GI 2 Flashcards
What are choledochal cysts?
Dilatation of the EXTRA-hepatic bile ducts.
T/F 30-40% of pts with choledocal cysts present before 1 year of age?
True
What is the clinical triad seen in 25% of pts presenting with choledochal cysts?
- Intermittent obstructive jaundice,
- Recurrent RUQ pain,
- RUQ mass.
What are the US features of choledochal cysts?
- cyst adjacent to the gallbladder,
- intra-hepatic bile duct dilatation caused by pressure on the CHD,
- may be seen on antenatal scans.
What are the HIDA features of choledochal cysts?
- Delayed filling of the cyst. Differential dx includes hepatic cysts, pancreatic pseudocysts and enteric duplication cysts.
T/F cholesterol stones are radiolucent?
True
T/F pneumobilia can be seen with emphysematous cholecystitis?
True, dirty shadowing on US
What is xanthogranulomatous cholecystitis?
- inflammation of the gallbladder with intramural nodules,
- peak age 70-80.
What are the US features of xanthogranulomatous cholecystitis?
- thick gallbladder wall and intramural hypo echoic nodules.
- focal fatty inflammation,
- biliary obstruction.
What are the US features of intra-hepatic cholangiocarcinoma?
Dilated biliary tree with hyper echoic mass.
What are the CT features of intra-hepatic cholangiocarcinoma?
Homogenous delayed enhancement, dilated ducts.
What are indirect signs of Klatskin tumour?
- segmental dilatation of the main ducts,
- portal vein obstruction,
- lobar atrophy.
T/F PSC Intra-hepatic ducts more often involved than extra-hepatic ducts?
True
Name some associations f PSC?
IBD, pancreatitis, Sjogrens, RPF, Peyronies
What space does the pancreas lie in?
Anterior pararenal space at T12-L1
T/F the pancreas lies anterior to the lesser sac?
False- it lies posterior to the lesser sac and mesentery of the transverse colon.
What is the blood supply of the pancreas?
- superior pancreaticoduodenal artery (branch of gatroepiploic artery)
- inferior pancreaticoduodenal artery (branch of SMA).
T/F the dorsal Santorini duct drains the body and tail of the pancreas?
True- the ventral (Wirsung’s duct) drains the uncinate process via the major papilla. The distal dorsal duct regresses and drains via the minor papilla.
What is pancreas divisum?
Failure of the ventral and dorsal pancreatic ducts to fuse- the dorsal and ventral ducts drain separately.
In pancreas divisum, what does the dorsal duct drain and where does it drain to?
The dorsal duct drains the body and tail and the superior aspect of the head and uncinate process through the minor duodenal papilla. The ventral duct drains the inferior aspect of the head and uncinate process into the major papilla.
T/F annular pancreas can give rise to the double bubble sign in neonates?
True- due to duodenal obstruction.
How long does a pancreatic pseudocyst take to form?
4 weeks
2/3 of pancreatic pseudocysts are in the pancreas- where is the next commonest site?
Omental bursa
T/F rupture of a pancreatic pseudocyst can result in peritonitis?
True