Pathology of the Biliary System Flashcards
Someone who presents with the following symptoms could have what?
Acute RUQ pain
Positive Murphy’s sign- inspiratory arrest on palpation of GB area
Fever
Leukocytosis
Increase in serum bilirubin and alkaline phosphatase
Acute Cholecystitis
Most common disease of the gallbladder?
Cholelithiasis
stone in cystic duct creates compression of the CHD—painful jaundice
Mirizzi syndrome
What is Hilar Cholangiocarcinoma?
Klatskin’s Tumor- specific type- occurs at bifurcation
Involvement of central left and right hepatic ducts
Most suggestive sonographic sign-
Isolated intrahepatic duct dilation
Nonunion of right and left duct appreciated
May not see mass
What is the most common pseudotumor of the GB?
Cholesterol polyp
May result from pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct and distal CBD
Choledochal Cyst
Most common tumor sites that spread to the biliary tree
Breast
Colon
Melanoma
Adenomyomatosis
Hyperplastic change in the GB wall
What is Hemobilia?
Blood in the Biliary system.
Benign neoplasms of the GB with a premalignant potential (much lower than colonic adenomas)
Adenoma
RUQ pain with radiation to right shoulder and pain after a fatty meal could be what?
Cholelithiasis
What are the two types of Hyperplastic Cholecystitis?
Cholesterolosis
Adenomyomatosis
What is Cholangiocarcinoma and what are the 3 classifications?
Bile duct cancer.
May arise from any portion of the biliary tree
Uncommon, frequency increases with age
Most common risk factor in the Western world- primary sclerosing cholangitis
Classification is based on the location of the tumor
Intrahepatic (peripheral)
Hilar (Klatskin’s)
Distal
Most cholangiocarcinomas are adenocarcinomas
What is Emphysematous Cholecystitis?
Acute infection of the gallbladder wall caused by gas-forming organisms.
What is Ascariasis?
Parasitic roundworm that uses fecal-oral route of transmission
Grows in the bowel before entering the biliary tree via the ampulla of Vater
Often referred to as “strawberry GB” because the mucosa resembles the surface of a strawberry
Cholesterolosis
What is Acalculous Cholecystitis?
Uncommon, acute inflammation without stones.
What pathology has Ultrasound Findings
Medium to coarse echogenic densities filling GB without bile duct obstruction
Material has 3 characteristics -
Does not shadow, not gravity dependent, does not show layering effect
Wall is irregular- from edematous pockets representing hemorrhage or abscess collections
Gangrenous Cholecystitis
What is Gangrenous Cholecystitis?
Prolonged infection which causes the GB to undergo necrosis.
What is Cholangitis?
Inflammation of the bile ducts
Patients with the Five F’s more prone to what?
Gallstones (Cholelithiasis)
What shows signs of prominent bright echoes along the anterior wall with ring down or comet-tail artifact?
If a large amount of gas is present it could look similar to WES sign.
Emphysematous Cholecystitis
What is Pneumobilia?
Air in the Biliary system.
What is Cholesterolosis?
Condition in which cholesterol is deposited within the lamina propria of the GB
What is Intrahepatic Cholangiocarcinoma?
Least common location, it is the second most common primary malignancy of the liver
What is Acute Cholecystitis? and the most common cause?
inflammation of the GB
Acute- most common cause—gallstones impacted in the cystic duct or neck
What disease presents with the Ultrasound Findings of a Heterogeneous solid or semisolid echo-texture
Large, irregular, fungating mass
GB wall is abnormal and thickened
May see dilated ducts within the liver (“double-barrel” appearance of portal veins and dilated ducts)
Gallbladder Carcinoma
Describe what a Porcelain Gallbladder is?
Rare- calcium incrustation of the GB wall
What is a rare complication of acute cholecystitis?
Emphysematous Cholecystitis
Rare, congenital abnormality
Communicating cavernous ectasia of intrahepatic ducts—characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts
Caroli’s Disease
Characteristics of Cholangiocarcinoma?
Difficult to distinguish from hilar
Progressive jaundice seen in majority of patients
Evaluation of tumor spread to superior ductal system and extrahepatic area should be carefully evaluated
Tumor may extend into adjacent lymph nodes
Multiple cystic structures in area of ductal system that converge towards the porta hepatis
Caroli’s Disease
What is the most common form of gallbladder inflammation?
Chronic Cholecystitis
What has presents with sonographic Findings of
Thick walls of >4-5 mm
Echogenic sludge is seen
and you should Look for pericholecystic fluid with ascites or subserosal edema?
Acalculous Cholecystitis
