Chapter 4: Bile ducts Flashcards
Bile is produced where
The liver
What is the major component of bile
Cholesterol
What is the function of the biliary tree
Provide a conduct for bile to drain from liver to intestine
Each portal triad contains what three components
hepatic artery
Portal vein
Intrahepatic ducts (biliary radicales)
What are the spiral valves of heister
Tiny structures within the cystic duct that prevent it from collapsing or distending
The ampulla of vater is also called
Hepatopancreatic ampulla
CBD diameter shouldn’t exceed ___ mm
6
Intrahepatic ducts are considered dilated if they exceed ___mm
2
What is the parallel sign or shotgun sign
CBD becomes so enlarged that it matches the size of the portal vein
Biliary dilation will occur _____ to the level of obstruction
Proximal
The most common level for an obstruction to occur is
The distal CBD
The CBD segment closer to the pancreas head is considered the most ____ segment of the biliary tree
Distal
The CBD, cystic duct, and part of the common hepatic duct are considered _______ in location
Extrahepatic
What are the most common causes of CBD obstruction
(There are 4)
Choledocholithiasis
Chronic pancreatitis
Acute pancreatitis
Pancreas cancer
If there’s an obstruction, patient will suffer from jaundice. This is called ____
Posthepatic (obstructive) Jaundice
What is cholangitis
Inflammation of biliary ducts
With cholangitis the walls of the biliary ducts will be thicker than ___mm
5
What is the Charcot triad (clinical finding present with cholangitis)
Fever, RUQ pain, and jaundice
What lab values may be elevated with cholangitis
WBCs, ALP, ALT, GGT, and obstructive bilirubin
What are the sonographic findings of cholangitis
Biliary pus or sludge, biliary dilation, choledolithiasis, wall thickening
Cholangitis is often caused by an ________ obstruction
Acute bacterial
Describe sclerosing cholangitis
Fibrotic thickening of bile ducts, associated with inflammatory bowel disease or ulcerative colitis
Sclerosing cholangitis often affects what group of people
Young men
What is pneumobilia
Air within the biliary tree
What does pneumobilia look like on ultrasound
Echogenic linear structures within the ducts, produce ring down artifact and shadowing
What are the clinical findings of Pneumobilia
Same symptoms of acute cholecystitis
Recent biliary or gastric surgery, emphysematous or acute cholecystitis or fistula formation
What is ascariasis
When an intestinal parasitic round worm makes its way up to the biliary tree
What are the symptoms of ascariasis
Asymptomatic
What is the primary biliary tree cancer called
Cholangiocarcinoma
What kind of tumor is the most common manifestation of cholangiocarcinoma
Klatskin tumor
Klatskin tumors are located where
At the junction of the right and left hepatic ducts, causing dilation of intrahepatic ducts
What are the clinical findings of cholangiocarcinoma
Jaundice, pruritus, unexplained weight loss, abdominal pain, elevated bilirubin, elevated ALP
Cholangiocarcinoma has a poor prognosis. What patients are at most risk of developing it
Those with primary sclerosing cholangitis
What is a choledochal cyst (pediatric pathology)
Cystic mass in the area of ports hepatis causing biliary dilation. Most commonly found in CBD
What are the symptoms of a choledochal cyst
Jaundice, fever, pain
What is Caroli disease (pediatric pathology)
Segmental dilation of Intrahepatic ducts. Associated with central dot sign
What are the clinical findings of Caroli disease
Pain, jaundice, fever, portal hypertension
Pts with Caroli disease may also have what other disease
Cystic renal disease
What is biliary atresia (pediatric pathology)
Narrowing of obliteration of all or a portion of the biliary tree
Biliary atresia has a poor prognosis. Pts will eventually suffer from what other disorders
Cirrhosis, and hypertension
Biliary atresia is related to what two “signs”
Triangular cord sign and
Pseudogallbladder sign
Biliary atresia is caused by a viral infection at birth. What are other clinical findings related to it
Neonatal jaundice, elevated AST, ALT, and bilirubin
What is the gold standard imaging for evaluating bile ducts
Magnetic resonance cholangiopancreatography (MRCP)
