biliary tree Flashcards
Which labs are mildly to moderately elevated with biliary obstruction
Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)
which labs are elevated with obstructive jaundice
Lactic dehydrogenase (LDH)(mildly elevated
Alkaline phosphate (markedly increased)
Direct (conjugated) bilirubin (elevated)
Which labs are elevated in hepatocellular disease and hemolytic anemias
Indirect (unconjugated) bilirubin
3 congenital anomalies
Biliary atresia
Choledochal cysts
Interposition of the gallbladder
Ranges from a total absence of biliary tree to formation of a rudimentary gallbladder and cystic duct
Suspected with persistent neonatal jaundice (infectious causes must be excluded)
BILIARY ATRESIA
Cystic dilation of the entire length of the CHD and CBD with the cystic duct entering the cyst
Caused by:
congenital weakness of the duct wall resulting in the formation of a cystic structure
angulation of the CBD, causing partial obstruction which leads to dilation and cyst formation
CHOLEDOCHAL CYSTS
found in babies and children so what could it be?
intermittent jaundice
colicky pain
possibly a subhepatic mass displacing the stomach
usually diagnosed before 10 years of age
CHOLEDOCHAL CYSTS
what is postprandial
after eating
types of acquired diseases
Biliary sludge
Cholelithiasis
Acute Cholecystitis
Gallbladder neoplasms
Miscellaneous gallbladder pathology
what is CHOLELITHIASIS
just medical term for gallstones
acute Calculous more common in _________ and produces ___________
women
layered appearance of a thickened gallbladder wall, with a hypoechoic region between echogenic lines
acute Acalculous more common in ________
men
74-year-old man with acute acalculous cholecystitis.
LEFT: US at the spot of maximum tenderness shows mural thickening of the gallbladder (arrow) that is completely filled with sludge (asterix) without any stones.
RIGHT: Power-Doppler sonography shows hypervascularity of the gallbladder wall (arrowhead), as a supporting sign of inflammation.
Malignant melanoma is most common __________ to gallbladder
metastases
SONOGRAPHIC FINDINGS
-Calculous and Acalculous are same
-Gallbladder distension greater than 5 cm in transverse diameter
-Wall thickness >2 mm (3mm considered abnormal)
-Irregular wall thickening
-Cholelithiasis
-Sonographic Murphy’s sign
-Halo sign (edema)
-Pericholecystic fluid (?perforation)
-Bizarre gallbladder wall echoes (necrosis)
-Non-shadowing, mobile, intraluminal echoes
-A tense, distended shape
DIFFERENT GALLBLADDER NEOPLASMS
polyps
adenoma
adenomyomatosis
small elevations in the gallbladder lumen. no shadow, non mobile
polyp
flat elevation in wall (usually near gallbladder fundus)
adenoma
hyperplastic change in gallbladder wall. may cause “ring down” artifact from wall
adenomyomatosis
what pathology
sonographically will see a hyperechoic semilunar structure with shadowing or an irregular clump of echoes with shadowing
also associated with a high incidence of gallbladder carcinoma
porcelain gallbladder
what pathology
hyperplastic change in GB wall usually seen in females beyond their 50s
characteristically demonstrate “comet tail”
adenomyomatosis
which pathology
occurs with distal obstruction to the cystic duct due to malignancy
GB will dilate to >10cm then CBD, then intrahepatic ducts
Courvoisier gallbladder
which pathology
shows marked wall thickening with intramural hypoechoic nodules and an intraluminal stone
xanthogranulomatous cholecystitis
air in the biliary tree is called
pneumobilia
collections of bile is called
bilomas
rare complication of untreated acute cholecystitis where a stone in the cystic duct compresses the common bile duct, causing obstruction and jaundice
Mirizzi syndrome
Typically blockage of the cystic duct only impacts the gallbladder and therefore would not cause jaundice…but with this scenario you would have jaundice.
measurement of distal duct
> 6mm
associated with gallstones or pancreatitis possibly obstruction of duct
measurement of distal duct
> 11mm
suggests obstruction by stone or tumor of duct or pancreas
how to diagnose dilated intrahepatic ducts
need to see bold branching of the right hepatic ducts. The ducts will be seen on top of the portal vein in the right lobe
what is ERCP
endoscopic retrograde cholangiopancreatography
