Lesson 2A (Part 4) Flashcards
What are indications for a biliary US? (2)
- Patients have increased LFT’s
- Painless or painful jaundice
- acute obstruction or infection of biliary tree
What are you trying to rule out with a biliary US? (5)
- Obstruction of bile ducts
- are the ducts or gallbladder dilated
- if dilated, at what level - Stones
- Infection
- Neoplasms
- Extrinsic compression
Stasis
Bile has been sitting in the gallbladder for a long time without being excreted
When you lay down, where do the stones in a gallbladder normally fall to?
The neck
- gravity dependent
What happens in gangrenous cholecystitis?
The inner most layer of the wall becomes detached and ends up in the lumen
Acalculus
No stones
What kind of a disease is a choledochal cyst?
Congenital disease
What are type 1, 2 and 3 of choledochal cysts involved with?
Cystic dilation of the common bile duct
What type 4 of choledochal cysts involved with?
Intrahepatic ducts
What type 5 of choledochal cysts involved with?
Caroli’s disease
- not a true choledochal cyst
Carolis disease
Is a rare congenital disease that involves the intrahepatic biliary tree associated with medullary sponge kidneys
- usually diffuses
Who does caroli’s disease effect?
Men and women equally
What kind of complications can arise with caroli’s disease? (6)
- Biliary stasis
- Cholangitis
- Stones and sepsis
- Hepatic fibrosis
- Portal hypertension
- At risk for cholangiocarcinoma
Primary choledocholithiasis
Stones form within ducts related to diseases causing strictures or dilation of bile ducts resulting in stasis
What are the causes of primary choledocholithiasis? (5)
- Sclerosing cholangitis
- Caroli’s disease
- Parasitic infections of liver
- Chronic hemolytic disease
- sickle cell anemia - Prior biliary surgery
- enteric anastomosis
Secondary choledocholithiasis
Migration of stones from the gallbladder into the common bile duct
What symptoms do patients with secondary choledocholithiasis have?
Pain in the RUQ/epigastric region
What is the sonographic appearance of secondary choledocholithiasis? (4)
- Dilated common bile duct proximal to the stone
- Dilated Intrahepatic ducts
- Large stone shadow
- smaller stones may not shadow - GB distension
Where will the majority CBD stones be?
In the distal portion of the CBD at the ampulla of vater
What are potential differential diagnosis for CBD stones? (3)
- Blood clot
- hemobilia - Papillary tumor
- Biliary sludge
- None of these shadow
Hemobilia
Blood in the biliary
When are intrahepatic bile duct stones seen?
In patients with cystic fibrosis
What is a fistula?
Abnormal connection between an organ,vessel,intestine or other structure
What is a fistula usually a result of? (4)
- Injury
- Surgery
- Infection
- Inflammation
What is hemobilia caused by?
- Percutaneous biliary procedures(ERCP)
- Liver biopsies
- Cholangitis/cholecystitis
- Vascular malformations
- Trauma
- Malignancies
What occurs with hemobilia? (3)
- Pain
- Bleeding
- Increased bilirubin
What is essential in the diagnosis of hemobilia?
Clinical history
How does hemobilia appear?
As blood clot within biliary tree
What is the sonographic appearance of hemobilia? (3)
- Echogenic
- Mixed echogenicity
- Conforms to shape of the duct
Pneumobilia
The presence of gas in the biliary system
What is the sonographic appearance of pneumobilia? (1)
- Bright echogenic linear structures following portal triads
- Reverberation ring down artifact
What are the causes of pneumobilia? (4)
- Previous biliary intervention
- iatrogenic - Emphysematous cholecystitis
- Choledochoduodenal fistula
- Cholecystoenteric fistula
What is choledochoduodenal fistula caused by?
By stones in the CBD
- inflammation
Cholecystoenteric fistula
Prolonged acute cholecystitis erodes into an adjacent bowel loop
Gallstone ileus
Paralysis of the nerves
How do stones pass from the gallbladder into the bowel?
Cholecystoenteric fistula
What does gallstone ileus frequently involve? (2)
- Duodenum
2. Transverse colon
What is the result of gallstone ileus?
Prolonged inflammation of gallbladder
