GI Section III: BILIARY

Question 1

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

Answer 1

Portal venous gas

vs

Pneumobilia

Question 2

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

Answer 2

Central = pneumobilia

Peripheral = PVG

Question 3

Portal venous gas

vs

Pneumobilia

Answer 3

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

Question 4

Answer 4

Pneumobilia - Central

Question 5

Answer 5

Portal Venous gas = peripheral

Question 6

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

Answer 6

2 cm

Question 7

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

Answer 7

anything that fucks with the sphincter of Oddi

Question 8

Gas in the portal system can be from lots of stuff

Answer 8

COPD
Bowel necrosis = pneumatosis

Question 9

when you talk about jaundice, think about

Answer 9

CBD stoneMos

Question 10

Most common etiology of jaundice?

Answer 10

Benign stricture (post traumatic from surgery or biliary intervention)

Question 11

Cholangitis is the result of? that can lead to?

Answer 11

From stasis (think stoenes)

Can lead to hepatic abscess

Question 12

Bacterial Cholangitis Triad

Answer 12

Jaundice + Fever + RUQ pain

Question 13

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

Answer 13

Primary Sclerosing Cholangitis

Question 14

Chronic cholestatic liver disease of unknown etiology

Answer 14

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

Question 15

Answer 15

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.

Question 16

“central regenerative hypertrophy”

Answer 16

Primary Sclerosing Cholangitis

Question 17

Primary Sclerosing Cholangitis associated diseases

Answer 17

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

Question 18

Answer 18

Primary Sclerosing Cholangitis

“Withered tree appearance”

abrupt narrowing of the branches

Question 19

Answer 19

Primary Sclerosing Cholangitis

“Beaded Appearance”

Strictures + Focal dilatations

Question 20

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

Answer 20

AIDS

Question 21

AIDS Cholangiopathy classic finding

Answer 21

Papillary stenosis

Question 22

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

Answer 22

AIDS Cholangiopathy

Question 23

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

Answer 23

PSC

Question 24

Recurrentpyogenic cholangitis is a.k.a.

Answer 24

Recurrent pyogenic cholangitis

dilated ducts that are full of pigmented stones.

Question 25

Answer 25

Recurrent pyogenic cholangitis "Straight rigid intrahepatic ducts"

Question 26

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

Answer 26

Primary Biliary Cirriiosis:

Question 27

What helps distinguish pirmary bilary cirrhosis from Primary sclerosis cholangitis?

Answer 27

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

Question 28

What happens in the late stages of Primary biliary Cirrhosis?

Answer 28

EXTRAHEPATIC DUCTS: Normal INTRAHEPATIC DUCTS: Irregular dilatation

Question 29

Answer 29

Primary biliary cirrhosis "Lace-like" pattern of fibrosis

Question 30

Tx and prognosis of PBC (primary biliary cirrhosis

Answer 30

ursodeoxycholic acid. Excellent prognosis if caught early

Question 31

Increased in PBC

Answer 31

antimitochodrial antibodies (AMA)

Question 32

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).

Answer 32

Long Common Channel

Question 33

What biliary anatomic variant has an increased incidence of pancreatitis?

Answer 33

Long Common Channel ENZYME REFLUX

Question 34

Long common channel is associated with what type of choledochocysts?

Answer 34

Question 35

The most common Choledochal cyst

Answer 35

Type I DIlatation of the CBD

Question 36

Answer 36

Type I DIlatation of the CBD

Question 37

Answer 37

Type 2 Diverticulum of the bile duct

Question 38

Answer 38

Type 3 “choledochocele.” Intraduodenal diverticulum

Question 39

Answer 39

Type 4 (Type 2+3) both intra and extra.

Question 40

Answer 40

Type V Caroli's diease (multiple intrahepatic dilatations)

Question 41

Caroli’s is an AR disease associated with?

Answer 41

PCKD and Medullary sponge kidney

Question 42

Hallmark of Caroli's disease

Answer 42

is intrahepatic duct dilation, that is large and saccular.

Question 43

Answer 43

Caroli's disease

Question 44

Complications of Choledocal cysts

Answer 44

Cholangiocarcinoma Cirrhosis Cholangitis Intraductal Stones

Question 45

Classic hx of choledocal cyst

Answer 45

Dilated biliary ducts + repeated cholangitis These things get stones in them and can be recurrently infected.