Hepatobiliary Radiography

Question 1

Acute Cholecystitis

Answer 1

• stone obstructs the cystic duct and induces inflammatory process
• presence of stones, wall thickening, edema

Question 2

What are the complications of Acute cholecystitis

Answer 2

gangrene, perforation, cholecystoenteric fistula

Question 3

What does cholecystitis look like on imaging?

Answer 3

absence of echoes posterior to the calculi “shadowing”

Question 4

What is Biliary dyskinesia?

Answer 4

biliary pain resulting from primary gallbladder motility disturbance in the absence of gallstones, sludge, microlithiasis
-liver and pancreas blood tests are normal

Question 5

what infusion can elicit pain in biliary dyskinesia and can also be diagnostic?

Answer 5

CCK infusion

Question 6

What test do we do for Biliary dyskinesia

Answer 6

HIDA and PIPIDA with CCK-stimulated cholescintigraphy indicates ejection fraction <35-40%

Question 7

Which procedure is non invasive and is a good first choice?

Answer 7

MRCP

Question 8

Choledocholithiasis

Answer 8

Charcot’s triad
lab values reflect common bile/ hepatic duct obstruction
-MRCP and ERCP
-ERCP is diagnostic and therapeutic

Question 9

What are complications of choledocholithiasis?

Answer 9

Cholangitis, obstructive jaundice, acute pancreatitis, biliary cirrhosis

Question 10

Ascending Cholangitis

Answer 10

• infection of the biliary tract secondary to bile duct obstruction
• Clinical signs: Reynold’s pentad: Fever, jaundice, RUQ pain, shock, and mental status changes
• Hyperbilirubinemia, leukocytosis, mild elevation in serum transaminases

Question 11

What is the Tx for ascending Cholangitis?

Answer 11

ERCP, but not during acute phase

• Late finding: intrahepatic abscesses at duct ends
• IV antibiotics and fluids for supportive care

Question 12

Gallstone pancreatitis

Answer 12

• Mechanical obstruction of hepatopancreatic ampulla causes reflus of bile into main pancreatic duct
• elevated serum amylase and lipase; elevated ALT>AST
• RUQ ultrasound, ERCP and cholecystectomy relieve symptoms

Question 13

Gallstone ileus

Answer 13

Complication of cholelithiasis

• Gallstone enters bowel through cholecystoenteric fistula
• AIR IN THE BILIARY TREE
• 50-70% of stones become impacted in the ileum, the narrowest segment of the intestine

Question 14

What is Rigler’s triad?

Answer 14

• associated with Gallstone Ileus
• Small bowel obstruction
• Gas within the biliary tree
• Gallstone (usually in right iliac fossa)

Question 15

How does gallstone ileus present?

Answer 15

with episodic small bowel obstruction symptoms as stone passes through bowel lumen
-can complicate Crohn disease by obstructing a diseased segment of bowel

Question 16

What are the retroperitoneal structures?

Answer 16

SADPUCKER

• suprarenal glands (adrenals)
• Aorta and IVC
• Duodenum (2nd and 4th parts)
• Pancreas (except tail)
• Ureters
• Colon (descending and ascending
• Kidneys
• Esophagus
• Rectum

Question 17

What is pancreatic trauma a frequent cause of?

Answer 17

retroperitoneal hematomas

Question 18

What are some signs of pancreatic trauma?

Answer 18

Grey-turner and Cullen signs

Question 19

Grey turner sign?

Answer 19

flank bruising

Question 20

Cullen sign?

Answer 20

bruises on the belly button

Question 21

How is pancreatic trauma diagnosed?

Answer 21

imaging studies (CT)