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Abdominal Scanning > Biliary Tree > Flashcards

Biliary Tree Flashcards

1
Q

The GB and cystic duct form from the cranial/caudal portion of the bud on the fore/mid/hindgut in the 4th or 5th week of life.

A

caudal, fore

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2
Q

T/F? Agenesis of the GB is a serious birth defect that needs immediate treatment.

A

False.

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3
Q

Duplication of the GB often occurs with the ___and may be diagnosed prenatally.

A

cystic duct

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4
Q

Bile is a…

A

digestive liquid produced by the liver.

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5
Q

When bile is stored in the GB it becomes more ___ and therefore more ___.

A

concentrated, potent

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6
Q

The ingestion of food casuses the release of a hormone called…

A

cholecystokinin (CKK)

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7
Q

CKK signals the relaxation of the ___ and the contraction of the ___ which squirts the bile into the small intestine.

A

sphincter of Oddi (the valve at the end of the CBD); GB

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8
Q

___ form when bile salts and cholesterol get out of balance in the bile.

A

Gallstones

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9
Q

The two major functions of bile in the body are…

A

1) to break down fats

2) to remove toxins from the liver

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10
Q

The GB derives its blood supply from the ___ artery which arises from the ___ artery.

A

cystic, right hepatic

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11
Q

T/F? The cystic vein drains directly into the portal vein.

A

True.

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12
Q

What are the three parts of the GB?

A

neck, body, and fundus

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13
Q

This area of the neck is a common location for impaction of gallstones.

A

Hartmann’s pouch aka infundibulum aka that angulated portion of the neck

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14
Q

When the GB fundus folds onto the body, it’s known as a…

A

phrygian cap.

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15
Q

When the GB has two or more compartments divided by a thin septa, it’s known as a…

A

septate GB.

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16
Q

When the GB has a thick septa separating the components, it’s known as a…

A

hourglass GB.

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17
Q

The GB neck tapers to form the ___ duct which joins with the ___ duct to form the ___ duct.

A

cystic, common hepatic, common bile

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18
Q

The ___ duct and the ___ duct join to form the ampulla of vater.

A

common bile, main pancreatic

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19
Q

These valves are small mucsal folds and control the bile flow in the cystic duct.

A

spiral valves of heister

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20
Q

GB’s normal size is less than…

A

4 cm trans, 10 cm sag

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21
Q

GB’s normal wall thickness is less than…

A

3 mm.

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22
Q

Because food consumption stimulates the GB to contract, a GB exam should be performed after…

A

a minimum of 6 hrs fasting.

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23
Q

The proximal portion of the CBD is ___ to the proper hepatic artery and ___ to the main portal vein.

A

lateral, anterior

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24
Q

The common risk factors for gallstones are…

A

5 F’s:

  • forty something
  • female
  • fat
  • fertile
  • fair-skinned
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25
Q

Recurrent episodes of abd pain are called…

A

biliary colic.

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26
Q

What do the letters of the ‘WES’ sign stand for?

A

Wall
Echo
Shadowing

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27
Q

This is the presence of a gallstone in the CBD.

A

Choledocholithiasis

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28
Q

This is a rare condition in which the GB becomes filled with a pasty semi-solid substance made mostly of calcium carbonate.

A

Milk of calcium bile aka limey bile

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29
Q

This is a a residue of particles that remain in the GB after the bile is ejected which can solidify, forming gallstones.

A

Sludge aka biliary sand aka microlithiasis

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30
Q

The common risk factors for GB slude are…

A 
pregnancy 
rapid weight loss
prolonged fasting
critical illness
bone marrow transplant
biliary stasis
cystic duct obstruction
cholecystitis
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31
Q

Sonographically, this appears as an amorphous material in the lumen of the GB with low level echoes in the dependent position with no shadowing.

A

sludge

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32
Q

Sonographically, this appears as a highly echogenic material in the GB lumen with posterior acoustic shadowing.

A

Milke of calcium bile

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33
Q

Sonographically, this appears as a mobile echogenic foci with shadowing in the GB lumen.

A

gallstones

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34
Q

Sludge that moves but doesn’t shadow and mimics polypoid tumors is called…

A

tumefactive sludge aka ‘sludge balls’

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35
Q

When sludge has the same echotexture of the liver and camouflages the GB it’s referred to as…

A

the ‘hepatization’ of the GB.

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36
Q

This is a tumor or tumor-like projection arising from the GB mucosa.

A

GB polyp

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37
Q

Sonographically, this appears as a non-mobile, non-shadowing echogenic foci within the GB lumen.

A

GB polyp

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38
Q

This is an impaction of a stone in the cystic duct or the GB neck, associated with RUQ pain, fever, and leukocytosis.

A

Acute cholecystitis

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39
Q

Sonographically, this appears as a distended GB with a thickened hyperemic wall, stones in the lumen or the duct, fluid collections, and a positive Murphy’s sign.

A

Acute cholecystitis

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40
Q

Amylase elevation suggests…

A

obstruction at the level of the ampulla of vater.

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41
Q

This is when the GB wall necroses due to decreased blood supply.

A

Gangrenous cholecystitis

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42
Q

Sonographically, this appears as a GB with wall striations, intraluminal membranes, and pericholecystic fluid.

A

gangrenous cholecystitis

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43
Q

This is when GB wall ischemia and infections lead to acute cholecystitis.

A

emphysematous cholecystitis (occurs more commonly in diabetic men)

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44
Q

Sonographically, this appears as a comet tail or reverberation artifact due to the presence of gas within the GB lumen.

A

emphysematous cholecystitis

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45
Q

This is when the GB contains purulent material due to bacteria-containing bile, initiated with obstruction of the cystic duct.

A

empyema

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46
Q

Sonographically, this appears as atypical bile echoes within the GB of patients with RUQ pain, fever, and leukocytosis.

A

empyema

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47
Q

Sonographically, this appears as a localized fluid collection in the GB fossa.

A

GB perforation

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48
Q

This is acute cholecystitis without the presence of gallstones.

A

acalculous cholecystitis

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49
Q

Prolonged use of TPN, abd surgery, trauma, severe burns, sepsis, and AIDS are associated with…

A

acalculous cholecystitis

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50
Q

Sonographically, this appears as a massively distended and inflamed GB lying in an unusual horizontal position.

A

Torsion (volvulus) of the GB

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51
Q

This presents as acute cholecystitis requiring emergency surgery, often seen in elderly females.

A

torsion of the GB

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52
Q

This is characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis.

A

chronic cholecystitis

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53
Q

Sonographically, this appears the same as acute cholecystitis, but a thick-walled fibrotic contracted GB with sludge/stone in the cystic duct may be present.

A

chronic cholecystitis

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54
Q

This is an unusual variant of chronic cholecystits that resembles carcinoma of the GB.

A

xanthogranulomatous cholecystitis

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55
Q

Sonographically, this appears as a thickened irregular GB with extensions of inflammation to adjacent organs and hypoechoic intramural nodules.

A

xanthogranulomatous cholecystitis

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56
Q

T/F? GB wall thickness is > 3 mm and the most common cause is cholecystitis.

A

true

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57
Q

T/F? Once the GB is removed, bile is retained in the bile ducts and is not free to flow into the duodenum during fasting and digestive phases.

A

false, post-GB removal the bile flows freely.

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58
Q

T/F? Dilation of the extrahepatic bile duct occurs after GB removal.

A

true

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59
Q

This is a calcification of the GB wall.

A

porcelain GB

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60
Q

Porcelain GB occurs in association with gallstone ___ and may represent some form of ___ cholecystitis.

A

disease, chronic

61
Q

What determines the sonographic appearance of porcelain GB?

A

the degree and pattern of calcification

62
Q

When the entire GB wall is thickly calcified, a ___echoic ___lunar line with dense ___ is noted.

A

hyper, semi, posterior acoustic shadowing

63
Q

When the GB wall is only mildly calcified, an ___ line with variable degrees of ___ is observed.

A

echogenic, posterior acoustic shadowing

64
Q

In a porcelain GB, the luminal contents may be visible with…

A

interrupted clumps of calcium appearing as echogenic foci w/ posterior shadowing.

65
Q

Why is the WES sign absent in a porcelain GB?

A

Because the calcification occur in the GB wall.

66
Q

This is a benign condition in which diverticula within the GB wall accumulate stones or sludge within them.

A

adenomyomatosis

67
Q

Adenomyomatosis is also known as…

A

rokitansky-aschoff sinuses.

68
Q

T/F? Adenomyomatosis can be focal or diffuse.

A

true

69
Q

Sonographically, this appears as tiny echogenic foci in the GB wall that create comet-tail, ringdown, or twinkling artifacts.

A

adenomyomatosis

70
Q

If an echogenic foci in the GB wall does NOT create an ___ or DOES have internal ___ further investigation in needed to rule out ___.

A

artifact, vasularity, neoplasm

71
Q

What are the different types of polypoid masses in the GB?

A
  • cholesterol polyps (50-60%)
  • inflammatory polyps (5-10%)
  • adenoma (<5%)
  • focal adenomyomatosis
  • adenocarcinoma
  • metastases (esp melanoma)
72
Q

Differentiation of benign and malignant GB polyps is very important b/c the former are ___ and the latter require ___.

A

very common; early intervention to improve outcome

73
Q

What are the most frequently used criteria for GB polyps being benign?

A

multiplicity and size less than 10 mm

74
Q

Malignancy has been documented in 37-88% of resected GB polyps that were…

A

10 mm or more.

75
Q

Besides size, how else might you tell if a GB polyp was malignant?

A
  • older than 60
  • single lesion
  • gallstone disease
  • rapid change in size
  • sessile morphology (no stalk)
76
Q

Approximately half of all GB polyps are…

A

cholesterol polyps.

77
Q

Cholesterol polyps represent the ___ form of GB cholesterolosis, a common non-neoplastic condition.

A

focal

78
Q

Cholesterolosis results in the ___ of lipids in the GB ___.

A

accumulation, wall

79
Q

How do you tell a gallstone from a GB polyp?

A

Polyps don’t roll and don’t produce posterior shadowing.

80
Q

If the focal form of cholesterolosis is the polyp, what is the diffuse form called?

A

Strawberry GB

81
Q

T/F? Cholesterolosis is usually asymptomatic or presents with colicky abdominal pain.

A

True.

82
Q

Sonographically, this appears as tiny echogenic foci in the GB lumen (but without comet tail reverberation).

A

Cholesterolosis

83
Q

The two most common lesions that cause biliary obstruction are…

A

gallstones and carcinoma of the pancreas head.

84
Q

T/F? AFP and bilirubin are typically elevated/associated with biliary obstruction.

A

False. Serum alk phos and bilirubin.

85
Q

Obstruction of the distal CBD results in progressive dilation of the…

A

intra- and extrahepatic biliary tree.

86
Q

Besides gallstones and pancreatic head cancer, what else could cause a biliary obstruction?

A 
choledocholithiasis
pancreatic carcinoma
cholangiocarcinoma
cholangitis
mirizzi syndrome
choledochol cyst
GB carcinoma
87
Q

The ‘parallel channel’, ‘shotgun’, ‘star-shaped’ sign is indicative of what condition?

A

Dilated intrahepatic ducts

88
Q

Sonographically, these appear as irregular tortuous ducts in the liver that create lots of posterior acoustic enhancement.

A

dilated intrahepatic ducts

89
Q

What happens when the obstruction is in the distal CBD?

A

The entire system including the GB distends.

90
Q

What happens when the obstruction is in the CHD?

A

The proximal ducts distend, and the GB contracts.

91
Q

What happens when the obstruction is in the right and left hepatic ducts?

A

The intrahepatic ducts dilate.

92
Q

Here’s a list of some biliary tract abnormalities…

A 
choledochal cysts
caroli's disease
mirizzi syndrome
hemobilia
pneumobilia
acute (bacterial) cholangitis
recurrent pyogenic cholangitis
ascariasis
HIV cholangiopathy
primary sclerosing cholangitis
cholangiocarcinoma
metastases
93
Q

This is a congenital bile duct abnormality that consists of cystic dilation of the intra or extra hepatic bile ducts and is classified into five groups.

A

choledochal cysts

94
Q

Which type of choledochal cyst is the most common, a fusiform dilation of the CBD resulting in a long channel between distal CBD and MPV.

A

Type I

95
Q

Which type of choledochal cyst is confined to the intraduodenal portion of the CBD outside the liver, called ‘choledochoceles’?

A

Type III

96
Q

Which type of choledochal cyst presents with multiple intra and extra hepatic biliary dilations?

A

Type IVa

97
Q

Which type of choledochal cyst presents with multiple dilations ONLY in the extra hepatic ducts?

A

Type IVb

98
Q

Which type of choledochal cyst is called Caroli’s disease?

A

Type V

99
Q

Sonographically, this appears as a cystic structure in the bile duct which may contain internal sludge, stones, or even solid neoplasm.

A

choledochal cyst

100
Q

Because of the risk of cholangiocarcinoma with all choledochal cysts…

A

surgical resection is advocated

101
Q

ERCP is necessary to ensure that ___ especially in the case of Type I choledochal cysts.

A

the dilation isn’t the result of a distal neoplasm

102
Q

This is a rare congenital anomaly of the biliary tract characterized by multi-focal segmental dilations of the INTRAhepatic bile ducts.

A

Caroli’s disease

103
Q

Sonographically, this appears as multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts. Sludge and calculi accumulate in the ectatic ducts resulting in posterior acoustic shadowing.

A

Caroli’s disease

104
Q

This condition presents with jaundice, pain, and fever resulting from an impacted stone in the cystic duct that compresses the CHD.

A

Mirizzi syndrome

105
Q

This condition is characterized by a blood clot in the biliary tree.

A

hemobilia

106
Q

This condition results from previous biliary intervention and is characterized by air in the biliary tree.

A

pneumobilia

107
Q

Sonographically, this appears as intrahepatic linear echogenic regions that produce dirty shadowing and reverberation artifacts.

A

pneumobilia

108
Q

Pneumobilia is best diagnosed by seeing the air bubbles move within the bile ducts. This phenomena can be produced by…

A

changing the patient’s position.

109
Q

This condition presents with leukocytosis, elevated alkaline phosphatase and bilirubin, and Charcot’s triad (fever, ruq pain, jaundice).

A

acute (bacterial) cholangitis

110
Q

What is an essential component of bacterial cholangitis along with CBD stones?

A

antecedent (precursor) biliary obstruction

111
Q

What kind of bile is most commonly affected by acute cholangitis?

A

bile infected by gram-negative enteric bacteria, as shown by blood cultures

112
Q

Sonographically, this appears as a dialation of the biliary tree, choledocholithiasis and possibly sludge, bile duct wall thickening, and hepatic abscesses.

A

acute (bacterial) cholangitis

113
Q

This condition is an inflammation process affecting the biliary tree in the advanced stages of HIV infection.

A

HIV cholangiopathy aka AIDS cholangitis

114
Q

Patients with this condition present with severe RUQ or epigastic pain, markedly elevated alk phos but NORMAL bilirubin levels.

A

HIV cholangiopathy aka AIDS cholangitis

115
Q

Sonographically, this appears as bile duct wall thickening, intra & extra hepatic focal structures and dilations, CBD dilations, and diffuse GB wall thickening.

A

HIV cholangiopathy aka AIDS cholangitis

116
Q

This condition is a chronic disease process that affects the entire bliary tree, frequently seen in middle aged men, particularly if they have concomitant inflammatory bowel disease, usually ulcerative colitis.

A

primary sclerosing cholangitis

117
Q

Sonographically, this appears as irregular circumferential bile duct wall thickening of varying degrees, encroaching on and narrowing the lumen, with focal strictures and dilations of the bile ducts.

A

primary sclerosing cholangitis

118
Q

This develops in 7-30% of patients with primary sclerosing cholangitis.

A

cholangiocarcinoma

119
Q

T/F? Primary sclerosing cholangitis is not seen in extrahepatic ducts.

A

False, it’s seen in both intra- and extrahepatic ducts.

120
Q

In this condition, roundworms spread by the fecal-oral route that are active in the small bowel may enter the biliary tree through the ampulaa of vater and cause a biliary obstruction.

A

ascariasis

121
Q

Sonographically, this appears as a tube or parallel echogenic line within the bile ducts like a stent or, transversely, as a ‘target’ surrounded by bile ducts.

A

ascariasis

122
Q

This condition is associated with gallstones, chronic gallstone disease, and resultant dysplasia.

A

GB carcinoma

123
Q

Sonographically, this can appear a a mass arising in the GB fossa, obliterating the GB and invading the adjacent liver.

A

GB carcinoma

124
Q

Sonographically, this can appear as a focal or diffuse, markedly abnormal and irregular wall thickening.

A

GB carcinoma

125
Q

Sonographically, this can appear as an intraluminal polypoid mass.

A

GB carcinoma

126
Q

What are the two patterns of GB carcinoma tumor spread?

A

contiguous hepatic spread**(most common)

lympatic spread

127
Q

Contiguous hepatic spread of GB carcinoma is the most common pattern because…

A

the GB wall is thin and so little connective tissue separates it from the liver parenchyma.

128
Q

How does GB carcinoma mimic hilar cholangiocarcinoma?

A

by extending up the cystic duct into the porta hepatis

129
Q

This pattern of GB carcinoma spread may occur even in the absence of invasion of adjacent organs.

A

lympatic spread

130
Q

Where are the first nodes to be affected in the lymphatic spread of GB carcinoma?

A

the hilar region

131
Q

Sonographically, small masses of ___ in the GB fossa may be difficult to appreciate because they blend into the liver.

A

GB carcinoma spread

132
Q

The absence of a normal appearing GB with no history of cholecystectomy should raise suspicion of…

A

GB carcinoma spread

133
Q

Sonographically, this may appear as a polypoid mass in the GB.

A

primary GB adenocarcinoma

134
Q

Sonographically, this appears as multiple hyperechoic broad based polyps.

A

primary GB adenocarcinoma

135
Q

This condition is an uncommon neoplasm that may arise from any portion of the biliary tree.

A

cholangiocarcinoma

136
Q

The two types of cholangiocarcinoma are…

A

intra- and extrahepatic

137
Q

This is the least common (but second most common) primary malignancy of the liver.

A

intrahepatic cholangiocarcinoma

138
Q

Sonographically, this appears as a large hepatic mass, hypovascular, solid with heterogeneous echotexture.

A

intrahepatic cholangiocarcinoma

139
Q

Primary sclerosing cholangitis**(most common) and chronic biliary stasis and inflammation are the risk factors for…

A

intrahepatic cholangiocarcinoma

140
Q

Hilar intrahepatic cholangiocarcinoma is also known as…

A

klatskins.

141
Q

Klatskins staging and tumor growth patterns begin where?

A

in either the right or left bile ducts and extend proximally (into the higher order branches) and distally (into the CHD and contralateral bile ducts).

142
Q

T/F? Klatskin tumors can extend outside of the bile ducts into the adjacent portal vein and arteries.

A

True

143
Q

T/F? Klatskin tumor usually do not metastasize to the liver.

A

False

144
Q

T/F? In klatskins, nodal disease often begins at the porta hepatis.

A

True

145
Q

This condition mimics the different appearances of cholangiocarcinoma and affects both intra and extra hepatic ducts.

A

metastases

146
Q

These sites constitute the majority of primary metastases to the biliary tree.

A

breast, colon, and melanoma

147
Q

This condition is the most common malignant neoplasm that obstructs the biliary tree.

A

pancreatic adenocarcinoma

148
Q

Sonographically, this appears as an enlarged, often palpable, GB in a patient pancreatic head carcinoma. It is associated with jaundice due to obstruction of the CBD.

A

Courvoisier GB

Abdominal Scanning (11 decks)

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