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4. GASTROINTESTINAL > GI Section III: BILIARY > Flashcards

GI Section III: BILIARY Flashcards

1
Q

What are the two patterns of branching air in the liver?

A

Portal venous gas

vs

Pneumobilia

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2
Q

What is the classic way to distinguish Portal venous gas and pneumobilia?

A

Central = pneumobilia

Peripheral = PVG

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3
Q

Portal venous gas

vs

Pneumobilia

A

Portal blood - pumped INTO the liver - so it will be traveling TOWARDS the periphery

bile is draining out of the liver into the bowel - so it is flowing towards the porta-hepatis and should be CENTRAL

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4
Q
A

Pneumobilia - Central

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5
Q
A

Portal Venous gas = peripheral

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6
Q

Within how many cm of the liver capsule is portal venous gas?

A

2 cm

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7
Q

gas in the bile is usually related to what prior procedure?

A

anything that fucks with the sphincter of Oddi

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8
Q

Gas in the portal system can be from lots of stuff

A

COPD
Bowel necrosis = pneumatosis

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9
Q

when you talk about jaundice, think about

A

CBD stoneMos

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10
Q

Most common etiology of jaundice?

A

Benign stricture (post traumatic from surgery or biliary intervention)

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11
Q

Cholangitis is the result of? that can lead to?

A

From stasis (think stoenes)

Can lead to hepatic abscess

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12
Q

Bacterial Cholangitis Triad

A

Jaundice + Fever + RUQ pain

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13
Q

Dilated intrahepatic bile ducts is very rare in all forms of cirrhosis EXCEPT

A

Primary Sclerosing Cholangitis

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14
Q

Chronic cholestatic liver disease of unknown etiology

A

Progressive inflammation = multifocal stricutres of the intra/extrahepatic bulde ducts = cirrhosis = Cholangiocarcinoma

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15
Q
A

Primary Sclerosing Cholangitis

“central regenerative hypertrophy”

cirrhotic, lobulated liver and ductal dilatation. The right hepatic duct is dilated, thickened, and hyperenhancing, suggesting active ductal inflammation.

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16
Q

“central regenerative hypertrophy”

A

Primary Sclerosing Cholangitis

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17
Q

Primary Sclerosing Cholangitis associated diseases

A

Ulcerative colitis (80%)
Crohn’s (20%)

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18
Q
A

Primary Sclerosing Cholangitis

“Withered tree appearance”

abrupt narrowing of the branches

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19
Q
A

Primary Sclerosing Cholangitis

“Beaded Appearance”

Strictures + Focal dilatations

20
Q

Infection of the biliary epithelium {classically Cryptosporidium) can cause ductal disease in patients with

A

AIDS

21
Q

AIDS Cholangiopathy classic finding

A

Papillary stenosis

22
Q

Focal Strictures of the extrahepatic duct > 2cm
+ Absent saccular deformities of the ducts
+ Associated Papillary Stenosis

A

AIDS Cholangiopathy

23
Q

Extrahepatic strictures rarely > 5mm
Has saccular defoiiiiities of the ducts

A

PSC

24
Q

Recurrentpyogenic cholangitis is a.k.a.

A

Recurrent pyogenic cholangitis

dilated ducts that are full of pigmented stones.

25
Q
A

Recurrent pyogenic cholangitis

“Straight rigid intrahepatic ducts”

26
Q

An autoimmune disease that results in the destruction of small & medium bile ducts (intra not extra)

A

Primary Biliary Cirriiosis:

27
Q

What helps distinguish pirmary bilary cirrhosis from Primary sclerosis cholangitis?

A

Normal bile ducts in the early course of the primary biliary cirrhosis

28
Q

What happens in the late stages of Primary biliary Cirrhosis?

A

EXTRAHEPATIC DUCTS: Normal

INTRAHEPATIC DUCTS: Irregular dilatation

29
Q
A

Primary biliary cirrhosis

“Lace-like” pattern of fibrosis

30
Q

Tx and prognosis of PBC (primary biliary cirrhosis

A

ursodeoxycholic acid.

Excellent prognosis if caught early

31
Q

Increased in PBC

A

antimitochodrial antibodies (AMA)

32
Q

An anatomic variant in which the common bile and pancreatic duct fuse prematurely at the level of the pancreatic head (prior to the sphincter of Oddi complex).

A

Long Common Channel

33
Q

What biliary anatomic variant has an increased incidence of pancreatitis?

A

Long Common Channel

ENZYME REFLUX

34
Q

Long common channel is associated with what type of choledochocysts?

A
35
Q

The most common Choledochal cyst

A

Type I

DIlatation of the CBD

36
Q
A

Type I

DIlatation of the CBD

37
Q
A

Type 2

Diverticulum of the bile duct

38
Q
A

Type 3

“choledochocele.”

Intraduodenal diverticulum

39
Q
A

Type 4 (Type 2+3)

both intra and extra.

40
Q
A

Type V

Caroli’s diease (multiple intrahepatic dilatations)

41
Q

Caroli’s is an AR disease associated with?

A

PCKD and Medullary sponge kidney

42
Q

Hallmark of Caroli’s disease

A

is intrahepatic duct dilation, that is large and saccular.

43
Q
A

Caroli’s disease

44
Q

Complications of Choledocal cysts

A

Cholangiocarcinoma
Cirrhosis
Cholangitis
Intraductal Stones

45
Q

Classic hx of choledocal cyst

A

Dilated biliary ducts + repeated cholangitis

These things get stones in them and can be recurrently infected.

4. GASTROINTESTINAL (47 decks)

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