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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
Pediatric cholelithiasis is associated with?
- Cystic fibrosis - Malabsorption - Crohn’s disease - Bowel resection - Sickle cell anemia
26
Neonatal cholelithiasis associated with?
- Anomalies of the biliary system - Dehydration - TPN (total parenteral nutrition - causes bile stasis) - Infection - Hemolytic anemia
27
cholelithiasis clinical presentations?
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
cholelithiasis sono?
Mobile echogenic intraluminal structures with PAS, may have twinkle artifact with colour doppler
29
GB sludge? - what is it? - artifact? - causes?
- 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
Cholecystitis causes?
- Hypoalbuminemia - Acute Viral Hepatitis - Heart and renal failure - Cystic duct obstruction from external source
31
Cholecystitis symptoms?
- RUQ pain - Fever - Vomiting - Palpable RUQ lump
32
what Hydropic gallbladder??
- Acutely ill children on TPN associated with: - Kawasaki syndrome - leptospirosis - chronic biliary obstruction
33
Hydropic gallbladder clinical presentation?
- RUQ pain - Fever - Dehydration - Abdo distention - Cause is unclear
34
Hydropic gallbladder sono features?
GB - enlarged, anechoic, with thin walls
35
Biliary Obstruction?
- Can be intrahepatic or extrahepatic examples of intrahepatic: - Stones, strictures examples of extrahepatic: - tumor, LNs. acute pancreatitis
36
Biliary Obstruction presents as?
- ducts become dilated | - multiple irregular branching of bile ducts
37
ducts cab rupture in biliary obstruction and cause?
- neonatal jaundice - biliary ascites - biloma
38
Sclerosing Cholangitis?
Chronic disease with inflammatory fibrosis that obliterates the intra and extra hepatic bile ducts
39
Sclerosing Cholangitis result in? (3)
- biliary cirrhosis - portal hypertension - liver failure
40
Sclerosing Cholangitis associated with?
- IBD (70-80%)
41
Sclerosing Cholangitis clinical presentation?
- UQ pain - Jaundice - Abnormal LFTs and ↑ bilirubin
42
Sclerosing Cholangitis sono features?
- thickened bile duct walls - choledocholithiasis - ductal strictures
43
Biliary Neoplasm- Rhabdomyosarcoma
- Rare - Ages 1-5 years - Arises from biliary tract and causes obstruction
44
Rhabdomyosarcoma clinical presentation?
- Increasing abdo girth - Jaundice - Pain - Weight loss
45
Rhabdomyosarcoma sono feature?
Solid Hyperechoic Within bile ducts

Peds (18 decks)

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