gall bladder WB quest Flashcards
a congenital disease in which there is a narrowing or obliteration of the bile ducts is referred to as
biliary atresia
primary biliary tree cancer is referred to as
cholangiocarcinoma
the merging of the pancreatic duct and common bile duct at the level of duodenum is reffered to as the
ampulla of vater
a gall stone located in the biliary tree is called
choledocholithiasis
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 klatskin tumor is located
at the junction of the rt and lt hepatic ducts
inflammation of the bile ducts is referred to as
cholangitis
a pt presents with jaundice, pain , fever, secondary to am impacted stone in the cystic duct this is referred to as
mirizzi syndrome
air within the biliary tree is referred to as
pneumobilia
the spiral valves of heister are located within the
cystic duct
if a gall stone, causing obstruction, is located within the distal common hepatic duct what become dialated
intrahepatic ducts
what is considered the most proximal portion of the biliary tree
intrahepatic radicles
what would be the most distal portion of the biliary tree
common bile ducts
what could dilate if there was an obstructive biliary calculus located within the distal common duct
common bile duct
gall bladder
common hepatic duct
the gall bladder is connected to the biliary tree by the
cystic duct
formation or presence of stones within the gall bladder
cholelithiasis
hormone which stimulates gall bladder contractions
cck
cholecystokinin
fold with the neck or body of the gallbladder
junctional fold
pain in the area of the gall bladder when applying pressure with the u/s transducer
murphy’s sign
inflammation of the bile ducts
cholangitis
surgical removal of the gall bladder
cholecystectomy
solid or semi solid or thickened bile within the gall bladder or bile duct
sludge
pear shaped sac responsible for storing bile until it is released through the cystic duct
gall bladder
duct which carries bile from the cystic and hepatic ducts to the duodenum
common bile duct
acute or chronic inflammation of the BG
cholecystitis
duct of the gall bladder which joins with the hepatic duct to form the common bile duct
cystic duct
what is the upper limit of normal for measurement of the gall bladder wall
3mm
what makes up the portal triad
bile duct
portal vein
hepatic artery
what is the normal measurement for an intrahepatic bile duct
less than 2mm
what is a fold or kinking of the gall bladder fundus onto the body commonly called
phrygian
which anatomic landmark can help locate the gall bladder
main lobar fissure
what three labs can be used to evaluate the biliary system?
alkaline phosphate
bilirubin
lactic dehydrogenase
a 2wk old infant presents with persistent jaundice and a palpable RUQ mass. the u/s demonstrates a normal gb and a cystic mass in the porta hepatis that appears to separate from the gall bladder. the CBD appears to be entering the cystic mass. what is most likely the diagnosis
choledochal cyst
2 week old presents with a sudden on set of jaundice. the u/s demonstrates intrahepatic ductal dilation but does not deminstrate a gall bladder or CHD. which congenital biliary anomaly is the most likely cause
biliary atresia
most common maligancy to matastisize to the gb
melanoma
a comet-tail reverberation artifact is seen originating from the anterior gall bladder wall. what gall bladder pathology could be causing this
adenomyomatosis
a distal obstruction of the panc head will cause which part of the biliary tree to dilate first
gallbladder
what will cause a thin walled gallbladder
hydrops
an abdominal u/s shows lg hypoechoic mass in the head of the panc. The gallbladder is enlarged with a thin wall. murphy’s sign is negative. no gallstone are present and bile ducts are normal size. what is most likely the diagnosis
courvoisier gallbladder
a 76 yr old pt presents for an abdominal u/s with chronic abd pain. an irregular mass is seen projecting into the gallbladder lumen. color doppler detects flow within the mass. gallstones are also seen. what is most likely the diagnosis?
gallbladder carcinoma
3 things that increase the risk of developing gallbladder malignancy
gall stones
chronic cholecystitis
porcelain gallbladder
what would cause intrahepatic dialation with a normal GB and CBD
klatskin tumor
the normal distended GB size
7-10cm
the normal distended GB in AP and trans measures
less than 3cm
purpose of gallbladder
store and concentrate bile
an infundibulum at the neck of the gallbladder where stones may collect is called
hartmens pouch
_______ bilirubin is typically elevated in cases of obstructive jaundice as can occur in choledocholithiasis
direct
____ bilirubin is typically elevated with liver diease and hemolytic anemia
indirect
do polyps move or cause acoustic shadowing?
no
95% of gallbladder carcinoma have
gallstones
what can be used to look for internal vascularity in a suspected gallbladder mass and to distinguish sludge from a malignant mass
color doppler
2 most common hyperplastic cholecystoses are
adenomyomatosis
cholesterosis
a distended gallbladder caused by an obstruction of the gallbladder neck or cystic duct
hydropic gallbladder
RUQ pain, jaundice, fever, elevated bilirubin or alkaline phosphate are symptoms of
biliary obstruction
bile ducts should be measured from
inner wall to inner wall
CBD measuring larger than ____ is abnormal
8mm
primary maligancies of the bile ducts
cholangiocarcinoma
23 yr ols female pt presents to the u/s dept with hx of a fever, leukocytosis, and RUQ pain. u/s shows dialated bile ducts that have thickened walls and contain sludge. what is the most likely diagnosis
cholangitis
u/s shows scattered echogenic linear structures within the liver parenchyma that produce a ring-down artifact what could the diagnosis be
pneumobilia
for pt over 60 who have had a cholecystectomy a maximum diameter of ____ cm may be considered normal
1
the yellow pigmant found in bile that id produces by the breakdown of red blood cells by the liver is
bilirubin
common form of symptomatic GB disease, typically with stones
chronic cholecystitis
repeated attacks of chronic cholecystitis results in
thickening and fibrosis of GB wall
may also cause contraction of the GB
what symptoms are associated with chronic cholecystitis
intalorance to fatty foods
nausea/vom
moderate RUQ pain/ or radiating pain
may be asymptomatic
Sonographic apperarence
- small contracted GB with stones and evenly thickened, fibrous echogenic walls
- stone often lodged in neck
- WES or double arc sign may be seen
chronic cholecystitis
chronic cholecystitis complications
porcelain GB
Bouveret syndrome
mirizzi syndrome
*pathlogy that can mimic WES
*calcified gb
associated with high incidence of GB carcinoma
porcelain GB
in what syndrome does biliary enteric fistula from between the gb and the duodenum
Bourveret syndrome
who is at a higher risk for bouveret syndrome
women over 60 w/ symptoms of bowel obstruction and GB disease
stone impacts in neck or cystic duct, obstruction of bile proximal to cystic duct
mirizzi syndrome
at what measurement is the GB wall considered thickened
greater than 3mm
symptomatic thickening of GB wall
pancreatitis
CHF
patient with hep
end stage liver disease
causes of focal GB wall thickening
GB cancers
gangrenous cholecystitis
adenomyomatosis
stagnant bile may leak out into the blood stream
ICP
intrahepatic cholestasis of pregnancy
sonographic appearance of ICP
gallstones may be seen
no ductal dialation
benign GB neoplasm
adenoma (polyp)
polyps are made out of
adenomatous
cholesterol
sonographic appearance of benign neoplasm
fixed
non shadowing
echogenic mass protruding into the gb lumen
typically less than 2mm
polyps greater than 1 cm are suggestive of
malignancy
Benign GB neoplasm caused by
chronic inflammation
hyperplasia of GB wall
lipid deposits
pus or blood cam mimic what
sludge
intrahepatic ducts should measure
2mm or less
what crosses anterior to the undivided rt portal vein
CHD
seen in cross section between the portal vein posteriorly and the CHD anteriorly
Hepatic artery
proper size of the common bile duct
10mm
correlate bile duct size to age in decades
presbyductia
what lie posterior to the CBD
Cystic duct
proper size of cystic duct
less than 2mm
allows for improved contrast
harmonics
a CHD with a measurement of greater then 8mm suggests
obstruction
types of bile duct obstructions
intrinsic
(intrahepatic)
extrinsic
(extrahepatic)
obstruction of intrahepatic biliary caused by
primary sclerosing cholangitis
space occupying mass in liver
obstruction at porta hepatis caused by
cholangiocarcinoma
primary sclerosing cholangitis
GB cancer
metastic tumors
biliary obstruction extrinsic cause
blunt abrupt end to duct may indicate malignancy
tapered dilated duct typically benign cause
where is an obstruction if the intrahepatic ducts are dilated
ducts between porta hepatis and pancreas will be normal
obstruction at porta hepatis
dilated intrahepatic ducts measure at
greater than 2mm
sonographic appearence
parallel channel sign (shotgun sign)
irregular jagged walls
stallate confluence
dilated intrahepatic ducts
most common pathology of the biliary tract
choledocholithiasis
a condition where stones that form in the Gb and move to the CBD
choledocholithiasis
sonographic appearence dilated or non dilated ducts may create shadow single or double large or small mobile or stationary small stones mare difficult to see
choledocholitiasis
primary maligancy of bile duct
cholangiocarcinoma
cholangiocarcinoma occurs where
throughout biliary tree
in the porta hepatis (klatskin)
ampullary carcinomas at distal CBD
grows slowly and may extend along the length of CHD and CBD
cholangiocarcinoma
risk factors of cholangiocarcinoma
sclerosing cholangitis
choledocal cyst
parasitic infection
symptoms of cholangiocarcinoma
abd pain anorexia fatigue weight loss hepatomegaly ascites
sonographic appearance of cholangiocarcinoma
ductal wall irregularity
non union or ft and rt hepatic ducts is suggestive of what type of tumor
hilar cholangiocarcinoma
chronic inflammatory and fibrosing disorder of bile duct
primary sclerosing cholangitis (psc)
assoctiated with ulcerative colitis and crohns disease
PSC
can progress to cirrhosis, liver failure and colangiocarcinoma
PSC
Primary sclerosing cholagitis
sonographic appearence
thickened edematous duct walls that narrow the lumen dialating more proximal ducts
PSC
a medical emergency
acute cholangitis
sonographic appearance
mobile bright echoes with dirty shadowing
pneumobilia
portal vein air can occur with
necrotic bowel
result from surgical trauma, or blunt abd trauma
strictures
may penitrate into the CBD creating a
fistula
sonographic appearance intrahepatic duct dialation normal cbd distal to the cystic duct stone in the neck of the gb or cystic duct contracted gb
mirizzi syndrome
collection of bile
biloma
adbominal fluid collection, can bee seen along falciform ligament or ligamantun venosum
biloma
can occur with lacoration or rupture of biliary tract
biloma
sonographic appearance thickening gb wall striations, gb dilation pericholecystic fluid collection sludge, biliary dilatation, duct wall thickening
AIDS cholecystopathy
occurs in pt with recurrent pyogenic cholangitis
inrahepatic biliary calculi
roundworms found in the biliary tree
ascaris lumbricoides
sonographic appearance
worms seen in bile duct or gb
ascaris lumbricoides
liver fluke
chonorchis sinensis
sonographic appearance
minimal or absent dilaation of intrahepatic ducts
increased echogenicity of the involved duct wall
chonorchis sinensis
needle inserted into the biliary tree
percutaneous transhepatic cholangiography
