hepatobiliary radiograph TB

Question 1

what is acute cholecystitis and what are findings with it

complications

liver enzymes and bilirubin

Answer 1

stone obstructing the cystic duct
induces inflammatory process

• presence of stones, wall thickening (4-5mm)
• edema

complications: gangrene, perforation, cholecystoenteric fistula

liver enzymes and bilirubin normal bc no back flow into liver with cystic duct blockage

Question 2

what is biliary dyskinesia

Answer 2

biliary pain resulting from a primary GB motility disturbance in absence of gallstones, sludge, microlithiasis

Question 3

biliary dyskinesia

• liver and pancreas blood test
• test to diagnos
• symptoms relieved with what

Answer 3

liver and pancreas blood tests are normal

HIDA and PIPIDA with CCK stimulated cholescintigraphy indicates ejection fraction of less than 35-40%

pain elicited during CCK infusion is diagnostic

symptoms releived with cholecystectomy

Question 4

complications with choledocholithiasis

Answer 4

cholangitis
obstructive jaundice
actue pancreatitis
biliary cirrhosis

Question 5

main causes of acending cholangitis

Answer 5

choledocholithiasis
pancreatic/biiary neoplasm
postoperative stricture
choledocal cysts

Question 6

bacteria in ascending cholangitis

Answer 6

e coli
klebsiella pneumoniiae
streptococcus faecalis
enterobacter
bacteroides fragilis

Question 7

clinical signs of ascending cholangitis

Answer 7

reynolds pentad

• hyperbili
• leukocytosis
• mild elevation in serum transminases

Question 8

what is a late finding in ascending cholangitis

Answer 8

intrahepatic absceses at duct ends

Question 9

what is complication of ERCP for ascending cholangitis

Answer 9

perforation of duodenum

-would have history of air underneath diaphragm

Question 10

gallstone pancreatitis

what is it

• labs
• diagnose and treat

Answer 10

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

• elevated serum amylase and lipase, elevated ALT>AST
• RUQ ultrasound, ERCP and cholecystectomy relieve symptoms

Question 11

gallstone ileus

Answer 11

complication of cholelithiasis
pericholecystic inflammation leads to development of adhesions and pressure necrosis

• gallstone enters bowel through cholecystoenteric (cholecystoduodenal) fistula–>air in biliary tree
• 50-70% of stones become impacted in the ileum

Question 12

gallstone ileus rigler’s triad

• pt present with
• can complicate

Answer 12

small bowel obstruction
gas within biliary tree
gallstone (usually in right iliac fossa)
-pt present with episodice small bowel obstruction symproms as stone passes
-can complicate crohn disease by obstructing disesaed segment of bowel

Question 13

retroperitoneal structures

Answer 13

SAD PUCKER

Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2-4th parts)

Pancreas (except tail)
Ureters
Colon (descending and ascending)
Kidneys
Esophagus
Rectum

Question 14

what is a common cause of retroperitoneal hematomas

Answer 14

pancreatic trauma