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Abdominal Pathology > Lesson 2A (Part 4) > Flashcards

Lesson 2A (Part 4) Flashcards

1
Q

What are indications for a biliary US? (2)

A
  1. Patients have increased LFT’s
  2. Painless or painful jaundice
    - acute obstruction or infection of biliary tree
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2
Q

What are you trying to rule out with a biliary US? (5)

A
  1. Obstruction of bile ducts
    - are the ducts or gallbladder dilated
    - if dilated, at what level
  2. Stones
  3. Infection
  4. Neoplasms
  5. Extrinsic compression
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3
Q

Stasis

A

Bile has been sitting in the gallbladder for a long time without being excreted

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4
Q

When you lay down, where do the stones in a gallbladder normally fall to?

A

The neck

- gravity dependent

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5
Q

What happens in gangrenous cholecystitis?

A

The inner most layer of the wall becomes detached and ends up in the lumen

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6
Q

Acalculus

A

No stones

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7
Q

What kind of a disease is a choledochal cyst?

A

Congenital disease

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8
Q

What are type 1, 2 and 3 of choledochal cysts involved with?

A

Cystic dilation of the common bile duct

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9
Q

What type 4 of choledochal cysts involved with?

A

Intrahepatic ducts

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10
Q

What type 5 of choledochal cysts involved with?

A

Caroli’s disease

- not a true choledochal cyst

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11
Q

Carolis disease

A

Is a rare congenital disease that involves the intrahepatic biliary tree associated with medullary sponge kidneys
- usually diffuses

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12
Q

Who does caroli’s disease effect?

A

Men and women equally

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13
Q

What kind of complications can arise with caroli’s disease? (6)

A
  1. Biliary stasis
  2. Cholangitis
  3. Stones and sepsis
  4. Hepatic fibrosis
  5. Portal hypertension
  6. At risk for cholangiocarcinoma
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14
Q

Primary choledocholithiasis

A

Stones form within ducts related to diseases causing strictures or dilation of bile ducts resulting in stasis

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15
Q

What are the causes of primary choledocholithiasis? (5)

A
  1. Sclerosing cholangitis
  2. Caroli’s disease
  3. Parasitic infections of liver
  4. Chronic hemolytic disease
    - sickle cell anemia
  5. Prior biliary surgery
    - enteric anastomosis
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16
Q

Secondary choledocholithiasis

A

Migration of stones from the gallbladder into the common bile duct

17
Q

What symptoms do patients with secondary choledocholithiasis have?

A

Pain in the RUQ/epigastric region

18
Q

What is the sonographic appearance of secondary choledocholithiasis? (4)

A
  1. Dilated common bile duct proximal to the stone
  2. Dilated Intrahepatic ducts
  3. Large stone shadow
    - smaller stones may not shadow
  4. GB distension
19
Q

Where will the majority CBD stones be?

A

In the distal portion of the CBD at the ampulla of vater

20
Q

What are potential differential diagnosis for CBD stones? (3)

A
  1. Blood clot
    - hemobilia
  2. Papillary tumor
  3. Biliary sludge
  • None of these shadow
21
Q

Hemobilia

A

Blood in the biliary

22
Q

When are intrahepatic bile duct stones seen?

A

In patients with cystic fibrosis

23
Q

What is a fistula?

A

Abnormal connection between an organ,vessel,intestine or other structure

24
Q

What is a fistula usually a result of? (4)

A
  1. Injury
  2. Surgery
  3. Infection
  4. Inflammation
25
Q

What is hemobilia caused by?

A
  1. Percutaneous biliary procedures(ERCP)
  2. Liver biopsies
  3. Cholangitis/cholecystitis
  4. Vascular malformations
  5. Trauma
  6. Malignancies
26
Q

What occurs with hemobilia? (3)

A
  1. Pain
  2. Bleeding
  3. Increased bilirubin
27
Q

What is essential in the diagnosis of hemobilia?

A

Clinical history

28
Q

How does hemobilia appear?

A

As blood clot within biliary tree

29
Q

What is the sonographic appearance of hemobilia? (3)

A
  1. Echogenic
  2. Mixed echogenicity
  3. Conforms to shape of the duct
30
Q

Pneumobilia

A

The presence of gas in the biliary system

31
Q

What is the sonographic appearance of pneumobilia? (1)

A
  1. Bright echogenic linear structures following portal triads
  2. Reverberation ring down artifact
32
Q

What are the causes of pneumobilia? (4)

A
  1. Previous biliary intervention
    - iatrogenic
  2. Emphysematous cholecystitis
  3. Choledochoduodenal fistula
  4. Cholecystoenteric fistula
33
Q

What is choledochoduodenal fistula caused by?

A

By stones in the CBD

- inflammation

34
Q

Cholecystoenteric fistula

A

Prolonged acute cholecystitis erodes into an adjacent bowel loop

35
Q

Gallstone ileus

A

Paralysis of the nerves

36
Q

How do stones pass from the gallbladder into the bowel?

A

Cholecystoenteric fistula

37
Q

What does gallstone ileus frequently involve? (2)

A
  1. Duodenum

2. Transverse colon

38
Q

What is the result of gallstone ileus?

A

Prolonged inflammation of gallbladder

Abdominal Pathology (49 decks)

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