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ABD Boards! > Biliary tract > Flashcards

Biliary tract Flashcards

1
Q

What do the left and right hepatic ducts unite to form?

A

Common Hepatic Duct CHD

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2
Q

Where is the GB located?

A

Inferior end of MLF

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3
Q

GB neck tapers to form the 1) ______ which joins with the 2) _______ to form the 3)_________.

A
  1. cystic duct
  2. CHD
  3. CBD
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4
Q

What do the CBD and Duct of Wirsung join to form?

A

Ampulla of Vater

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5
Q

What is consisted in the portal triad?

A

MPV
CHD
Hepatic Art.

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6
Q

What does the portal triad appear as?

A

“Mickey Mouse” sign

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7
Q

What are the segments are the GB?

A

Neck
Body
Fundus

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8
Q

Where are the Valves of Heister?

A

Spiral fold which controls bile flow in the cystic duct

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9
Q

What is a Hartmann’s pouch?

A

abnormal diverticulum of the neck of the GB

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10
Q

What is a pharygian cap?

A

Fold between body and the fundus of GB

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11
Q

What is a junctional fold?

A

Fold between the body and neck of the GB

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12
Q

What does the CBD pass posterior to?

A

Duodenum and Pancreatic head

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13
Q

What is the Ampulla of Vater controlled by?

A

Sphincter of Oddi

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14
Q

What is the normal GB wall thickness measurement?

A

3 mm

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15
Q

What is the most common cause of GB wall thickening?

A

Cholecystitis

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16
Q

What is sludge composed of?

A

Calcium bilirubinate granules and cholesterol crystals

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17
Q

What does sludge appear as?

A

Nonshadowing, echogenic material which layers and shifts with patients position

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18
Q

What are some sonograph criteria for Cholelithiasis?

A

Mobile
Echogenic
Shadowing

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19
Q

What are gallstones composed of?

A

Cholesterol
Calcium Bilirubinate
Calcium Carbonate

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20
Q

What are the terms used for a GB filled with stones and you see a strong shadow in RUQ?

A
  • Wall-Echo-Shadow (WES sign)

- Double Arc

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21
Q

What is Acute Cholecystitis?

A

GB wall Inflammation due to cystic duct obstruction by a gallstone

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22
Q

What are the signs of acute cholecystitis?

A
  • Gallstones
  • Positive Murphy’s sign
  • Diffuse wall thickening
  • GB dilatation
  • Sludge
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23
Q

Explain what the Murphy’s sign is….

A

Intense point tenderness transducer pressure directly on the GB
90% sensitive and specific

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24
Q

What does a Amylase elevation suggest?

A

Obstruction in Ampulla of Vater

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25
Q

What is Chronic Cholecystitis?

A

Chronic GB disease characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis

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26
Q

What is a Emphysematous GB?

A

Acute cholecystitis due to GB wall ischemia and infection

  • gas produced by aneorbic bacteria
  • Gas found in GB wall (Produce Ring down Artifact or Comet tail)
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27
Q

What is Empyema of the GB?

A

Purulent material within the GB due to bacterial- containing bile associated with acute cholecystitis

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28
Q

What is GB perforation?

A
  • Complication of Acute cholecystitis

- Localized fluid collection in the GB fossa

29
Q

What is Acalculous Cholecystitis?

A

Acute cholecystitis without the presence of Cholelithiasis.

30
Q

What is Milk of Calcium Bile?

A

(Limy Bile)

  • Sludge like material with high concentration of calcium
  • Associated with chronic cholecystitis and GB obstruction in cystic duct
31
Q

What is a Porcelain GB?

A

Calcification of GB wall associated with chronic cholecysitis

32
Q

What is a Hydroptic GB?

A
  • AKA mucocele of the GB

- overdistended GB filled with mucoid or clear watery contents

33
Q

What is the measurement for a hydroptic GB?

A

5 cm

34
Q

What is a hydroptic GB caused by?

A

Chronic cystic duct obstruction

35
Q

Know about GB polyps….

A
  • Less than 10 mm in diameter are less likely to be cancerous
  • Greater than 10 mm and demonstrate growth are most likely to be malignant
36
Q

What is Cholesterolosis?

A

Lipids are deposited in the GB. Can look like polyps can be as large as 1 cm
- “strawberry GB” due to golden yellow lipid deposits against red GB mucosa

37
Q

What is GB carcinoma?

A

Can mimic cholecystitis

  • Intraluminal mass
  • Assymetric wall thickening
  • mass that fills the entire GB
38
Q

What is Adenomymatosis?

A

Hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticulum
- Comet tail artifact (Reverb)

39
Q

What is Rokitansky- Aschoff sinuses? (RAS)

A

Diverticula within the GB wall that accumulates stones and sludge within them

40
Q

What is the most common place to find biliary obstruction?

A

Distal CBD

41
Q

What are the most common lesions?

A

Gallstones and Carcinoma of the Head of Pancreas

42
Q

What labs will be elevated with biliary obstruction?

A
  • Alkaline Phosphatase (ALP)
  • Conjugated Bilirubin
  • Gamma Glutamyl Transpeptidase (GGT)
43
Q

How is the CBD measured?

A

Inner to inner

44
Q

What is the normal measurement of the CBD?

A
  • Normal: < 5 cm
  • Equivocal: 6 to 7 mm
  • Dilated: > 8 mm
45
Q

In a postcholecystectomy patient, what is the normal measurement of the CBD?

A

Measure up to 10 mm

46
Q

What does the “shotgun sign” refer to as?

A

Dilated hepatic ducts adjacent to the portal vein

47
Q

What is a Stellate Confluence?

A

Bile ducts branch in a “star shaped” configuration

48
Q

What is the hormone that is released when you eat?

A

Cholecystokinine

- causes GB to contract with ingestion of fatty foods

49
Q

What is a Choledocholithiasis?

A

Formation or presence of calculi in the bile ducts

- most common cause of extrahepatic obstructive jaundice

50
Q

What is Mirizzi Syndrome?

A

Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the CHD

51
Q

Where does a Cholangiocarcinoma reside?

A

Originate within the extrahepatic bile ducts (CHD or CBD)

52
Q

What is a Klatskin Tumor?

A

Cholangiocarcinoma located at the hepatic hilum (junction of left and right hepatic ducts) resulting in intrahepatic but not extrahepatic dilation

53
Q

What is the most common finding with a Klatskin tumor?

A

Intrahepatic Bile Duct Dilatation

54
Q

What is Cholangitis?

A

Bacterial infection imposed on an obstruction of the biliary tree.

55
Q

What is the most common cause of Cholangitis?

A

Choledocholithiasis

56
Q

What labs will be increases with Cholangitis?

A
  • Bilirubin
  • ALP
  • GGT
  • Amylase
  • Lipase
  • White blood cells
57
Q

What is Biliary Atresia?

A
  • Absence of extrahepatic biles ducts (CHD and CBD)
58
Q

What is the treatment for biliary atresia?

A

Kasai portoenterostomy is most successful treatment of biliary atresia if performed before 90 days of life.
- Liver Transplant also considered

59
Q

What is pneumobilia?

A

Air in the biliary tract

- commonly associated with ERCP (endoscopic retrograde cholangiopancreatogram)

60
Q

What artifact goes with pneumobilia?

A

Comet tail or reverberation

61
Q

What is a choledochal cyst?

A

Bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts

62
Q

What is the most common type of choledochal cysts?

A

Dilatation of the CBD

63
Q

Where is Choledochal cysts more prevelant?

A

Asia

- more than 33% of reported cases from Japan

64
Q

What is Caroli’s Disease?

A
  • Type 5 choledochal cyst
  • Congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts
65
Q

What is the most common cause of malignant neoplasm obstructing the biliary tree?

A

Pancreatic Adenocarcinoma

- causes Courvoisier GB ( enlarged non diseased GB due to obstruction of CBD)

66
Q

What is Primary biliary cirrhosis?

A

Destruction of the small intrahepatic bile ducts leading to end stage liver disease
- diagnosis confirmed by liver biopsy

67
Q

What labs will be elevated with Biliary cirrhosis?

A
  • ALT/AST
  • ALP
  • GGT
  • AMAs
68
Q

What is Bilirubin?

A

End product of hemoglobin breakdown

69
Q

More labs…

A

Page 62 ESP

ABD Boards! (12 decks)

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