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Abdo review > Biliary Tree disease > Flashcards

Biliary Tree disease Flashcards

1
Q

Choledochal cysts?

A

Congenital, focal, or diffuse cystic dilation of the biliary tree

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2
Q

Choledochal cysts may be the result of?

A

pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and outpouching of the ductal walls

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3
Q

coledochal cysts risk?

A

Rare
More common in women than in men (4:1), with an increased incidence in infants
Most often seen in East Asia populations
May be associated with gallstones, pancreatitis, or cirrhosis

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4
Q

choledochal cysts s/s?

A

Abdominal mass
Pain
Fever
Jaundice

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5
Q

choledochal cysts diagnosis?

A

Diagnosis may be confirmed with a nuclear medicine hepatobiliary scan

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6
Q

Choledochal Cysts- type 1?

A

fusiform dilation of the common bile duct.
Most common, along with type Iva
Associated with a long common channel (>20 mm) between the distal bile duct and the pancreatic duct

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7
Q

Choledochal Cysts- type 2?

A

cysts are true diverticuli of bile ducts

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8
Q

cholecochal cysts type 3?

A

cysts (choledochoceles) are confind to the intraduodenal portion of the CBD

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9
Q

Choledochal Cysts- type IVa?

A

cysts are intrahepatic and extrahepatic biliary dilations

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10
Q

Choledochal Cysts- type IVb?

A

cysts are confined to the extrahepatic biliary tree

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11
Q

choledochal cysts- type V?

A

cysts have been classified as Caroli’s disease

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12
Q
A

choledochal cyst

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13
Q

Caroli’s Disease?

  • type
  • involves
  • associated with
  • affects
A 
Rare,congenital disease
Type  V
Involves intrahepatic biliary tree
Associated with medullary sponge kidneys
Affects men &women equally
Usually diffuse
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14
Q

Caroli’s Disease complications? (6)

A 
Biliary stasis
Cholangitis 
Stones and sepsis
Hepatic fibrosis
Portal hypertension
At risk for cholangiocarcinoma
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15
Q

what is Caroli’s Disease?

A

Multiple cystic structures in the area of the ductal system converge toward the porta hepatis.
Masses seen as localized or diffusely scattered cysts communicate with the bile ducts.
Differential diagnosis includes polycystic liver disease.
Ducts may show a beaded appearance as they extend into the periphery of the liver.
Ectasia of the extrahepatic and common bile ducts may be present.
Sludge or calculi may reside in the dilated ducts.

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16
Q
A

caroli’s disease

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17
Q

Dilated Biliary Ducts?

A

Generally a duct >6 mm in diameter is considered borderline; >10 mm is dilated.

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18
Q

Most common cause of biliary obstruction?

A

presence of a tumor or thrombus within the ductal system

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19
Q

Obstruction of biliary ductal system is diagnosed by ultrasound when the sonographer finds?

A

the presence of ductal dilation

- This finding is called “too many tubes” or “shotgun” sign when intrahepatic ducts are dilated.

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20
Q

Three primary areas for biliary obstruction?

A

Intrapancreatic
Suprapancreatic
Porta hepatic

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21
Q

Intrapancreatic Obstruction- Three conditions cause the majority of biliary obstruction at the level of the distal duct and cause the extrahepatic duct to be entirely dilated?

A

Pancreatic carcinoma
Choledocholithiasis
Chronic pancreatitis with stricture formation

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22
Q

Suprapancreatic Obstruction?

A

Originates between the pancreas and the porta hepatis
The head of the pancreas, the intrapancreatic duct, and pancreatic duct are normal with ultrasound.
The most common cause for this obstruction is malignancy or adenopathy at this level.

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23
Q

Porta Hepatic Obstruction?

A

This area of obstruction is usually the result of a neoplasm.
In patients with obstruction at the level of the porta hepatis, ultrasound will show intrahepatic ductal dilation and a normal common duct.
Hydrops of the gallbladder may be present.

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24
Q

Cholangiocarcinoma

A

Rare malignancy that originates within the larger bile ducts (usually the common duct or common hepatic duct)

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25
Q

Klatskin tumor?

A

is a specific type of cholangiocarcinoma that can occur at the bifurcation of the common hepatic duct, with involvement of both the central left and right ducts

26
Q

The most suggestive sonographic feature that indicates cholangiocarcinoma is?

A

isolated intrahepatic duct dilation

27
Q

characteristic for a Klatskin tumor?

A

nonunion of the right and left duct

28
Q

Mirizzi syndrome?

A

uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the common hepatic duct

29
Q

mirizzi syndrome presentation?

A

painful jaundice

  • Stones may penetrate into the common hepatic duct or the gut, resulting in a cholecystobiliary or cholecystenteric fistula
30
Q
A

mirizzi syndrome

31
Q

Primary choledocholithiasis?

A

Stones form within ducts related to diseases causing strictures or dilation of bile ducts resulting in stasis

32
Q

causes of Primary choledocholithiasis?

A

Sclerosing cholangitis
Caroli’s disease
Parasitic infections of liver
Chronic hemolytic disease –sickle cell anemia
Prior biliary surgery-enteric anastomosis

33
Q

Secondary choledocholithiasis?

A

Migration of stones from the gallbladder into the CBD

34
Q

Secondary choledocholithiasis symptoms?

A

Patients present to emergency with RUQ/epigastric pain

35
Q

sono signs of Secondary choledocholithiasis?

A

Dilated CBD proximal to stone
Intrahepatic ducts may also be dilated
Large stones shadow ,smaller stones may not shadow
GB distension

36
Q

Majority of stones will be in?

A

distal CBD at the Ampulla of Vater

37
Q

CBD stones D/D?

A

Blood clot-hemobilia
Papillary tumor
Biliary sludge

38
Q

Intrahepatic Bile Duct Stones are seen in patients with?

A

systic fibrosis

39
Q

fistulas are usually the result of?

A

Injury
Surgery
Infection
Inflammation

40
Q

Hemobilia cause?

A
  • Main cause of hemobilia is biliary trauma secondary to percutaneous biliary procedures or liver biopsies
  • cholangitis
  • cholecystits
  • vascular malformations
  • abdominal trauma
  • malignancies
41
Q

hemobilia clinical findings?

A
  • pain
  • bleeding
  • trauma
42
Q

Pneumobilia on u/s?

A

Air within biliary tree appears as bright echogenic linear structures following portal triads
Reverberation ringdown artifact

43
Q

pneumobilia etiology?

A

Previous biliary intervention-iatrogenic

Patient presents with acute abdomen

44
Q

Pneumobilia 3 causes?

A

1-Emphysematous cholecystitis

2-Choledochoduodenal fistula:
- Caused by stone in CBD- inflammation

3-Cholecystoenteric fistula:
- Prolonged acute cholecystitis erodes into an adjacent bowel loop

45
Q

Gallstone ileus?

A

paralysis of nerves
Stones may pass from gallbladder into the bowel by a cholecystoenteric fistula
Frequently involves duodenum or transverse colon
Result of prolonged inflammation of GB

46
Q

Acute Bacterial Cholangitis

A

Antecedent biliary obstruction:

Associated in 85% of cases with CBD stones

47
Q

Acute Bacterial Cholangitis causeS?

A

Stricture due to trauma or surgery
Choledochal cysts
Partially obstructive tumors

48
Q

Acute Bacterial Cholangitis clinical presentation?

A

Classic Charcot’s Triad-
Fever
RUQ pain
Jaundice

49
Q

Parasitic infections-flukes–Fascioliasis

A

Larvae travel through bowel wall -peritoneal cavity-liver capsule into liver parenchyma
Matures and produces eggs in the biliary tree

Symptoms relate to biliary obstruction:
Jaundice
Fever
Abscess

50
Q

Flukes- Fascioliasis sono findings?

A 
Hepatomegaly
Hilar adenopathy
Lesions:
Hypoechoic or mixed echogenicity
Present in 90% cases   
Flukes may be seen  within ducts & GB
51
Q

Recurrent Pyogenic Cholangitis

A

Chronic biliary obstruction, stasis & stone formation
Leads to recurrent episodes
Etiology remains unknown

52
Q

Recurrent Pyogenic Cholangitis sono findings?

A 
Lateral left Lobe most often affected
Acute complication:
Sepsis
Chronic complications :
Biliary cirrhosis and cholangiocarcinoma
53
Q

Primary Sclerosing Cholangitis?

A 
Chronic inflammatory disease of entire biliary tree
Fibrosing inflammation of small 
   and large bile ducts
More frequent in men
Median age 39yrs
Etiology not known
80% of patients however, have 
   inflammatory bowel disease-colitis
54
Q

Primary sclerosing cholangitis leads to?

A 
Biliary strictures
Cholestasis
Biliary cirrhosis
Portal hypertension
Hepatic failure
55
Q

Secondary Sclerosing Cholangitis etiology?

A 
AIDS cholangiopathy
Bile duct neoplasm
Biliary tract surgery
Trauma
Choledocholithiasis
Congenital  anomalies
56
Q

Cholangiocarcinoma

A

cancerous (malignant) growth in one of the ducts that carries bile from the liver to the small intestine

57
Q

Cholangiocarcinoma risk factors?

A

Age
Recurrent biliary infections
Stone disease

58
Q

Cholangiocarcinoma 3 classifications?

A

Hilar: 60%-also called Klatskin’s tumor

Distal: 30%- distal CBD

Intrahepatic: 10%-also called- Peripheral

59
Q

Klatskins tumor?

A 
Hilar: most common
Located in porta hepatis
Causes fibrous tissue formation
Difficult to ID and stage
Symptoms-
Jaundice, pruritis, increased LFTS, nodes
60
Q

second most common primary malignancy of the liver?

A

Intrahepatic cholangiocarcinoma

61
Q

Metastases to the Biliary Tree ?

A

Most common tumor sites that can spread to the biliary system are from the breast, colon, or melanoma.
Metastases can affect the intrahepatic and extrahepatic ductal systems.
On sonography, the appearance of metastases is similar to that of cholangiocarcinoma.

Abdo review (11 decks)

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