Hepatobiliary Radiograph - Taylor Brown

Question 1

Main modality of acute cholecystitis diagnosis is

Answer 1

Ultrasound and look for gallbladder wall thickening or edema

Question 2

Acute choleystitis finding on US

Answer 2

• Stones
• absence of echoes posterior to calculi ‘ shadowing’
• may show Thickened wall (> 4-5mm)
• may show Free fluid

Question 3

If a patient presents with RUQ pain w/o radiation that starts 30 mins after eating greasy food, nausea w/o vomiting, and US shows no gallstones, sludge or microlithiasis, liver and pancreas tests are all normal, what is the likely diagnosis?

Answer 3

Biliary dyskinesia

Question 4

How is biliary dyskinesia diagnosed?

Answer 4

• HIDA and PIPIDA with CCK-stimulated cholescinthigraphy indicating EF < 35-40%
• pain elicited during CCK infusion is also diagnostic

Question 5

cause of gallstone pancreatitis

Answer 5

mechanical obstruction of hepatopancreatic ampulla causes reflex of bile into main pancreatic duct

Labs would show elevated amylase and lipase along with elevated ALT and AST

Question 6

How is gallstone ileus developed?

Answer 6

• complication of cholelithiasis
• pericholecystic inflammation leads to development of adhesions and pressure necrosis
• gallstones enters bowel through cholecystoenteric fistual –> air in biliary tree
• stones get impacted in ileum which is the narrowest portion of intestine

Question 7

what’s Rigler’s triad?

Answer 7

Seen in gallstone ileus:

• Small bowel obstruction
• gas within biliary tree
• gallstone (usually in right iliac fossa)

Question 8

Diagnosis of pancreatic trauma is best done by what imaging modality?

Answer 8

CT

Question 9

best imaging modality for gallstone pancreatitis

Answer 9

• RUQ ultrasound

- ERCP