Lesson 2B (Part 1)

Question 1

What is acute bacterial cholangitis?

Answer 1

Its an antecedent biliary obstruction

Question 2

What is acute bacterial cholangitis caused by? (4)

Answer 2

1. CBD stones
2. Stricture due to trauma or surgery
3. Choledochal cysts
4. Partially obstructive tumors

Question 3

What are signs and symptoms of acute bacterial cholangitis?(3)

Answer 3

1. Fever
2. RUQ pain
3. Jaundice

Question 4

What are the signs and symptoms fever, RUQ pain and jaundice known as?

Answer 4

Classic Charcot’s Triad

Question 5

What can acute bacterial cholangitis cause? (3)

Answer 5

1. Leukocytosis
2. Increase levels of ALP and bilirubin
3. Gram-negative enteric bacteria in blood

Question 6

What is the sonographic appearance of acute bacterial cholangitis? (7)

Answer 6

1. Dilation of intrahepatic biliary tree
2. Choledocholithiasis
   - stone in distal CBD
3. CBD wall thickening
4. Hepatic abscess
5. Dilated CBD >6mm
6. Pneumobilia
   - suggests a fistula-choledochoenteric
7. Gallbladder wall may be thickened

Question 7

Fasioliasis

Answer 7

Parasitic flatworms that travel through bowel wall and into the peritoneal cavity to the liver capsule into liver parenchyma to cause an infection

Question 8

What do fascioliasis do?

Answer 8

Matures and produces eggs in the biliary tree

Question 9

What are the symptoms of fascioliasis? (3)

Answer 9

1. Jaundice
2. Fever
3. Abscess

Question 10

What is the sonographic appearance of fascioliasis? (3)

Answer 10

1. Hepatomegaly
2. Hilar adenopathy
3. Lesions
   - hypoechoic or mixed echogenicity

Question 11

Where can flukes be seen? (2)

Answer 11

1. Within ducts

2. Within the gallbladder

Question 12

Clonorchiasis and Opisthorchiasis

Answer 12

Larvae that migrate through the Ampulla of Vater into the CBD

Question 13

Where does clonorchiasis and opisthorchiasis mature?

Answer 13

Within the intrahepatic bile ducts

Question 14

What is the sonographic appearance of clonorchiasis and opisthorchiasis? (3)

Answer 14

1. Diffuse dilation of the peripheral intrahepatic ducts
2. Periportal echoes
   - edema (excess of watery fluids)
3. Floating echogenic foci in gallbladder
   - flukes or debris

Question 15

What is ascariasis?

Answer 15

Roundworm that causes infection in the small bowel

- enters the biliary tree via the Ampulla of Vater

Question 16

Who is ascariasis spread?

Answer 16

Fecal-oral route

Question 17

Where do is ascariasis active?

Answer 17

In small bowel, then enters the biliary tree via the Ampulla of Vater

Question 18

What is the sonographic appearance of ascariasis? (3)

Answer 18

1. Appears as a tube or parallel echogenic lines within bile ducts or GB
2. Worm moves during US
3. May be multiple

Question 19

Primary sclerosing cholangitis

Answer 19

Chronic inflammatory disease of entire biliary tree that slowly damages the bile ducts

Question 20

Who is primary sclerosing cholangitis more frequent in?

Answer 20

Men

- around the age of 39

Question 21

What is the cause of primary sclerosing cholangitis?

Answer 21

Unknown

- however, 80% of patients have inflammatory bowel disease (colitis)

Question 22

What does primary sclerosing cholangitis lead to? (5)

Answer 22

1. Biliary strictures
2. Cholestasis
3. Biliary cirrhosis
4. Portal hypertension
5. Hepatic failure

Question 23

What causes secontary sclerosing cholangitis? (10)

Answer 23

1. AIDS cholangiopathy
2. Bile duct neoplasm
3. Biliary tract surgery
4. Trauma
5. Choledocholithiasis
6. Congenital anomalies
7. Ischemic stricturing of bile ducts
8. Toxic strictures
   - infusion of fluxuridine
9. Post treatment for hydatid cyst
10. Primary sclerosing cholangitis

Question 24

What does secondary mean?

Answer 24

That it is caused by something else