Pathology of the Biliary System

Question 1

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

Answer 1

Acute Cholecystitis

Question 2

Most common disease of the gallbladder?

Answer 2

Cholelithiasis

Question 3

stone in cystic duct creates compression of the CHD—painful jaundice

Answer 3

Mirizzi syndrome

Question 4

What is Hilar Cholangiocarcinoma?

Answer 4

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

Question 5

What is the most common pseudotumor of the GB?

Answer 5

Cholesterol polyp

Question 6

May result from pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct and distal CBD

Answer 6

Choledochal Cyst

Question 7

Most common tumor sites that spread to the biliary tree

Answer 7

Breast
Colon
Melanoma

Question 8

Adenomyomatosis

Answer 8

Hyperplastic change in the GB wall

Question 9

What is Hemobilia?

Answer 9

Blood in the Biliary system.

Question 10

Benign neoplasms of the GB with a premalignant potential (much lower than colonic adenomas)

Answer 10

Adenoma

Question 11

RUQ pain with radiation to right shoulder and pain after a fatty meal could be what?

Answer 11

Cholelithiasis

Question 12

What are the two types of Hyperplastic Cholecystitis?

Answer 12

Cholesterolosis

Adenomyomatosis

Question 13

What is Cholangiocarcinoma and what are the 3 classifications?

Answer 13

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

Question 14

What is Emphysematous Cholecystitis?

Answer 14

Acute infection of the gallbladder wall caused by gas-forming organisms.

Question 15

What is Ascariasis?

Answer 15

Parasitic roundworm that uses fecal-oral route of transmission
Grows in the bowel before entering the biliary tree via the ampulla of Vater

Question 16

Often referred to as “strawberry GB” because the mucosa resembles the surface of a strawberry

Answer 16

Cholesterolosis

Question 17

What is Acalculous Cholecystitis?

Answer 17

Uncommon, acute inflammation without stones.

Question 18

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

Answer 18

Gangrenous Cholecystitis

Question 19

What is Gangrenous Cholecystitis?

Answer 19

Prolonged infection which causes the GB to undergo necrosis.

Question 20

What is Cholangitis?

Answer 20

Inflammation of the bile ducts

Question 21

Patients with the Five F’s more prone to what?

Answer 21

Gallstones (Cholelithiasis)

Question 22

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.

Answer 22

Emphysematous Cholecystitis

Question 23

What is Pneumobilia?

Answer 23

Air in the Biliary system.

Question 24

What is Cholesterolosis?

Answer 24

Condition in which cholesterol is deposited within the lamina propria of the GB

Question 25

What is Intrahepatic Cholangiocarcinoma?

Answer 25

Least common location, it is the second most common primary malignancy of the liver

Question 26

What is Acute Cholecystitis? and the most common cause?

Answer 26

inflammation of the GB

Acute- most common cause—gallstones impacted in the cystic duct or neck

Question 27

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)

Answer 27

Gallbladder Carcinoma

Question 28

Describe what a Porcelain Gallbladder is?

Answer 28

Rare- calcium incrustation of the GB wall

Question 29

What is a rare complication of acute cholecystitis?

Answer 29

Emphysematous Cholecystitis

Question 30

Rare, congenital abnormality
Communicating cavernous ectasia of intrahepatic ducts—characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts

Answer 30

Caroli’s Disease

Question 31

Characteristics of Cholangiocarcinoma?

Answer 31

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

Question 32

Multiple cystic structures in area of ductal system that converge towards the porta hepatis

Answer 32

Caroli’s Disease

Question 33

What is the most common form of gallbladder inflammation?

Answer 33

Chronic Cholecystitis

Question 34

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?

Answer 34

Acalculous Cholecystitis