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DMST ABD 3 > Metabolic Disease: GB And Bile Ducts > Flashcards

Metabolic Disease: GB And Bile Ducts Flashcards

1
Q

What is biliary sludge? 2

A
  1. Biliary sand/ Microlithiasis
  2. A mixture of particulate matter and bile
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2
Q

Biliary sludge can be a precursor of what?

A

GB disease

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3
Q

Are there s/s with Biliary sludge? Does it resolve?

A
  1. May or may not have symptoms
  2. May resolve by spontaneously
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4
Q

Bile stasis most likely cause is what? 4

A
  1. Prolonged fasting
  2. Rapid weight loss
  3. TPN
  4. Extrahepatic biliary obstruction
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5
Q

What does bile look like sonographically? 4

A
  1. Non- shadowing homogenous low level echoes
  2. Layers in dependent part of GB
  3. Fluid/ fluid level
  4. Moves with changing position of patient
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6
Q

Sludge ball/ tumefactive sludge is what? (what does it mimic?)

A

Sludge that mimics polyploid tumors

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7
Q

How do we different sludge balls and polyp? 3

A
  1. Look at vascularity
  2. Mobility (polyploid are not mobile)
  3. GB wall thickness (Sludge might not have thickened wall)
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8
Q

What is GB hepatization? What does it do?

A
  1. When sludge has the same echogenicity as the liver
  2. Camouflages the GB
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9
Q

What is pseudo sludge? 3

A

Artifacts due to
1. Excessive gains
2. Slice thickness or side lobe artifacts
3. Independent of gravity

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10
Q

What is Empyema?

A

The presence of pus in the bile

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11
Q

What is Hemobilia?

A

The presence of blood in bile, usually due to liver biopsy, Percutaneous biliary procedures

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12
Q

How common is Milk of calcium (limey bile)?

A

Rare

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13
Q

Milk of calcium is a different category of what?

A

Biliary sludge

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14
Q

What is milk of calcium (limey bile) ?

A

GF filled with semi solid deposit

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15
Q

How does Milk of calcium (Limey bile) look like sonographically? 4

A
  1. Hyperechoic debris
  2. Posterior shadowing
  3. Changes with position
  4. Calcium/ bile fluid level
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16
Q

What is a cholelithiasis?

A

Gallstones

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17
Q

What is the most common condition of the GB?

A

Gallstones/ Cholelithiasis

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18
Q

What is the etiology of Gallstones? 3

A
  1. Abnormal bile composition
  2. Biliary stasis
  3. Infection
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19
Q

What is the patient clinical presentation of gallstones? 4 (s/s)

A
  1. Asymptomatic
  2. RUQ pain (after meals)
  3. N and V
  4. Belching
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20
Q

Who is at risk for gallstones?5

A
  1. Female
  2. Fat
  3. Fertile
  4. Forty
  5. Family history
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21
Q

Gallstones need to be at least how big to shadow

A

1mm but <5mm may not shadow

22
Q

What is the sonographic appearance of gallstones? 4

A
  1. Echogenic focus
  2. Posterior shadowing
  3. Mobile
  4. Float in bile
23
Q

What are some things that might cause some false positives for gallstones? 3

A
  1. Valves of heisted
  2. Fat in porta hepatis
  3. Duodenal gas
24
Q

WES sign is seen when?

A

The GB is filled with multiple stones or one large stone

25
Q

What are some lab values that are affected by Gallstone? 4

A
  1. AST
  2. ALT
  3. ALP
  4. BILI
26
Q

What are some complications of Gallstones? 5

A
  1. Biliary colic
  2. Obstruction of cystic duct or CBD > hydrops
  3. Bacterial infection
  4. Cholecystits
  5. Ascending cholangitis
27
Q

What is the most common complication of gallstones

A

Biliary colic

28
Q

An ultrasound examination to investigate possible obstruction of the biliary tree should focus on answering what three questions?

A
  1. Are the bile ducts or GB dilated
  2. If yes, to what level
  3. If yes, what is the cause
29
Q

What kind of dilation can the biliary tract be? 2

A

Biliary dilation may be
1. Intra or extra hepatic
2. Mild, moderate, or severe

30
Q

What causes the ducts to dilate? 3

A
  1. Obstruction
  2. Loss of duct wall elasticity
  3. Ampullary dysfunction
31
Q

What is the clinical presentation of biliary obstruction?

A

Painless or painful jaundice

32
Q

How does painless biliary obstruction clinically present like? 2 (not s/s)

A
  1. Neoplastic conditions
  2. Choledochal cysts
33
Q

What is the clinical presentation of painful jaundice of biliary obstruction seen with?

A

Seen with acute obstruction (stones) and/or infection of the biliary tree

34
Q

What are S/S of obstruction? 4

A
  1. Jaundice
  2. Clay covered stools
  3. Abnormal LFT
  4. Pain, nausea
35
Q

What is Choledocholithiasis?

A

Stones in the biliary tree

36
Q

What are secondary causes of choledocholithiasis?

A

Most commonly stones passing from GB to ducts

37
Q

What are some primary causes of choledocholithiasis? 2

A
  1. Formation of stones in the duct
  2. Related to inflammation, certain types of infection, caroli disease, prior surgery
38
Q

What is the most common location of choledocholithiasis?

A

Distal CBD at ampulla of vater

39
Q

What does choledocholithiasis looks like sonographically? 2

A
  1. Hyperechoic focus
  2. Posterior shadowing
40
Q

What are some scanning techniques for scanning choledocholithiasis? 4

A
  1. Change patient position
  2. Compress bowel
  3. Change windows
  4. Use pancreatic head for reference
41
Q

What would result in false positives of choledocholithiasis? 3

A
  1. Surgical clips post cholecystectomy
  2. Air
  3. Edge artifact
42
Q

What are some lab values that are affected by choledocholithiasis? 4

A

Increase in
1. ALP
2. AST
3. ALT
4. Bilirubin

43
Q

What are treatment options for choledocholithiasis? 3

A
  1. ERCP spincterotomy
  2. ERCP extraction
  3. Stenting
44
Q

What does this image demonstrate?

A

Biliary sludge

45
Q

What does this image represent?

A

Sludge balls/ tumerfactive sludge

46
Q

What does this image represent?

A

GB hepatization

47
Q

What does this image represent?

A

Cholelithiasis

48
Q

What does this image represent?

A

Gall stones

49
Q

What does this image represent?

A

WES sign
(Wall, Echo, shadow)

50
Q

What does this image represent?

A

Choldedocholithiasis

51
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatograph

DMST ABD 3 (11 decks)

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