Chapter 10- Gallbladder, Biliary Tree Flashcards
Are Choledochal Cysts congenital or acquired? How common are they?
Congenital. They are rare.
Who is at risk for Choledochal Cysts?
It is 4x as common in women and is also noted in infants.
What is Type 1 Choledochal Cysts?
It is most common along with type 4a. A fusiform dilaton of CBD
What is a Type 2 Choledochal Cyst?
A true diverticuli of the bile ducts
What is a Type 3 Choledochal Cyst?
Are located in the intraduodenal portion of the CBD
What is a Type 4a Choledochal Cyst?
They are intrahepatic and extrahepatic biliary dilations
What is a Type 4b Choledochal Cyst?
Type 4b is confined to the extrahepatic biliary tree
What is a Type 5 Choledochal Cyst?
It is multiple intrahepatic cysts also called Caroli disease.
What is a common cause of sludge?
bile stasis
when a gallbladder measures greater than 5 cm, what is this called?
hydropic
what is cholecystitis?
inflammation of the gallbladder.
what is the most common cause of acute cholecystitis? who is at risk?
the most common cause of acute cholecystitis is gallstones (90% of cases). women are 3x more likely than men. 40-50 years old.
What is Emphysematous cholecystitis? Is it common?
The presence of gas-forming bacteria in the gallbladder wall, lumen, and/or biliary ducts. It is a rare complication of acute cholecystitis.
Who is at risk for emphysematous cholecystitis?
More commonly men with diabetes
How does emphysematous cholecystitis appear sonographically?
Gas in the gallbladder partially or completely obscures the lumen. Gallstones may or may not be present.
What is gangrenous cholecystitis caused by and what is it a complication of?
A painful complication of acute
cholecystitis that may lead to perforation of the GB wall. It occurs after infection which causes necrosis.
How does gangrenous cholecystitis appear sonographically
Gallstones appear in 80-95% of patients. Packed bag or WES sign.
The acute inflammation of the gallbladder in the absence of cholelithiasis is called?
Acalculous Cholecystitis
What is the most likely cause of Acalculous Cholecystitis
decreased bloodflow through the cystic artery, compression of the cystic duct, or lymphadenopathy.
Is gallbladder torsion common? Who is most commonly affected?
It is rare and found most commonly in older women
What is the most common form of gallbladder inflammation?
Chronic Cholecystitis
What does the Wall Echo Sign (WES) look like? What does it indicate?
It shows that the gallbladder is a “packed bag” of gas. A sharp posterior shadow is noted
What is the most common disease of the gallbladder?
Cholelithiasis. It might be one large gallstone or multiple tiny stones.
What are the five categories of Cholelithiasis patietns?
Fat, Female, Forty+, Fertile years, Fair skin
With what symptoms does Cholelithiasis typically present?
RUQ pain with radiation to the shoulder after a high-fat meal
What is porcelain gallbladder? Is it common?
It is a rare occurance defined as calcium incrustation of the
gallbladder wall. It is usually associated with gallstones
Who does porcelain gallbladder typically affect? 20% of these patients typically develop what disease?
older females. 25% develop cancer of the gallbladder wall.
How does a porcelain gallbladder appear sonographically? What else appears similar?
Bright echogenic echo with posterior shadow. The WES sign is similar.
What is a gallbladder polyp?
A benign epithelial tumor- also called an adenoma
Hyperplastic Cholecystitis is represented by 3 degenerative changes of the gallbladder. What are they?
Hyperconcentration, Hyperexcitability, Hyperexcretion
What are the two types of hyperplastic cholecystitis
Cholesterolosis, Adenomyomatosis
What is Chloesterolosis?
“strawberry gallbladder” is a condition in which cholesterol is deposited within the lamina propria of the gallbladder.
What is adenomyomatosis
A hyperplastic change in the gallbladder wall. Small cholesterol crystals lodged within the
Rokitansky-Aschoff sinuses
How does adenomyomatosis appear sonographically?
Multiple papillomas are demonstrated along the anterior wall of the gallbladder, causing a “ring down” of echoes to occur.
What is gallbladder carcinoma? Is it common?
primary gallbladder carcinoma is rare and is nearly always a rapidly progressive disease with a mortality rate approaching 100%
Primary carcinoma of the gallbladder is twice as common as cancer of the bile ducts. Who is at risk?
women over 60
What is the most common indirect extension of matastais?
melanoma
what is Caroli’s disease?
A rare congenital abnormality found in young adults/kids. It is strongly associated with renal disease and hepatic fibrosis
How might Caroli’s disease appear sonographically?
“string of pearls” appearance of intrahepatic bile ducts
At what diameter is the common hepatic duct considered dilated?
5-6 mm
At what diameter is the common bile duct considered dilated?
6/7 mm is borderline and greater than 10mm.
What are two reasons for someone having a larger than average (not enlarged) bile duct?
With age and cholecystectomy
what is the most common cause of a biliary obstruction?
The presence of a tumor or thrombus in the ductal system
What does “too many tubes” or the “double barrel shotgun” sign demonstrate?
A dilated CBD appearing similar in size to the portal vein throughout the liver.
What are the three primary areas for biliary obstruction?
intrapancreatic, suprapancreatic, porta hepatic
What causes Courvoisier’s Gallbladder?
A mass in the head of the pancreas compresses the common bile duct and enlarges the gallbladder.
what are the most common causes of suprapancreatic obstuction between the pancreas and porta hepatis?
Malignancy and adenopathy
What is the most common cause of porta hepatic obstruction?
Neoplasms
What is primary choledocholithiasis
The formation of calcium stones in the bile duct
What is secondary choledocholithiasis
Stones in the gallbladder migrate to the common bile duct.
What is Mirizzi syndrome? Is it congenital or acquired?
A large stone in the cystic duct causes compression of the common hepatic duct. It is due to a congenital malformation of the cystic duct.
What is the cause of hemobilia?
Blood in the bile duct due to trauma
what is pneumobilia and how does it appear sonographically?
air within the biliary tree appears as ring down that follows the portal triads
What is cholangitis? What are symptoms?
Inflammation of the bile ducts. patients might have fever, jaundice, leukocytosis, and increase of AlkPhos and bilirubin
What is ascariasis?
A parasitic worm which uses a fecal-oral route of transmission through the ampulla of vater.
Intrahepatic Biliary Neoplasms are rare. What is the most common type and who is most commonly at risk?
They are usually limited to cystadenoma and cystadenocarcinoma Middle-aged women are most frequent.
What is the second most common primary malignancy in the liver? Is it common?
Intrahepatic cholangiocarcinoma. it is rare, but numbers are rising with numbers of cirrhosis and hepatitis C.
What is Hilar Cholangiocarcinoma (Klatskin’s) and does it have a good prognosis?
A specific type of cancer that occurs most commonly at the bifurcation of the common hepatic ducts. Most patients die within 1 year of diagnosis.
What are the most common metastatic sites that spread to the biliary system?
Breast, colon, and melanoma
