Biliary Tract Flashcards

(135 cards)

1
Q

____ converges to form the RT and LT hepatic duct?

A

Intrahepatic Bile Duct

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2
Q

The RT and LT hepatic ducts join to form the _____

A

Common Hepatic Duct (CHD)

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3
Q

Where is the GB located?

A

Inferior end of Main lobar fissure

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4
Q

The GB neck tapers to form the ___ ?

A

Cystic duct

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5
Q

The cystic duct joins with what?

A

CHD

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6
Q

What Cystic duct and the CHD form the ___ ?

A

CBD

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7
Q

What CBD and the main panc duct form the ___?

A

Ampulla of vater

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8
Q

What is another name for the pancreatic duct?

A

Duct of Wirsung

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9
Q

What does the Portal triad consist of ?

A

MPV, CHD, PHA.

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10
Q

What do sonographers refer to the portal triad as?

A

Mickey mouse

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11
Q

What supplies the GB?

A

Cystic artery

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12
Q

Where does the cystic artery branch from?

A

RHA

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13
Q

What is the GB divided into?

A

Neck, Body, Fundus.

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14
Q

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

A

Valve of Heister’s

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15
Q

What is an ABNL sacculation (diverticulum) of the neck of the GB?

A

Hartmann’s pouch

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16
Q

Where is the phrygian cap located?

A

A fold between the body and fundus of the GB

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17
Q

Where is a junctional fold in the GB?

A

Between the body and the neck (infundibulum) of the GB

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18
Q

The GB passes posterior to the ___ and ___ and then joins the main ___ at the ___.

A

Duodenum and Panc Head
Panc duct at the ampulla of vater

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19
Q

Where does the Ampilla of vater empties through and is what is it controlled by?

A

Duodenal papilla
Sphincter of Oddi

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20
Q

What is a NL wall thickness?

A

<3mm

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21
Q

What can cause GB wall thickening?

A

Cholecystitis
Hypoalbuminemia
Ascities
Hepatitis
CHF
Pancreatitis

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22
Q

What are the 3 types of jaundice?

A

Pre hepatic, Hepatic, Post Hepatic

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23
Q

What is Pre-Hepaic jaundice caused by?

A

Excessive red cell breakdown

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24
Q

What happens if the liver excessively breaks down red cells?

A

The liver becomes overwhelmed and the liver cant conjugate bilirubin = unconjugated hyperbilirubinemia

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25
What is Hepatic jaundice caused by?
There is a dysfunction in the liver itself. The liver cant conjugate bilirubin
26
What is Post-Hepatic jaundice?
Obstruction of the biliary tree
27
What does an obstruction in the biliary tree cause? - what does that result in?
Conjugated hyperbilirubinemia - pale stool and dark urine
28
What are examples of biliary obstruction?
Choledocholithiasis Choledochal cyst Cholangiocarcinoma Biliary atresia Panc carcinoma GB carcinoma Carolis dz Mirizzi syndrome
29
What is calcium bilirubinate granules and cholesterol crystals?
Sludge
30
What is non shadowing, echogenic material which layers shift with patient position?
Sludge
31
Sludge is associated with what ?
Biliary stasis
32
What is sludge is secondary associated to?
Cholecystitis Cystic duct obst. Prolonged fasting Parenteral nutrition (intravenous feeding) Hemolysis
33
What does long term parenteral nutrition (TPN) cause ?
GB stasis-> sludge, milk of calcium or stones
34
What is tumefactive sludge?
Thick sludge that appears as an intraluminal GB mass
35
What is cholelithiasis?
GB stone
36
What is a GB filled with stones and may be seen as a strong shadow in the RUQ?
WES- wall echo shadow or Double arc
37
What is Acute cholecystitis?
Inflammation of the GB due to obst of the cystic duct
38
What is the murphy's sign?
Tenderness d/t transducer pressure over GB area
39
What are complications of acute cholecystitis?
Empyema Gangrenous cholecystitis Perforation Pericholecystic abscess
40
What is chronic cholecystitis?
Reoccurring symptoms of biliary colic d/t multiple episodes of acute cholecystitis
41
what is the difference sonographicly of an acute vs chronic cholecystitis?
Does not appear different
42
What is emphysematous cholecystitis ?
Acute cholecystitis d/t GB wall ischemia and infection
43
Emphysematous cholecystitis occurs more commonly in what kind of patients?
Diabetic patients
44
What is gas produced by in emphysematous cholecystitis?
Anerobic bacteria (clostridium E. coil)
45
What does gas look like in the GB?
Comet tail or ring down artifact
46
What is referred to as the champagne sign?
Gas bubbles to the nondependent wall of the GB
47
What does gangrenous cholecystitis result in?
Pneumoperitoneum peritonitis and sepsis
48
What causes gas in the biliary system?
Emphysematous cholecystitis GB fistula Choledochojejunostomy Sphincter of Odii papilotomy ERCP
49
What is a choledochojejunostomy?
Creating an anastomosis of the CBD to the jejunum to relieve biliary obst.
50
What is empyema of the GB?
The GB fills with purulent material (pus)
51
GB perforation is a ____ and ____ complication of acute cholecystitis
Rare Life threating
52
What are complications of a perforated GB?
Peritonitis Pericholecystitis Biliary fistula
53
What is acalculous cholecystitis
Acute cholecystitis without gallstones
54
Sonographic findings: in the GB you see wall thickening, Murphy sign, and pericholecystic fluid
Acalculous cholecystitis
55
What is Milk of calcium bile (limy bile)
Sludge like material with high concentration of calcium
56
What is milk of calcium bile associated with?
Chronic cholecystitis and GB obst. of the cystic duct
57
What is a porcelain GB?
Calcification of the GB wall
58
What is Porcelain GB associated with?
Chronic Cholecystitis
59
A porcelain GB is linked with what?
Cancer
60
What is a hydrops of the GB? - what is another name for this?
Overdistended GB Mucocele of the GB
61
What is the measurement for a hydropic GB?
>5cm in Trans
62
What is hydropic GB associated with ?
Kawasaki dz Acute febrile illness-> multiorgan vasculitis
63
What measurement is unlikely to be cancerous in a GB polyp?
<10mm
64
What measurement is likely to be cancerous in a GB polyp?
>10mm
65
What is the malignancy rate for a GB poylp?
Between 37% - 88%
66
What is cholesterolosis?
Lipis are deposited in the GB wall
67
Cholesterolosis can sonographicly look like what?
Polpys
68
What is another name for cholesterolosis?
Strawberry GB
69
What are the clinical symptoms of cholesterolosis
Usually silent but can cause colicky ABD pain
70
What is the survival rate of GB carcinoma? - how is it found?
5year less than 5% usually diagnosed post cholecystectomy. <50% preoperatively
71
What is adenomyomatosis?
Hyperplastic changes in the GB wall causing overgrowth of the mucosa
72
Sonographic finding: GB: hyperechoic foci with thickened GB wall (comet tail artifact)
Adenomyomatosis
73
Where are the majority of biliary Obst. located?
Distal CBD
74
What are the most common reasons for Biliary Obst?
GB and Carcinoma of the Panc head
75
What is the NL, equivocal, and Dilated measurements for the CBD?
NL <5 mm Equivocal 6 to 7mm Dilated >8 mm
76
What is the CBD measurement rule with age?
1 mm per decade Increases with age 10mm upper limites
77
What is the normal measurement for a post cholecystectomy patient?
Up to 10mm
78
Wha is the parallel channel sign or shotgun sign of the liver?
Dilated intrahepatic ducts
79
What is cholecystokinin ?
Hormone that is released into the blood by the ingestion of fatty foods -> causes the GB to contract
80
With a fatty meal what is a negative and positive sign of the duct?
Neg- duct unchange or decreases Post- duct increases
81
Where is a distal CBD Obst?
Outside usually a stone it includes the GB
82
Where is a common hepatic Obst?
Only the common Hepatic ducts and intrahepatic ducts with dilate. GB will be contracted
83
Where is a Obst at the Junc Hepatic ducts?
At the junc of the RT and LT hepatic ducts GB will be contracted
84
What is choledocholithiasis ?
Gallstones in the bile ducts
85
What are symptoms of choledocholithiasis?
Biliary colic (RUQ pain) and jaundice
86
What lab values are increased with choledocholithiasis?
ALP, Conjugated bilirubin, GGT
87
What is Mirizzi syndrome?
Extrahepatic biliary Obst. from and impacted stone in the cystic duct causing extrinsic mechanical compression of the CHD
88
Mirizzi syndrome is associated with what findings?
Intrahepatic duct dilatation, cystic duct stone, curved seg stenosis of CHD, Cholecystocholedochal fistula
89
What is Cholangiocarcinoma?
Bile duct adenocarcinomas
90
Where is Cholangiocarcinoma usually found?
Extrahepatic bile ducts (CHD or CBD)
91
What is Klatskin tumor? - where is it located?
Cholangiocarcinoma hepatic hilum (RT and LT intrahepatic duct) but not extrahepatic biliary dilation
92
What is Biliary ascariasis ? - what can it block?
Parasitic roundworm Ascaris Lumbricoides ampulla vater or main panc duct
93
Where is Ascariasis commonly encountered?
South East Asian countries
94
What is cholangitis
Inflammation of the biliary tree.
95
What is the classical triad of cholangitis?
RUQ pain, Fever, and Jaundice
96
What are the types of cholangitis?
Acute bacterial cholangitis AIDS cholangitis Recurrent pyogenic cholangitis Sclerosing cholangitis
97
What is the most common cause of cholangitis?
Choedocholithiasis
98
What lab work is increased with cholangitis?
COnjugated bilirubin ALP GGT Amylase and Lipase White blood cells (leukocytosis)
99
When is biliary atresia suspected?
Jaundice (hyperbilirubinemia) last longer than 14 days
100
What ducts arent affected with biliary atresia?
Absence of extrahepatic bile ducts (CBD and CHD)
101
What is biliary atresia associated with sonographicaly?
Triangular cord sign
102
What is the triangular cord sign?
Echogenic triangular structure anterior to the PV
103
Polyspenia **, absent IVC, sinus inversus/ambiguous, cardiac anomalies (ASD/VSD) is associated with what?
Biliary Atresia
104
What is the treatment for Biliary Atresia?
Kasai portoenterostomy (KPE) If done within 90 days of life.
105
What is Pneumobilia?
Air in the biliary tract
106
Pneumobilia is associated with what?
ERCP ( endosopic retrograde cholangiopancreatogram)
107
What causes pneumobilia?
ERCP Sphincter of Oddi papillotomy CHoledochojejunostomy GB fistula Emphysematous cholecystitis
108
What causes choledochal cyst?
Congenital bile duct cystic dilation of the ectrahepatic ducts
109
Sonographic findings Bile duct has two cystic structure in the RUQ (GB and dilated CBD) intrahepatic bile duct dilatation
Chholedochal cyst
110
Where is choledochal cyst more prevent in?
Asia -before the age 10.
111
What is Caroli DZ/ Caroli syndrome?
Congenital anomaly of the intrahepatic ducts that have multi segment dilation
112
How do you get caroli dz/syndrome? - associated with?
Generally inherited - Congenital fibrosis, Auto Recessive Poly Kid dz, Portal HTN
113
Sonographic findings: in the bile ducts you see multi cystic structures from the porta hepatis to bile ducts. May see sludge and calculi in the ectatic ducts that can cause acoustic shadowing
Caroli DZ/syndrome
114
Pancreatic adenocarcinoma can cause what to the bile duct and GB?
Obst. of the biliary tree Ciurvoiser GB
115
What is the double duct sign? - casue
Dilation of the CBD, Duct of wursung. Panc carcinoma
116
What is primary Sclerosing Cholangitis (PSC)
Inflammation and fibrosis of the intra and extra hepatic bile ducts
117
PSC can lead to __ of the liver?
Liver TX
118
What lab vaules are incresed with PSC?
ALP, GGT, ALT/AST, Conjugated
119
Sonogrpahic findings: The bile duct walls are thick and the PT has Cirrhosis?
PSC
120
What is Primary Biliary Cholangitis (PBC)?
Autoimmune disorder resulting in cholestasis due to destruction of the small intrahepatic ducts leading to cirrhosis
121
what lab values are increased with PBC?
ALT, AST, APLP, GGT, AMAs
122
What is done to rule out blockage of the bile ducts?
Ultrasound
123
What is the end product of hemoglobin breakdown?
Bilirubin
124
What is total bilirubin?
Conjugated + unconjugated bilirubin
125
What is conjugated bilirubin?
Process of removing protein (albumin) from unconjugated bilirubin making it soluble.
126
What is important for bilirubin disposal?
Conjugation
127
What is unconjugated hyperbilirubinemia resulted from?
Impaired hepatic bilirubin uptake Impaired conjugation bilirubin Increase bilirubin production
128
What are is Impaired hepatic bilirubin?
CHF, liver varices, TIPS, drugs, Contrast agents
129
What is Impaired conjugation bilirubin
Gilbert syndrome Crigler-Najjae syndrome type I and II
130
What is Increase bilirubin production?
Hemolysis/ ineffective erythropoiesis
131
Do the kidneys filter conjugated or unconjugated bilirubin?
Conjugated NOT unconjugated bc its bound to albumin
132
What does conjugated Hyperbilirubinemia result from?
Direct bile outflow
133
What is Alkaline Phosphate ALP
An enzyme that is concentrated in the bile ducts (also bone, liver, placenta)
134
ALP increases with what pathology?
Bile duct obst. ANY BILE OBST. (bone growth and pregnancy)
135