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19 Cards in this Set

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Normal cystic duct average diameter
2mm
Size of the CBD
1mm/decade starting at 4mm
-60 yrs old: 6mm
Post Op extrahepatic bile ducts can dilate up to:
Can dilate up to 10cm
Pitfalls in imaging intrahepatic bile ducts:
Large hepatic arteries, pneumobilia, parenchymas calcifications, peribiliary cysts pneumobilia, parenchymal calcifications, peribiliary cysts
Primary reason for US in the bile ducts
Determine whether an obstruction is present, and if so, at what level
Extrahepatic obstruction occurs before intrahepatic obstruction
Intrapancreatic Obstruction
90% of biliary obstruction occur in the head of the pancreas
Pancreatic carcinoma, choledochochalithiasis, chronic pancreatitis w/ stricture formation
Suprapancreatic Obstruction
Obstructions occuring between the pancreas and porta hepatis
Caused by bile duct malignancies
Suprapancreatic Obstruction sonographically:
Mimics a dilated duct filled w/ echogenic material
In reality, its a diffuse and extensive duct wall thickening from tumor invasion
Calculi are often rare at this level
Porta Hepatis Obstruction
Usually due to neoplasm
Normal CBD and intrahepatic ductal dilation
Possible GB obstruction depending on level of lesion
Unusual causes for bile duct dilation
cholangiocarcinoma, Klatskins tumor, Mirizzi syndrome, choledochal cyst, biliary parasite
Cholangiocarcinoma
Rare malignancy, occurs in CBD or CHD
Predisposing conditions: ulcerative colitis, sclerosing cholangitis, caroli's, choledochal cyst, parasitic infection
Klatskins Tumor
More specific type of cholangiocarinoma
Nonunion of the R and L hepatic ducts by the tumor invasion
Intrahepatic duct dilation, local invasion of portal vein, normal pancreas, no calculi
Mirizzi Syndrome
Uncommon cause for extrahepatic biliary obstruction
Cystic duct inserts unusually low into the CHD allowing the ducts to align parallel
Mirizzi Syndrome is caused by:
Caused by an impacted stone in the cystic duct, creating extrinic pressure on the CHD
Choledocal Cyst-Type 1
Cystic fusiform dilation of the CBD
Most common form
Choledocal Cyst-Type 2
A diverticulum protruding from the wall of the CBD
Rare
Choledocal Cyst-Type 3
Herniation of the CBD into the duodenum
Rare
Asian women, may be asymptomatic
Symptomatic-pain, jaundice, mass
Choledochalithiasis imaging pitfalls:
overlying bowel gas, soft pigment stone, primary tumors, 1/3 of stones are in non-dilated GB
Detecting choledochlithiasis
Approx 75% of stones in CBD are detectable
Stones must be seen and shown to move for dx