The Bile Ducts Flashcards
___: inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
acute pancreatitis
___: the merging point of the pancreatic duct and common bile duct just before the sphincter of Oddi; also referred to as the hepatopancreatic ampulla
ampulla of Vater
___: an infection of the small intestine that is caused by Ascaris lumbricoides, a parasitic roundworm
ascariasis
___: a congenital disease described as the narrowing or obliteration of all or a portion of the biliary tree
biliary atresia
___: pain secondary to a blockage of the biliary tree
biliary colic
___: a condition in which bile is stagnant and allowed to develop
into sludge or stones
biliary stasis
___: a yellowish pigment found in bile that is produced by the breakdown of old red blood cells by the liver
bilirubin
___: a green pigment found in the bile
biliverdin
___: a congenital disorder characterized by segmental dilatation of the intrahepatic ducts
Caroli disease
___: the presence of echogenic dots in the nondependent part of the dilated duct representing small fibrovascular bundles; seen with Caroli disease
central dot sign
___: fever, right upper quadrant pain, and jaundice associated with cholangitis
Charcot triad
___: primary bile duct cancer
cholangiocarcinoma
___: a radiographic procedure in which contrast is injected
into the bile ducts to assess for the presence of disease
cholangiography
___: inflammation of the bile ducts
cholangitis
___: the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring, and the development of calcifications within the gland
chronic pancreatitis
___: coexisting dilation of the common bile duct and pancreatic duct
double-duct sign
___: endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas
endoscopic retrograde cholangiopancreatography
___: the level of the biliary tree where the common bile duct and the main pancreatic duct meet; may also be referred to as the ampulla of Vater
hepatopancreatic ampulla
___: the muscle that controls the emptying of bile and pancreatic juices into the duodenum; may also be referred to as the sphincter of Oddi
hepatopancreatic sphincter
___: chronic inflammation of all or parts of the bowel
inflammatory bowel disease
___: a malignant biliary tumor located at the junction of the right and left hepatic ducts
Klatskin tumor
___: a clinical condition when the patient presents with jaundice, pain, and fever secondary to a lodged stone in the cystic duct causing compression of the common duct
Mirizzi syndrome
___: the enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis
parallel tube sign
___: air within the biliary tree
pneumobilia
___: severe itchiness of the skin
pruritu
___: the enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis; also referred to as the parallel tube sign
shotgun sign
___: the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic sphincter
sphincter of Oddi
___: an inflammatory bowel disease that leads to the development of ulcers within the bowel
ulcerative colitis
what is bile made of
- cholesterol
- bilirubin
- biliverdin
- bile acids
where does bile first accumulate
in the small intrahepatic biliary radicles that are located throughout the liver
each portal triad consists of what
- hepatic artery
- portal vein
- intrahepatic duct
what two ducts units together to form the common hepatic duct
right and left hepatic ducts
the GB is attached to the biliary tree by the ___
cystic duct
___: tiny structures within the cystic duct that prevent the cystic duct from collapsing or distending
spiral valves of Heister
what is the hormone that encourages the GB to contract
cholecystokinin
when the Gb contracts and empties bile into the biliary tree at the level of ____
prox CBD
where does the CBD meet up with the main pancreatic duct
ampulla of vater
v the opening that allows bile and pancreatic juices to flow into the duodenum
sphincter of oddi
list the flow of bile starting with the liver
liver- biliary radicles- right or left hepatic ducts- common hepatic duct- cystic duct- gallbladder- CBD- ampulla of vater- sphincter of oddi- duodenum
in general a CBD that exceeds __ is typically abnormal
6mm
the intrahepatic ducts are considered dilated if measuring more than ___
2mm
where should your calipers be places when measuring the ducts
inner to inner
what is considered the most distal part of the CBD
at the pancreas head
where is the most common level for obstruction
the distal part of the CBD
what are the most common causes of bile duct obstructions
- choledochallithiasis
- chronic pancreatitis
- acute pancreatitis
- pancreatic carcinoma
jaundice occurs as a consequence of what
bilirubin accumulation within the tissues of the body
___: the presence of gallstones within the bile ducts
choledochalithiasis
with choledochalithiasis where are most stores located
near the ampulla of vater
an uncommon manifestation of choledocholithiasis is ___
mirizzi syndrome
___: a lodged stone in the cystic duct with subsequent compression of the cannon duct
mirizzi syndrome
S/S choledocholithiasis
- jaundice
- elevated ALP, ALT, GGT, bilirubin
- RUQ pain
S/A choledocholithiasis
- echogenic foci within bile duct that ay or may not shadow
- may have biliary dilation but not always
___: inflammation of the biliary ducts
cholangitis
when the bile duct walls thicken greater than ___ one should suspect some form of cholangitis
5mm
what is the most common cause of cholangitis
some type of obstructive disease
what are the different types of cholangitis
- acute bacterial
- AIDS
- oriental (recurrent pyogenic cholangitis)
- sclerosing
acute bacterial cholangitis is typically preceded by what
biliary obstruction
cholangitis can lead to what liver diseases
cirrhosis and portal hypertension
S/S cholangitis
- charcot triad
- leukocytosis
- elevated ALP, ALT, GGT, bilirubin
S/A cholangitis
- biliary dilatation
- biliary sludge or pus
- choledocholithiasis
- bile duct wall thickening
what does Charcot triad consist of
- fever
- RUQ pain
- Jaundice
sclerosis cholangitis is associated with what
inflammatory bowel disease or ulcerative colitis
___: air within the biliary tree
pneumobilia
pneumobiliar may be associated with what things
- recent biliary or gastric surgery
- emphysematous or prolonged acute cholecystitis
- fistula formation
S/S pneumobilia
- recent biliary or gastric surgery
- symptoms of acute cholecystitis
S/A pneumobilia
- echogenic linear structures within the ducts
- ring down artifact and dirty shadowing
___: infection of the small intestine that is caused by a parasitic roundworm
ascariasis
what is the roundworm that causes ascariasis
ascaris lumbricoides
how does ascariasis travel to the biliary tree
develops in the small intestine and makes its way to the biliary tree via the ampulla of vater
S/S ascariasis
- asymptomatic
- may have symptoms of inflammation of the biliary tree, gb, or pancreas
S/A ascariasis
- the worm will be notes within the biliary duct as an echogenic linear structure in the sagittal plane
- movement of the worm will be seen
___: primary biliary tree cancer
cholangiocarcinoma
what is the most common risk factor for cholangiocarcinoma
primary sclerosis cholangitis
___ is the most common manifestation of cholangiocarcinoma
klatskin tumors
where are klatskin tumors located
at the junction of the right and left hepatic ducts
S/S cholangiocarcinoma
- jaundice
- pruritus
- weight loss
- abdominal pain
- abdominal pain
- elevated bilirubin
- elevated ALP
S/A cholangiocarcinoma
- dilated intrahepatic ducts that abruptly terminate at the level of the tumor
- a solid mass may be noted within the liver ducts
___: the narrowing or obliteration of all or portions of the biliary tree
biliary atresia
infants with biliary atresia will suffer from what
cirrhosis and portal hypertension
what sonographic sign is associated with biliary atresia
triangular cord sign
S/S biliary atresia
- neonatal jaundice
- elevated AST, ALT, and bilirubin
S/A biliary atresia
- absent biliary ducts
- triangular cord sign
- cirrhosis ad portal hypertension
choledochal cysts can lead to what things
- cholangitis
- portal hypertension
- pancreatitis
- liver failure
S/S choledochal cyst
- jaundice
- pain
- fever
S/A choledochal cyst
- cystic mass in the area of the porta hepatic
- biliary dilatation
Carol disease is seen in association with what
cystic renal disease
___: a congenital disorder characterized by segmental dilatation of intrahepatic ducts
Caroli disease
S/S caroli disease
- pain
- fever
- jaundice
- signs of portal hypertension
S/A Carol disease
- segmental dilation of intrahepatic ducts
- may have cystic renal disease
- centra dot sign
what is the arrow pointing to
choledocolithiasis
what are the yellow arows pointing to
cholangitis
what is shown here by the arrow
pneumobilia
what pathology is shwon here
cholangiocarcinoma
what sign is shown here and what is it associated with
triagnular cord sign associated with biliary atresia
what pathology is shwon here
choledochal cyst
what is shown in thsi image
caroli disease
what pathology is shown here
mirizzi syndrome
