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Abdominal Sonography > Biliary Tree > Flashcards

Biliary Tree Flashcards

1
Q

List the convergence of the bile ducts.

A

Intrahepatic > right and left hepatic ducts > CHD

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2
Q

Where is the GB located in the liver?

A

Inferior end of the the main lobar fissure

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3
Q

Which ducts make up the ampulla of Vater?

A

CBD and main pancreatic duct ( Duct of Wirsung)

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4
Q

What is the Mickey Mouse sign?

A

The portal triad

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5
Q

What is the spiral fold that controls bile flow in the cystic duct?

A

Valve of Heister’s

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6
Q

What is the abnormal sacculation of the neck of the GB?

A

Hartmann’s pouch

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7
Q

What is the phrygian cap?

A

Fold between the body and the funds of the GB

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8
Q

Where does the CBD pass in the liver?

A

Posterior to the first part of the duodenum and pancreatic head

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9
Q

What controls the ampulla of Vater emptying through the duodenal papilla?

A

Sphincter of Oddi

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10
Q

What are some causes of GB wall thickening?

A 
Hypoalbuminemia
Ascites
Hepatitis
CHF
Pancreatitis
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11
Q

What are pre-hepatic causes of jaundice?

A

Increased bilirubin production (Hemolysis, Ineffective erythropoiesis, Absorption of large amounts of Hb)

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12
Q

What are hepatic causes of jaundice?

A 
Acute liver inflammation
Chronic liver disease
Infiltrative liver disease
Inflammation of bile ducts
Genetic disorders
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13
Q

What are post-hepatic causes of jaundice?

A

Obstruction of the biliary tree

causes pale stool and dark urine

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14
Q

What is GB sludge?

A

Calcium bilirubinate granules and cholesterol

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15
Q

What is GB sludge associated with?

A

Biliary stasis secondary to prolonged fasting, TPN, hemolysis, cystic duct obstruction, cholecystitis.

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16
Q

What are gallstones made of?

A

Cholesterol
Calcium bilirubinate
Calcium carbonate

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17
Q

What is another name for WES?

A

Double Arc

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18
Q

What are complications of acute cholecystitis?

A 
Empyema
Gangrenous cholecystitis
Perforation
Pericholecystic abscess
Bilioenteric fistula
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19
Q

What causes gas in the biliary system?

A 
ERCP
Sphincter of Oddi papillotomy
Choledochojejunostomy
GB fistula
Emphysematous cholecystitis
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20
Q

What is emphysematous cholecystitis?

A

Acute cholecystitis due to GB wall ischemia and infection

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21
Q

What is empyema of the GB?

A

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

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22
Q

What are complications of a GB perforation?

A

Peritonitis
Pericholecystic abscess
Biliary fistula

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23
Q

What is acalculous cholecystitis?

A

Acute cholecystitis without presence of gallstones

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24
Q

What are causes of calculus cholecystitis?

A

Bile stasis
Decreased GB contraction
Infection

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25
What is milk of calcium bile (Limy bile)?
Sludge-like material with high concentration of calcium
26
How does Limy bile appear on US?
Layering of sludge that results in distal acoustic shadowing
27
What is a porcelain GB?
Calcification of the GB wall associated with chronic cholecystitis
28
What is hydrops of the GB?
Mucocele of the GB from an over distended GB filled with mucoid or clear, watery contents
29
What size are noncancerous GB polyps?
<10 mm in diameter
30
What is cholesterolosis of the GB?
Lipids (cholesterol and TGs) deposited in the GB wall
31
What is a "strawberry GB"?
Cholesterolosis from the golden yellow lipid deposits against the red gallbladder mucosa
32
What are US findings of GB CA?
Intraluminal mass Asymmetric wall thickening Mass that fills GB (most common)
33
What is adenomyomatosis?
Hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula
34
What are the diverticula within the GB wall called?
Rokitansky-Aschoff sinuses
35
What causes the majority of biliary obstruction?
Pathology in the distal CBD Gallstones CA of head of pancreas
36
Where is the CHD routinely measured?
Point where the right hepatic artery courses between the portal vein and biliary duct
37
What is the "Parallel channel sign"?
"Shotgun sign" dilated hepatic duct adjacent to the portal vein
38
What vessels are more irregular and tortuous than the portal vein?
Bile ducts
39
How do bile ducts branch?
Stellate confluence - "star-shaped" configuration
40
Why do bile structures produce acoustic enhancement?
They attenuate sound less than blood
41
Which hormone causes gallbladder contraction?
Cholecystokinin
42
What is a negative result of the CBD with a fatty meal?
Unchanged or decreased size
43
Where do biliary tree obstructions occur?
``` Distal CBD (most common) Common hepatic obstruction Obstruction at the junction of the R and L hepatic ducts ```
44
What is choledocholithiasis?
Calculi in bile ducts (most common cause of extra hepatic obstructive jaundice)
45
What are complications of choledocholithiasis?
Biliary cirrhosis Cholangitis Pancreatitis
46
What is Mirizzi Syndrome?
Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing compression of the CHD
47
What are associated findings of Mirizzi Syndrome?
Intrahepatic duct dilatation Cystic duct stone Curved segmental stenosis of CHD Cholecystocholedochal fistula
48
What is cholangiocarcinoma?
Bile duct adenoCA
49
What is cholangiocarcinoma located at the hepatic hilum called?
Klatskin tumor
50
What are some predisposing conditions for cholangiocarcinoma?
``` Primary sclerosing cholangitis (most common) Ulcerative colitis Caroli's disease Choledochal cyst Parasitic infestation Chemical toxins ```
51
How do cholangiocarcinoma patients present?
Jaundice Weight loss Abdominal pain
52
What is cholangitis?
Bacterial infxn superimposed on an obstruction of the biliary tree
53
What are common causes of cholangitis?
Choledocholithiasis ERCP Obstructive tumors
54
What is biliary atresia?
Absence of extrahepatic bile ducts
55
What is biliary atresia associated with?
Polysplenia syndrome Absent IVC Situs inversus Cardiac anomalies
56
How is biliary atresia treated?
Kasai portoenterostomy within 90 days of life - surgical drainage Liver transplant
57
What is pneumobilia?
Air in the biliary tract
58
What are choledochal cysts?
Congenital bile duct anomalies with cystic dilatation of intra or extra hepatic bile ducts - prevalent in Asia
59
What are choledochal cysts associated with?
``` Pancreatitis Cholangitis Hepatic abscesses Cirrhosis Portal HTN CholangioCA ```
60
What is Caroli's disease?
Type V choledochal cyst - congenital anomaly of biliary tract with multifocal segmental dilatation of intrahepatic bile ducts
61
What is Caroli's disease look like on US?
Multiple cystic structures that converge toward the portal hepatic communicating with bile ducts
62
What is the most common cause of malignancy obstructing the biliary tree?
Pancreatic adenoCA
63
What is a Courvoisier GB?
Enlarged, non-diseased GB due to mechanical obstruction of the CBD
64
What is primary sclerosing cholangitis?
Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts
65
What is sclerosing cholangitis associated with?
IBD ERCP Cholangiocarcinoma
66
How does sclerosing cholangitis look on US?
Thickening of the bile duct walls | Findings assoc with cirrhosis
67
What is primary biliary cirrhosis?
Chronic and progressive cholestasis due to obstruction of the small intrahepatic bile ducts leading to end-stage liver disease
68
What is bilirubin?
End product of Hb breakdown | Total bili = conj bili + unconj bili
69
What is the difference between conjugated and unconjugated bilirubin?
Conjugated bili has albumin removed from unconjugated bili that is needed for bilirubin disposal

Abdominal Sonography (12 decks)

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