Chapter 4 The Bile Duct Flashcards
The yellowish pigment found in bile that is produced by the breakdown of old RBC by the liver is
Bilirubin
Which segment of the biliary tree tends to dilate first with obstruction
Extrahepatic
Clinical findings of choledocholithiasis (3):
- Jaundice
- Elevated ALP, ALT, GGT and bilirubin with obstruction
- RUQ pain
The biliary duct wall should never measure more than
2mm
A klatskin tumor is a form of:
Cholangiocarcinoma
Clinical findings of Cholangiocarcinoma (6):
- Jaundice
- Pruritus
- Weight loss
- Pain
- Elevated bilirubin
- Elevated ALP
The most common level for biliary obstruction to occur is
Distal CBD
The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:
Sphincter of oddi
______ could accidentally introduce bacteria into the biliary tree and thus cause cholangitis
Endoscopic retrograde
_____ would be the most distal portion of the biliary tree
CBD
Pneumobilia will produce ______ artifact
Ring-down
______is considered the most proximal portion of the biliary tree
Inteahepatic radicles
If a gallstone, causing obstruction is located within the distal common hepatic duct, which of the ducts will dilate
Intrahepatic ducts
The spiral valves of Heister are located within the
Cystic duct
The presence of an echogenic dot in the nondependent part of the dilate duct representing small fibrovascular bundles is seen with
Caroli disease
Air within the biliary tree is referred to as
Pneumobilia
Inflammation of the bile ducts is referred to as
Cholangitis
The klatskin tumor is located
At the junction of the right and left hepatic ducts
_____is associated with the sonographic triangular cord sign
Biliary atresia
A gallstone located within the biliary tree is referred to as
Choledocholithiasis
The merging point of the pancreatic duct and CBD at the level of duodenum is referred to as the
Ampulla of vater
_______is associated with Charcot triad
Cholangitis
Primary biliary tree cancer is referred to as
Cholangiocarcinoma
Ascariasis is caused by:
A parasitic roundworm
A congenital disease in which there is narrowing or obliteration of the bile ducts is referred to as
Biliary atresia
The yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as
Jaundice
The common bile duct, the cystic duct, and part of the common hepatic duct are considered:
Extrahepatic in location
The most common level for an obstruction to occur is the:
Distal common bile duct
______is coexisting dilation off the common bile duct and pancreatic duct
Double duct sign
______ describes the enlargements of the common duct to the size of the adjacent portal vein within the portal hepatis
Shotgun sign or parallel tube sign
The intrahepatic ducts are considered dilated if they exceed
2mm
Biliary dilation will occur proximal to the
Level of obstruction
What is the common cause of obstructive jaundice
Gallstones in the common bile duct
Stones typically form in the gallbladder and pass into the
Biliary tree
______describes the presence of gallstones within the bile ducts
Choledocholithiasis
Clinical findings of choledocholithiasis (3):
- jaundice
- elevated ALP,ALT, GGT, and bilirubin
- pain
Inflammation of the biliary ducts is termed
Cholangitis
Types of cholangitis
•acute bacteria
•AIDS
•recurrent pyogenic cholangitis
•sclerosing
_____is an infection of the small intestine that is caused by ascaris lumbricoides, a parasitic roundworm
Ascariasis
Important points of oriental cholangitis (2):
- Endemic to Asia
- Seen in America because of immigration
Biliary atresia is described as the
Narrowing or obliteration of all or a portion of the biliary tree
Primary biliary tree cancer is referred to as
Cholangiocarcinoma
_______are the most common manifestation of Cholangiocarcinoma
Klatskin tumor
Klatskin tumor are located at the
Junction of the right and left hepatic ducts
The function of the biliary tree is to provide a
Conduit for bile to drain from the liver into the small intestine
Bile, a viral digestive fluid is produced by the
Liver
A common bile duct diameter that exceeds ______ is typically considered abnormal
6mm
The gallbladder is attached to the biliary tree by the
Cystic duct
Bile forest accumulates in the
Small intrahepatic biliary radicles in the Liver
_____ prevents the cystic duct from collapsing or distending
Spiral valves of heister
_______ is the opening that allows bile and pancreatic juices to flow into the duodenum
Sphincter of oddi
(hepatopancreatic sphincter)
______is the presence of echogenic dots in the nondependent part of the dilated duct representing small fibrovascular bundles
Central dot sign
______is a congenital disorder characterized by segmental dilation of the intrahepatic ducts
Caroli disease
When are choledochal cyst usually discovered
Infancy or in the first decade of life
Choledochal cysts Can lead to (3):
- Portal hypertension
- Pancreatitis
- Liver failure
Clinical findings of biliary atresia (2):
- neonatal jaundice
- elevated AST, ALT, and bilirubin
Sonographic findings of a choledochal cyst
- Cystic mas the area of the porta hepatis (separate from the gallbladder)
- Biliary dilation
_______is an avascular, echogenic, triangular or tubular structure anterior to the portal vein, representing the replacement of the extrahepatic duct with fibrous tissue in the porta hepatis
Triangular cord sign
_____is a congenital disease that is thought to be caused by a viral infection at birth
Biliary atresia
Clinical findings of ascariasis
- asymptomatic
- Symptoms of inflammation of the biliary tree, gallbladder or pancreas
Clinical findings of cholangitis
•Charcot triad: fever, RUQ pain, jaundice
•leukocytosis
•elevated ALP, ALT, GGT, and bilirubin
Sonographic findings of cholangitis
•biliary dilation
•biliary sludge or pus
•choledocholithiasis
•bile duct wall thickening
Sonographic findings of pneumobilia
- Echogenic linear structures within the ducts that produce ring down artifacts and dirty shadowing
Sonographic findings of choledocholithiasis
- Echogenic foci within the bile duct that may or may not shadow
- May have biliary dilation
Sonographic findings of caroli disease
•segment dilation of the intrahepatic ducts
•May also have cystic renal disease
•central dot sign
Clinical findings of caroli disease (4):
- Pain
- Fever
- Jaundice
- Signs of portal hypertension
Clinical findings of a choledochal cyst
•jaundice
•pain
•fever
•abdominal mass
Clinical findings of pneumobilia (2):
- Recent biliary or gastric surgery, emphysematosis or acute cholecystitis, or fistula formation
- Symptoms of acute cholecystitis
Important points of acute bacterial cholangitis
•caused by bacterial accumulation secondary to obstruction
• introduced during ERCP for choledocholithiasis
• pus
Important points of AIDS cholangitis
- Associated with advanced HIV and AIDS
- Results from inflection with cryptosporidium or cystomegalovirus
Important points of sclerosing cholangitis (4):
- Fibrotic thickening of the bile ducts
- Most often affects young men
- Associated with inflammatory bowel disease or ulcerative colitis
- Increase risk of cholangiocarcinoma
Sonographic findings of ascariasis (2):
- Worm within the biliary ducts as an echogenic linear structure
- Movement of the worm
Sonographic findings of cholangiocarcinoma (2):
- Dilated intrahepatic ducts that abruptly terminate at the level of the tumor
- A solid mass May be noted within the liver or ducts
Sonographic findings of biliary atresia (3):
- Absent biliary ducts
- Triangular cord sign
- Sonographic signs of cirrhosis and portal hypertension
Clinical findings of cholangiocarcinoma
- jaundice
- weight loss
- pain
- elevated bilirubin
- elevated ALP
