______ which joins with the CHD to form the CBD

cystic duct

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the CBD & the main pancreatic duct (duct of wirsung) join to form the _______

ampulla of vater

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what does the portal triad consist of?

MPV
proper hepatic a
common hepatic duct

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_______ is a spiral fold which controls bile flow in the cystic duct

valve of heister’s

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_______ is an abnormaal sacculation (diverticulum) of the neck of the GB

hartmann’s pouch

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A _______ is a fold between the body & the fundus of the GB

phrygian cap

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A _______ is a fold between the body and the neck (infundibulum) of the GB

junctional fold

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the CBD passes _______ to the 1st part of the duodenum and pancreatic head joining the main pancreatic duct at the ampulla of vater

posterior

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the ampulla of vater empties through the duodenal papilla, controlled by the _______

sphincter of oddi

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what is the sonographic criteria of cholelithiasis

mobile
echogenic
shadowing

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what are gallstones composed of?

cholesterol
calcium bilirubinate
calcium bicarbonate

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A gallbladder filled with stones may be seen as a strong shadow in the RUQ, this is called _______

double arc or WES

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_______ is when there is gallbladder wall thickening due to cystic duct obstruction by a gallstone

acute cholecystitis

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features of acute cholesystitis include:

gallstones
murphy's sign
diffuse wall thickening
gallbladder dilatation
sludge

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_______ is defined as intense point tenderness transducer pressure directly on the GB

murphy’s sign

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_______ elevated suggests obstruction at the level of the ampulla of vater

amylase

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_______ is defined clinically by recurrent symptoms of biliary colic due to multiple episodes of acute cholecystitis

chronic cholecystitis

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_______ is acute cholecystitis due to gallbladder wall ischemia and infection

emphysematous cholecystitis

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emphysematous cholecystitis more commonly occurs in _______

diabetic men

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with gangrenous cholecystitis, perforation is inevitable resulting in _______ & _______

pneumoperitoneum

peritonitits

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the following causes of gas in the biliary system include:

ERCP
sphincter of oddi papilotomy
choledochojejunoscopy
GB fistula
emphysematous choleystitis

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_______ is purulent material within the GB due to bacteria-containing bile associated with acute cholecystitis

empyema of the GB

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empyema of the GB is initiated with _______

obstruction of the cystic duct

_______ is a complication of acute cholecystitis resulting in a localized fluid collection in the GB fossa

GB perforation

peritonitis, pericholecystic absecess, and biliary fistula are complications of _______

GB perforation

_______ is inflammation of the GB without the presence of a gallstone. it is typically a secondary event in critically ill hospitalized patients

acalculous cholecystitis

other causes of GB wall thickening include _______ & _______

increased hypoalbuminemia causing ascites | congestive heart failure

_______ is sludge like material with a high concentration of calcium

milk of calcium bile

_______ is the calcification of the GB wall associated with chronic cholecystitis

prcelain GB

_______ is an overdistended GB filled with mucoid or clear, watery contents

GB hydrops

GB hydrops is aka _______

mucocele of the GB

GB hydrops is typically suggested with an anterior/posterior or transverse dia of greater than _______

5 cm

polyps less than _______ in dia are unlikely to be cancerous and generally don't require treatment

10 mm

_______ are lipids (triglycerides and cholesterol) are deposited in the GB wall

cholesterolosis

cholesterolosis is aka _______

strawberry GB

cholesterolosis may appear similar to adenomyomatosis without _______

reverberation artifact

porcelain GB is associated with _______

GB carcinoma

hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula

adenomyomatosis

diverticula in the GB wall _______ accumulate stones or sludge within them

rokitansky-aschoff sinuses or RAS

adenomyomatosis is associated with a _______ artifact

comet-tail (reverberation)

in the majority of patients, biliary obstruction is due to pathology is the _______

diatal CBD

elevated lab values in patients with biliary obstruction include:

alkaline phosphatase (ALP) conjugated bilirubin gamma glutamyl transpeptidase (GGT)

the CHD is routinely measures at the point where the _______ courses between the portal vn and the biliary duct

right hepatic artery

_______ refer to the dilated hepatic duct adj to the portal vein

parallel channel sign | shotgun sign

biliary ducts are more _______ than the accompanying portal veins

tortuous

bile ducts branch in a _______ configuration

star-shaped

_______ is a hormone that is released into the blood by the ingestion of fatty foods, causing gallbladder contration

cholecystokinin

the formation or presence of calculi in the bile ducts. most common cause of extraheaptic obstructive jaundice

choledocholithiasis

extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct

mirizzi syndrome

bile duct adenocarcinomas typically originate within _______

extrahepatic bile ducts (CHD or CBD)

a _______ tumor is a cholangiocarcinoma located at the hepatic hilum (junction of right and left hepatic duct) resulting in intrahepatic but not extrahepatic biliary dilation

klatskin

the most common predisposing condition of cholangiocarcinoma is _______

primary sclerosing cholangitis

_______ is a bacterial infection superimposed on an obstruction of the biliary tree. bile is usually sterile, although with an obstruction, bacteria gains access to the biliary tree.

cholangitis

most common cause of cholangitis is _______

choledocholithiasis

_______ is suspected when jaundice (hyperbilirubinemia) persists beyond 14 days of age

biliary atresia

_______ is the absence of extrahepatic bile ducts

biliary atresia

biliary atresia is associated with:

polysplenia syndrome absent IVC situs inversus, situs ambiguous cardiac anomalies (ASD, VSD)

surgical drainage with the _______ is the most successful treatment of biliary atresia if performed before 90 days of life

kasai portoenterostomy

_______ is air in the biliary tract

pneumobilia

pneumobilia is commonly associated with _______

ERCP (endoscopic retrograde cholangiopancreatogram)

_______ is a congenital bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts

choledochal cysts

the most common choledochal cyst involves the dilatation of the _______

CBD

choledochal cysts are more prevalent in _______ & symptoms usually occur before age 10.

Asia

_______ is type V choledochal cyst which is a congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts

caroli's disease

caroli's disease is associated with _______, _______, & _______

congenital hepatic fibrosis portal HTN renal tubular ectasia

_______ is the most common cause of malignant neoplasm obstructing the biliary tree

pancreatic adenocarcinoma

_______ is an enlarged, non-diseased GB due to a mechanical obstruction of the CBD

courvoisier GB

pancreatic adenocarcinoma at the head of the pancreas typically cause _______

courvoisier GB

_______ is an inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts. thought to be autoimmune.

primary sclerosing cholangitits

_______ is a chronic progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end stage liver disease

primary biliary cirrhosis

with primary biliary cirrhosis, what lab values are elevated?

aminotransferases (ALT/AST) alkaline phospatase (ALP) gamma glutamyl transpeptidase (GGT) antimitochondrial antibodies

_______ is the end product of hemoglobin breakdown

bilirubin

_______ increases with bile duct obstruction

alkaline phosphatase (ALP)