Lesson 2.1 - Biliary Path (part 1) Flashcards
What is bilirubin
a product of the breakdown of hemoglobin in old RBC
elevation of direct/conjugated bilirubin associated with (4)
obstruction
hepatitis
cirrhosis
liver mets
elevation of indirect/unconjugated bilirubin is assoc with (1)
non obstructive conditions i.e. fatty liver
ALP elevation assoc with (1)*
obstructive jaundice
ALT elevation assoc with (4)*
cirrhosis
hepatitis
biliary obstruction
AST elevation assoc with (3)*
cirrhosis
hepatitis
mononucleosis
2 congenital variants
duplication - rare
multiseptated
what are risk factors for cholelithiasis (6)
female age (increasing) pregnancy fecundity (premenopausal women) obesity diabetes
what is the key feature of stones allowing differentiation from polyps
mobility
sono appearance of gallstone (1)
echogenic
shadowing
mobility
What is WES complex
wall-echo-shadow
what is milk of calcium bile, how is it caused?
GB filled with semisolid calcium carbonate caused by stasis
sono appearance of biliary sludge
amorphous low-level echoes with no acoustic shadowing
with biliary sludge, is there vascularity and are the GB walls normal?
lacks vascularity and normal GB wall
Acute cholecystitis s/s (3)
RUQ pain that is constant/epigastric pain
RUQ tenderness
Nausea/vomiting
Acute cholecystitis is caused by what in most patients?
stones
acute cholecystitis most commonly affects (sex)
women 3x more <50 yrs
impaction of stones in cystic duct or GB neck causes (8)
bile flow obstruction (duct dilation) luminal distension ischemia infection necrosis fever leukocytosis increased ALP & bilirubin
sono role for determining + murphys sign
pt in decub, slight/mod pressure over GB with probe (sag)
Sono signs for acute cholecystitis (8)
Thickening of GB wall >3mm Edematous wall - can differentiate layers Hyperemic wall Percholecystic fluid collection GB lumen distension >4cm transverse Gallstones \+ murphys Duct dilation
Gangrenous cholecystitis main sono finding *
Sloughing of wall into lumen
non layering bands echogenic tissue
t/f Gangrenous cholecystitis shows a positive murphys sign
False - the nerves are necrosed in gangrenous cholecystitis so no + murphys sign
focal defect in wall and deflation of GB in what pathology
GB perforation
Pericholecystic fluid collection seen in what pathology
GB perforation (could also be acute cholecystitis)
what pathology is frequently acalculus
Emphysematous cholecystitis
(t/f) Emphysematous cholecystitis is most common in men
true
Emphysematous cholecstitis appearance (2)
GAS IN LUMEN AND WALL
echogenic line, posterior dirty shadow
ring down artifact
How is chronic cholecystitis differentiated from acute cholecystitis * (3)
Absence of the following:
- GB distension
- murphys sign
- hyperemia of the wall
what GB conditions do not show + murphys sign (2)
Gangrenous
chronic cholecystitis
What GB pathology is common in the critically ill*, old, immunocompromised, diabetic?
acalculous cholecystitis
Torsion of GB
GB lies in unusual horizontal position
If torsion of GB exceeds 180 degrees what may occur?
Gangrene
What might you expect if GB wall is thickly calcified with dense posterior acoustic shadowing
Porcelain GB
Is adenomyomatosis benign/malignant and is it symptomatic?
benign and asymptomatic
What is the key to diagnosing adenomyomatosis
thickening of adjacent GB wall
ring-down artifact from Rokitansky-Aschoff sinuses
what may appear as twinkling
adenomyomatosis
multiple polypoid masses characterizes benign or malignant
benign
