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ABDOMEN REGISTRY > Chapter 2. Biliary Tract > Flashcards

Chapter 2. Biliary Tract Flashcards

1
Q

What structures join to form the common hepatic duct?

A

The right and left hepatic ducts join to form the common hepatic duct

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2
Q

What biliary structures join to form the common bile duct?

A

The common hepatic duct joins with the cystic duct to form the common bile duct.

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3
Q

What structure is formed at the junction of the common bile duct and the duct of wirsung?

A

The ampulla of vater is formed at the junction of the CBD and main pancreatic duct (duct of wirsung).

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4
Q

What is the name of the sphincter that is located at the ampulla of vater?

A

The sphinter of oddi is located at the ampulla of vater.

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5
Q

What vessels does the portal triad consist of?

A

The portal triad is composed of the CBD/CHD, Hepatic artery and main portal vein.

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6
Q

The gallbladder receives it’s blood supply from which vessel? Where does this vessel originate from?

A

The GB receives blood supply from the cystic artery. The cystic artery is a branch of the right hepatic artery.

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7
Q

A spiral fold that controls bile flow into the cystic duct is called the…

A

Valve of Heisters

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8
Q

Abnormal sacculation or diverticulum of the GB neck is called…

A

Hartmans pouch

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9
Q

Term for a fold that is between the GB neck and body…

A

Junctional folds are folds between the GB body and neck. They are a common GB variant.

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10
Q

Term for a fold within the GB body and fundus…

A

A phrygian cap is a fold between the body and fundus of the GB.

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11
Q

Why is harmonic imaging needed when doing an US of the GB?

A

Harmonic imaging is used when investigating the GB to clear reverberation artifact that is commonly seen in the GB’s near field.

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12
Q

Where does the ampulla of vater empty?

A

The ampulla pf vater empties into the fist portion of the duodenum.

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13
Q

What is the normal GB wall measurement?

A

The normal GB wall should measure <3mm.

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14
Q

What is the most common cause of GB wall thickening?

A

Cholecystitis is the most common cause of GB wall thickening.

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15
Q

What is a pre-hepatic cause of jaundice?

A

Pre-hepatic jaundice may occur due to excessive RBC breakdown which overwhelms the livers ability to conjugate bilirubin. This leads to hyperbilirubinemia (excess bilirubin)

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16
Q

Describe how hepatic jaundice occurs and list causes of hepatic jaundice…

A

With intrahepatic jaundice, there is dysfunction of the liver itself. The liver loses the ability to conjugate bilirubin, but in cases of cirrhosis, it compresses the intrahepatic portions of the biliary tree, causing a degree of obstruction. Causes of hepatic jaundice include acute and chronic liver disease, hemochromatosis, Wilson’s disease, primary biliary cirrhosis, sclerosing cholangitis, and gilberts syndrome.

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17
Q

List causes of post hepatic jaundice…

A

Obstruction of the biliary tree causing unconjugated hyperbilirubinemia

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18
Q

List the trademark signs of post hepatic jaundice…

A

Dark urine and pale stool are trademark findings of a patient with post hepatic jaundice

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19
Q

GB sludge may be found in association of…

A

Prolonged fasting and IV tube feeding are associated with GB sludge formation (anything resulting in GB stasis may result in sludge)

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20
Q

Gb sludge that has a mass like appearance is called…

A

Tumefactive sludge may appear as an intraluminal GB mass.

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21
Q

Describe the WES sign. What is another term for this finding?

A

A GB filled with stones may be seen as a strong shadow in the RUQ. This is called the Wall Echo Shadow or WES sign. Another term for this condition is Double Arc sign.

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22
Q

An intense point of tenderness due to transducer pressure directly on the GB, quoted to be 90% sensitive and specific…

A

Murphy’s sign

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23
Q

List complications that may occur due to acute cholecystitis…

A

Empyema (collection of pus)
Gangrenous cholecystitis
Perforation
pericholecystic abscess

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24
Q

How can a sonographer distinguish acute cholecystitis from chronic cholecystitis based on the US alone?

A

Sonographically, acute and chronic cholecystitis appear identical.

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25
Q

List common findings associated with chronic and acute cholecystitis…

A

Thick walled contracted GB
Sludge
Obstructing cystic duct stone

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26
Q

Emphysematous cholecystitis is thought to be a different pathogenesis than calculus cholecystitis. What is believed to be the cause of emphysematous cholecystitis?

A

Acute cholecystitis due to GB wall ischemia and infection is believed to be the cause of emphysematous cholecystitis.

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27
Q

Emphysematous cholecystitis is more common among what patient population?

A

Diabetic patients are more commonly associated with emphysematous cholecystitis.

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28
Q

Gas bubbles seen in emphysematous cholecystitis may rise to the nondependent wall of the GB. This is referred to as the…

A

Champagne sign

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29
Q

What complication of gangrenous cholecystitis is considered inevitable?

A

Perforation of a GB associated with gangrene is inevitable. This will lead to pneumoperitoneum, peritonitis and sepsis.

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30
Q

Procedure for creating an anastomosis of the CBD to the jejunum, performed to relieve symptoms of biliary obstruction…

A

Choledochojejunostomy

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31
Q

What GB condition should be considered in the finding of atypical bile echos?

A

Empyema of the GB is associated with atypical bile echoes

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32
Q

What portion of the GB is most susceptible to perforation and why?

A

The fundus of the GB is the most common site of perforation. This is because it is the most distal portion in regards to blood supply) (cystic artery)

Note - GB perforation is life threatening and is associated with high morbidity and mortality rates

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33
Q

List causes of acalculus cholecystitis…

A

Bile stasis
Viscous bile
Decreased GB contraction
Infection

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34
Q

Sludge-like material with a high concentration of calcium is referred to as…

A

Milk of calcium bile or Limy bile

35
Q

What is Mucocele of the GB?

A

A hydropic GB

36
Q

What measurement is diagnostic of a hydropic GB?

A

In a transverse plane, if the GB measures >5cm, it is considered hydropic

37
Q

Mucocele GB is associated with what disease?

A

Kawasaki Disease is associated with mucocele or hydrops of the GB

38
Q

What causes a GB to become hydropic?

A

Outlet obstruction at the cystic duct may result in a hydropic GB

39
Q

GB polyps typically measure less than…If they measure greater than this, what should be considered?

A

GB polyps are typically <10 mm. Polyps greater than 10 mm should be investigated for malignancy.

40
Q

What condition of the GB is commonly referred to as Strawberry gallbladder?

A

Cholesterolosis

41
Q

T or F, majority of GB carcinoma cases are not diagnosed until later stages or even post cholecystectomy

A

True

42
Q

Adenomyomatosis is associated with…

A

Rokitansky - Aschoff sinuses are associated with adenomyomatosis

43
Q

Hyperplasic changes involving the GB wall causing over growth of the mucosa and the formation of diverticula is known as…

A

Adenomyomatosis

44
Q

What sonographic sign distinguishes adenomyomatosis from polyps or cholesterolsosis?

A

Adenomyomatosis will have comet tail or reverberation artifact, unlike polyps or cholesterolsosis (strawberry GB)

45
Q

Biliary obstruction is most common in which portion of the CBD?

A

The distal CBD is where the majority of biliary obstructions are located.

46
Q

What labs will be elevated with biliary obstruction?

A

ALP, Direct or conjugated bilirubin and GGT will be elevated in biliary obstruction.

47
Q

Biliary obstruction is considered clinically when the patient presents with what symptom?

A

Jaundice

48
Q

What are the two most common lesions leading to biliary obstruction?

A

Gallstones and carcinoma of the head of the pancreas are the two most common lesions leading to biliary atresia.

49
Q

Post cholecystectomy, the CBD acts as a reservoir for bile storage and may measure up to…

A

10 mm or 1.0 cm

50
Q

What sonographic sign refers to the dilated hepatic duct adjacent to the portal vein?

A

Parallel channel sign
Shotgun sign

51
Q

What is the condition associated with the shot gun or parallel channel sign?

A

Dilated intrahepatic ducts

52
Q

Name the hormone responsible for GB contraction…

A

Cholecytokikin

53
Q

What tumor is found with dilated intrahepatic ducts only?

A

Klatskin tumor

54
Q

What condition of the GB is the most common cause of extrahepatic obstructive jaundice?

A

Choledochalithiasis is the most common cause of extrahepatic obstructive jaundice.

55
Q

Condition in which a stone can be seen in the cystic duct leading to extrinsic mechanical compression of the common hepatic duct…

A

Mirizzi Syndrome

56
Q

Describe what happens in Mirizzi Syndrome…

A

There is a stone in the cystic duct and it is causing compression of the common hepatic duct.

57
Q

Type of cholangiocarcinoma that is located at the hepatic hilum at the junction of the right and left hepatic ducts resulting in intrahepatic biliary dilation…

A

Klatskin tumor

58
Q

What is the most common predisposing condition of cholangiocarcinoma?

A

Primary sclerosing cholangitis is the most common predisposing condition of cholangiocarcinoma.

59
Q

List symptoms associated with cholangiocarcinoma…

A

Jaunice
Weight loss/anorexia
Abdominal pain

60
Q

Name the GB condition that is mostly prevalent in south-east Asian countries, it is a disease caused by a parasite. Serious complications include intestinal and biliary tract obstruction…

A

Biliary Ascariasis (round worm)

61
Q

Inflammation of the biliary tree is known as…

A

Cholangitis

62
Q

What are the Charcot triad of findings associated with cholangitis?

A

RUQ pain, fever, jaundice

63
Q

What is the most common cause of cholangitis?

A

Choledocholithiasis`

64
Q

Biliary atresia should be suspected if jaundice persists beyond how many days of life?

A

14 days of life

65
Q

What is biliary atresia?

A

The absence of the extrahepatic bile ducts (CHD, CBD)

66
Q

What sonograpic sign is hallmark of biliary atresia?

A

The triangular cord sign is associated with biliary atresia.

67
Q

Where is the triangular cord sign seen in the liver?

A

Anterior to the portal vein

68
Q

What is the name of the treatment for biliary atresia that is not a liver transplant?

A

Kasai Portoenterostomy

69
Q

What type of biliary atresia is the most common?

A

Type 3 biliary atresia is the most common. It includes the right and left hepatic ducts, the CHD, cystic duct, and CBD.

70
Q

Pneumobilia is commonly associated in patients with hx of…

A

ERCP, endoscopic retrograde cholangiopacreatogram

71
Q

A congenital bile duct anomaly that is more common in Asia, consisting of cystic dilatation of the extrahepatic bile ducts…

A

Choledochal cysts

72
Q

Where are choledochal cysts more commonly found?

A

At the CBD.

73
Q

What are the sonographic signs of a choledochal cyst? What other conditions are choledochal cysts associated with?

A

US findings - two cystic structures in the RUQ representing the GB and dilated CBD. Intrahepatic bile duct dilatation

Associations - Pancreatitis, cholangitis, cirrhosis, portal HTN, cholangiocarcinoma.

74
Q

Congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the INTRAhepatic bile ducts…

A

Caroli Disease

75
Q

Caroli disease is genetically inherited and is associated with…

A

congenital hepatic fibrosis,
autosomal recessive polycystic kidney disease, portal hypertension

76
Q

The most common cause of malignant neoplasm obstructing the biliary tree is…

A

Pancreatic adenocarcinoma is the most common cause of malignant neoplasm obstructing the biliary tree.

77
Q

An enlarged, non-diseased GB due to mechanical obstruction of the CBD is referred to as…

A

Courvoisier GB

78
Q

Pancreatic adenocarcinoma at the head of the pancreas typically causes what condition of the GB?

A

Courvoisier GB

79
Q

Describe the double duct sign

A

Double duct sign is the dilation of the CBD and the duct of wirsung

80
Q

Primary sclerosing cholangitis is inflammation and fibrosis of the intra and extra-hepatic bile ducts. This condition results in liver failure leading to liver transplantation. List labs that will be elevated with this disease…

A

ALP, GGT, ALT, AST, Conjugated bilirubin (this causes the patient to have DARK urine)

81
Q

Unconjugated/Indirect hyperbilirubinemia is a result of…

A

Impaired hepatic bilirubin uptake. There is an issue with the liver itself, whether that be increased bilirubin production or impaired conjugation (breakdown) of bilirubin. The problem is within the LIVER.

82
Q

Conjugated/Direct hyperbilirubinemia is a result of…

A

Defective bile flow. An OBSTRUCTION.

83
Q

ALP is expected to increase in which biliary tract conditions?

A

ALP (alkaline phosphatase) will increase with any cause of bile duct obstruction.

ABDOMEN REGISTRY (6 decks)

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