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CNIH > Peds- GB biliary system > Flashcards

Peds- GB biliary system Flashcards

1
Q

3 variants of GB?

A
  1. Phrygian cap – fold at fundus
  2. Hartmann pouch – widening at neck
  3. Prominent spiral valves of Heister
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2
Q

6 congenital anomalies of GB?

A
  1. Ectopia
  2. Agenesis
  3. Duplication
  4. Biliary Atresia
  5. Choledochal Cyst
  6. Multiseptate Gb
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3
Q

Multiseptate GB can lead to?

A
  • septations can lead to bile stasis and formation of gallstones
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4
Q

the two major causes of conjugated hyperbilirubinemia in newborns?

A
  • liver diseases (hepatitis)

- biliary atresia

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5
Q

3 types of bilary atresia manifestations?

A
  1. Absence of biliary tree
  2. Rudimentary gb and cystic duct
  3. Visible gb, cystic duct and CBD
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6
Q

Newborns develop neonatal jaundice at what age?

A

3-4 weeks

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7
Q

Biliary atresia sono features?

A
  • GB, cystic duct, CBD and IHBD may be seen incompletely, depending on degree of severity
  • Early signs of cirrhosis
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8
Q

2 important findings to diagnose biliary atresia?

A
  • triangular cord sign

- GB length <1.5 cm or absent

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9
Q

TRIANGULAR CORD SIGN?

A

Triangular, cone-shaped, fibrous ductal remnant is positioned anterior and superior to the portal vein and the hepatic artery

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10
Q

Biliary atresia- kasai procedure?

A
  • Surgical intervention where a connection is made between the duodenum and gallbladder, CBD and liver to drain the bile
  • Successful if performed early
  • Successful in 1/3 of cases
  • 2/3 will need liver transplantation
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11
Q

Choledochal cyst symptoms? (3)

A
  • abdo pain
  • ando mass
  • jaundice
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12
Q

How many types of Choledochal cyst are there?

A

five

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13
Q

type 1 Choledochal cyst?

A
  • concentric dialation of CBD

- Most common type

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14
Q

Type 2 Choledochal cyst?

A
  • CBD diverticulum
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15
Q

Choledochal cyst type 3?

A

choledochocele:

- cystic dialation of intraduodenal portion of CBD

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16
Q

Choledochal cyst type 4?

A
  • Ditatation of CBD with IHBD involvement
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17
Q

Choledochal cyst type 5?

A
  • Caroli Disease
  • Saccular dilatation of IHBD with calculus formation and bacterial cholangitis
  • Minimal dilatation of IHBD, associated with hepatic fibrosis and portal hypertension
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18
Q

Choledochal cyst sono features?

A
  • Cystic structure near GB continuous with bile ducts
  • Large cysts containing sludge
  • IHBD dilatations (type IV and V)
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19
Q

Choledochal cyst complications?

A
  • Stone formation in cyst, GB, panc duct
  • Biliary obstruction
  • Chronic cholangitis
  • Cirrhosis
  • Bilirary rupture with biliary peritonitis (image)
20
Q

Acquired Pathology of the Gallbladder and Biliary System (7)?

A 
Gallbladder wall thickening
Cholelithiasis
Cholecystitis
Hydropic Gallbladder 
Biliary Obstruction
Sclerosing Cholangitis 
Rhabdomyosarcoma
21
Q

Gallbladder Wall Thickness?

A

Normal up to 3 mm (fasting)

> 3 mm indicates disease

22
Q

Gallbladder Wall Thickness inflammatory causes?

A
  • acute and chronic cholecystitis
23
Q

Gallbladder Wall Thickness noninflammatory?

A
  • Viral hepatitis
  • cirrhosis
  • congestive heart failure
  • pancreatitis
24
Q

What is Cholelithiasis?

A

Presence of one or more calculi in the GB, cystic duct or CBD

25
Q

Pediatric cholelithiasis is associated with?

A
  • Cystic fibrosis
  • Malabsorption
  • Crohn’s disease
  • Bowel resection
  • Sickle cell anemia
26
Q

Neonatal cholelithiasis associated with?

A
  • Anomalies of the biliary system
  • Dehydration
  • TPN (total parenteral nutrition - causes bile stasis)
  • Infection
  • Hemolytic anemia
27
Q

cholelithiasis clinical presentations?

A

Young Children:
- Nonspecific - jaundice, irritability

Older Children:

  • RUQ pain
  • Intolerance to fatty foods
  • N&V
  • Neonates may be examined because stones were seen in utero; most resolve within first year of life
28
Q

cholelithiasis sono?

A

Mobile echogenic intraluminal structures with PAS, may have twinkle artifact with colour doppler

29
Q

GB sludge?

  • what is it?
  • artifact?
  • causes?
A
  • Low-level echoes in GB
  • May create layer within GB, fill the lumen or create sludge balls
  • Slice thickness artifact

Causes:

  • Prolonged fasting
  • Hyperalimentation/TPN
  • Extraheptic bile duct obstruction
30
Q

Cholecystitis causes?

A
  • Hypoalbuminemia
  • Acute Viral Hepatitis
  • Heart and renal failure
  • Cystic duct obstruction from external source
31
Q

Cholecystitis symptoms?

A
  • RUQ pain
  • Fever
  • Vomiting
  • Palpable RUQ lump
32
Q

what Hydropic gallbladder??

A
  • Acutely ill children on TPN

associated with:

  • Kawasaki syndrome
  • leptospirosis
  • chronic biliary obstruction
33
Q

Hydropic gallbladder clinical presentation?

A
  • RUQ pain
  • Fever
  • Dehydration
  • Abdo distention
  • Cause is unclear
34
Q

Hydropic gallbladder sono features?

A

GB - enlarged, anechoic, with thin walls

35
Q

Biliary Obstruction?

A
  • Can be intrahepatic or extrahepatic

examples of intrahepatic:
- Stones, strictures

examples of extrahepatic:
- tumor, LNs. acute pancreatitis

36
Q

Biliary Obstruction presents as?

A
  • ducts become dilated

- multiple irregular branching of bile ducts

37
Q

ducts cab rupture in biliary obstruction and cause?

A
  • neonatal jaundice
  • biliary ascites
  • biloma
38
Q

Sclerosing Cholangitis?

A

Chronic disease with inflammatory fibrosis that obliterates the intra and extra hepatic bile ducts

39
Q

Sclerosing Cholangitis result in? (3)

A
  • biliary cirrhosis
  • portal hypertension
  • liver failure
40
Q

Sclerosing Cholangitis associated with?

A
  • IBD (70-80%)
41
Q

Sclerosing Cholangitis clinical presentation?

A
  • UQ pain
  • Jaundice
  • Abnormal LFTs and ↑ bilirubin
42
Q

Sclerosing Cholangitis sono features?

A
  • thickened bile duct walls
  • choledocholithiasis
  • ductal strictures
43
Q

Biliary Neoplasm- Rhabdomyosarcoma

A
  • Rare
  • Ages 1-5 years
  • Arises from biliary tract and causes obstruction
44
Q

Rhabdomyosarcoma clinical presentation?

A
  • Increasing abdo girth
  • Jaundice
  • Pain
  • Weight loss
45
Q

Rhabdomyosarcoma sono feature?

A

Solid
Hyperechoic
Within bile ducts

CNIH (69 decks)

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