Liver and Biliary Radiography

Question 1

acute cholecystitis- caused by? imaging?

Answer 1

stone obstructs the cystic duct- infl process!

-US- stones (shadowing), GB wall thickening, edema

Question 2

Acute cholecystitis- complications

Answer 2

-gangrene, perforation, fistula

Question 3

functional gallbladder disorder- HIDA scan

Answer 3

-CCK-induced GB ejection fraction <40%

Question 4

Biliary dyskinesia- caused by? tests

Answer 4

• biliary pain due to a primary gallbladder motility disturbance (in absence of gallstones, sludge, microlithiasis)
• liver and pancreas tests normal
• HIDA and PIPIDA with CCK-stim cholescintigraphy- ejection fraction < 40%
• pain elicited during CCK infusion- diagnostic

Question 5

Choledocholithiasis- sx, imaging

Answer 5

• charcot’s triad- RUQ pain, fever, jaundice
• lab- common bile/hepatic duct obstruction (elevated alk phos, T bili)
• MRCP- non invasive
• ERCP- diagnostic, therapeutic

Question 6

Choledocholithiasis- complications

Answer 6

-cholangitis, obstructive jaundice, acute pancreatitis, biliary cirrhosis

Question 7

Ascending cholangitis- caused by? sx?

Answer 7

infection of the biliary tract secondary to bile duct obstruction

• E coli, Klebsiella, Streptococcus faecalis, enterobacter, bacteroides fragilis
• Reynolds pentad- fever, jaundice, RUQ, shock, mental status changes!!

Question 8

Ascending cholangitis- tx

Answer 8

• ERCP (but not during active phase)
• late finding- intrahepatic abscesses at duct ends!!!
• IV antibiotics and fluids

Question 9

gallstone pancreatitis

Answer 9

obstruction of hepatopancreatic ampulla- reflux of bile into main pancreatic duct

• elevated amylase and lipase, ALT > AST
• RUQ US, ERCP, cholecystectomy

Question 10

gallstone ileus- caused by?

Answer 10

complication of cholelithiasis!

• infl- adhesions, pressure necrosis
• gallstone enters bowel thru cholecystoenteric fistula–> air in biliary tree!!
• stones become impacted in ileocecal valve!!

Question 11

Gallstone ileus- sx

Answer 11

• Rigler’s triad- small bowel obstruction, gas in biliary tree, gallstone!
• episodic small bowel obstruction sx as stone passes thru bowel lumen (gets stuck in ileocecal valve)
• can complicate Crohn dz

Question 12

retroperitoneal structures

Answer 12

SADPUCKER

• suprarenal (adrenal) glands
• AORTA and IVC
• Duodenum (2-4th parts)
• pancreas (except tail)
• ureters
• colon (asc and desc)
• kidneys
• esophagus
• rectum

Question 13

pancreatic trauma- causes what?

Answer 13

• cause of retroperitoneal hematomas!!
• grey-turner (flank), cullen (umbilicus) signs
• CT