GI Section III: BILIARY Flashcards
What are the two patterns of branching air in the liver?
Portal venous gas
vs
Pneumobilia
What is the classic way to distinguish Portal venous gas and pneumobilia?
Central = pneumobilia
Peripheral = PVG
Portal venous gas
vs
Pneumobilia
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
Pneumobilia - Central
Portal Venous gas = peripheral
Within how many cm of the liver capsule is portal venous gas?
2 cm
gas in the bile is usually related to what prior procedure?
anything that fucks with the sphincter of Oddi
Gas in the portal system can be from lots of stuff
COPD
Bowel necrosis = pneumatosis
when you talk about jaundice, think about
CBD stoneMos
Most common etiology of jaundice?
Benign stricture (post traumatic from surgery or biliary intervention)
Cholangitis is the result of? that can lead to?
From stasis (think stoenes)
Can lead to hepatic abscess
Bacterial Cholangitis Triad
Jaundice + Fever + RUQ pain
Dilated intrahepatic bile ducts is very rare in all forms of cirrhosis EXCEPT
Primary Sclerosing Cholangitis
Chronic cholestatic liver disease of unknown etiology
Progressive inflammation = multifocal stricutres of the intra/extrahepatic bulde ducts = cirrhosis = Cholangiocarcinoma
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.
“central regenerative hypertrophy”
Primary Sclerosing Cholangitis
Primary Sclerosing Cholangitis associated diseases
Ulcerative colitis (80%)
Crohn’s (20%)
Primary Sclerosing Cholangitis
“Withered tree appearance”
abrupt narrowing of the branches
Primary Sclerosing Cholangitis
“Beaded Appearance”
Strictures + Focal dilatations
Infection of the biliary epithelium {classically Cryptosporidium) can cause ductal disease in patients with
AIDS
AIDS Cholangiopathy classic finding
Papillary stenosis
Focal Strictures of the extrahepatic duct > 2cm
+ Absent saccular deformities of the ducts
+ Associated Papillary Stenosis
AIDS Cholangiopathy
Extrahepatic strictures rarely > 5mm
Has saccular defoiiiiities of the ducts
PSC
Recurrentpyogenic cholangitis is a.k.a.
Recurrent pyogenic cholangitis
dilated ducts that are full of pigmented stones.
Recurrent pyogenic cholangitis
“Straight rigid intrahepatic ducts”
An autoimmune disease that results in the destruction of small & medium bile ducts (intra not extra)
Primary Biliary Cirriiosis:
What helps distinguish pirmary bilary cirrhosis from Primary sclerosis cholangitis?
Normal bile ducts in the early course of the primary biliary cirrhosis
What happens in the late stages of Primary biliary Cirrhosis?
EXTRAHEPATIC DUCTS: Normal
INTRAHEPATIC DUCTS: Irregular dilatation
Primary biliary cirrhosis
“Lace-like” pattern of fibrosis
Tx and prognosis of PBC (primary biliary cirrhosis
ursodeoxycholic acid.
Excellent prognosis if caught early
Increased in PBC
antimitochodrial antibodies (AMA)
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).
Long Common Channel
What biliary anatomic variant has an increased incidence of pancreatitis?
Long Common Channel
ENZYME REFLUX
Long common channel is associated with what type of choledochocysts?
The most common Choledochal cyst
Type I
DIlatation of the CBD
Type I
DIlatation of the CBD
Type 2
Diverticulum of the bile duct
Type 3
“choledochocele.”
Intraduodenal diverticulum
Type 4 (Type 2+3)
both intra and extra.
Type V
Caroli’s diease (multiple intrahepatic dilatations)
Caroli’s is an AR disease associated with?
PCKD and Medullary sponge kidney
Hallmark of Caroli’s disease
is intrahepatic duct dilation, that is large and saccular.
Caroli’s disease
Complications of Choledocal cysts
Cholangiocarcinoma
Cirrhosis
Cholangitis
Intraductal Stones
Classic hx of choledocal cyst
Dilated biliary ducts + repeated cholangitis
These things get stones in them and can be recurrently infected.
