Lesson 2B (Part 1) Flashcards
What is acute bacterial cholangitis?
Its an antecedent biliary obstruction
What is acute bacterial cholangitis caused by? (4)
- CBD stones
- Stricture due to trauma or surgery
- Choledochal cysts
- Partially obstructive tumors
What are signs and symptoms of acute bacterial cholangitis?(3)
- Fever
- RUQ pain
- Jaundice
What are the signs and symptoms fever, RUQ pain and jaundice known as?
Classic Charcot’s Triad
What can acute bacterial cholangitis cause? (3)
- Leukocytosis
- Increase levels of ALP and bilirubin
- Gram-negative enteric bacteria in blood
What is the sonographic appearance of acute bacterial cholangitis? (7)
- Dilation of intrahepatic biliary tree
- Choledocholithiasis
- stone in distal CBD - CBD wall thickening
- Hepatic abscess
- Dilated CBD >6mm
- Pneumobilia
- suggests a fistula-choledochoenteric - Gallbladder wall may be thickened
Fasioliasis
Parasitic flatworms that travel through bowel wall and into the peritoneal cavity to the liver capsule into liver parenchyma to cause an infection
What do fascioliasis do?
Matures and produces eggs in the biliary tree
What are the symptoms of fascioliasis? (3)
- Jaundice
- Fever
- Abscess
What is the sonographic appearance of fascioliasis? (3)
- Hepatomegaly
- Hilar adenopathy
- Lesions
- hypoechoic or mixed echogenicity
Where can flukes be seen? (2)
- Within ducts
2. Within the gallbladder
Clonorchiasis and Opisthorchiasis
Larvae that migrate through the Ampulla of Vater into the CBD
Where does clonorchiasis and opisthorchiasis mature?
Within the intrahepatic bile ducts
What is the sonographic appearance of clonorchiasis and opisthorchiasis? (3)
- Diffuse dilation of the peripheral intrahepatic ducts
- Periportal echoes
- edema (excess of watery fluids) - Floating echogenic foci in gallbladder
- flukes or debris
What is ascariasis?
Roundworm that causes infection in the small bowel
- enters the biliary tree via the Ampulla of Vater
Who is ascariasis spread?
Fecal-oral route
Where do is ascariasis active?
In small bowel, then enters the biliary tree via the Ampulla of Vater
What is the sonographic appearance of ascariasis? (3)
- Appears as a tube or parallel echogenic lines within bile ducts or GB
- Worm moves during US
- May be multiple
Primary sclerosing cholangitis
Chronic inflammatory disease of entire biliary tree that slowly damages the bile ducts
Who is primary sclerosing cholangitis more frequent in?
Men
- around the age of 39
What is the cause of primary sclerosing cholangitis?
Unknown
- however, 80% of patients have inflammatory bowel disease (colitis)
What does primary sclerosing cholangitis lead to? (5)
- Biliary strictures
- Cholestasis
- Biliary cirrhosis
- Portal hypertension
- Hepatic failure
What causes secontary sclerosing cholangitis? (10)
- AIDS cholangiopathy
- Bile duct neoplasm
- Biliary tract surgery
- Trauma
- Choledocholithiasis
- Congenital anomalies
- Ischemic stricturing of bile ducts
- Toxic strictures
- infusion of fluxuridine - Post treatment for hydatid cyst
- Primary sclerosing cholangitis
What does secondary mean?
That it is caused by something else
