Abdomen Ultrasound Spring 2009 B

Front 1

The distal __________ usually is the culprit for Biliary obstruction due to gallstones or pancreatic cancer

Back 1

cbd

Front 2

The normal common
Bile duct measurements are as follows:

Back 2

< or = 5mm --normal
6 to 7 mm--equivocal
> or = 8mm—dilated
One millimeter per decade of age

Front 3

THE ROUTINE MEASUREMENT TO ASSESS BILIARY
OBSTRUCTION IS MADE AT A POINT AS IT CROSSES ANTERIOR TO THE UNDIVIDED ________ AND THE ________ IS VISIBLE IN CROSS-SECTION

Back 3

Right Portal Vein
Right Hepatic Artery

Front 4

If a study is questionable, a fatty meal can be given to the
patient and a repeat scan performed. This is helpful in assessing gallbladder
contractibility or obstruction. A non-obstructed bile duct should _______ in size
after a fatty meal.

Back 4

decrease

Front 5

The ________ and ______ levels are usually elevated with biliary obstruction, but exactly how much depends on the length and severity of the obstruction.

Back 5

serum alkaline phosphatase
conjugated bilirubin (direct)

Front 6

There are four criterion that helps us determine INTRAhepatic bile ducts from portal vessels:

Back 6

o Parallel channel or shotgun sign-This sees the dilated duct and portal vessel at once.
o Irregular and tortuous bile ducts
o Stellate confluence (star-shaped)
o Acoustic enhancement-this is because bile does not attenuate sound and blood does, therefore, creating enhancement.

Front 7

There are three main areas in which the Biliary tree can undergo obstruction. They are:

Back 7

o Distal CBD with entire system dilated
o Common Hepatic duct obstruction-only common hepatic and intrahepatic ducts will be dilated. Gallbladder and common bile duct will be normal in caliper.
o Obstruction at the junction of right and left hepatic ducts.

Front 8

o Obstruction at the junction of right and left hepatic ducts. Only the intrahepatic ducts are dilated. This is a called a ________.

Back 8

Klatskin's tumor

Front 9

Gallstones can migrate down from the gallbladder to the ductal system. This is the most common cause of Biliary obstruction. The patient may have pain or jaundice. Ultrasound can be useful in this area.

Back 9

Choledocholithiasis

Front 10

This is when a stone gets lodged in the cystic duct
and causes extrinsic or mechanical obstruction of the common hepatic duct.

Back 10

Mirizzi syndrome

Front 11

This is known as cholangiocarcinoma. A specific type of cholangiocarcinoma is a Klatskin tumor.

Back 11

Bile duct carcinoma

Front 12

This is inflammation of the bile ducts causing thickness of the hepatic duct walls. This is caused from infection. This disorder causes the laboratory values to be off just like choledocholithiasis.

Back 12

Cholangitis

Front 13

This is the most common malignant obstruction of
the Biliary system. This is located in the head of the pancreas.

Back 13

Pancreatic Adenocarcinoma

Front 14

This literally means air in the Biliary system

Back 14

Pneumobilia

Front 15

Pneumobilia can be caused from the following 4 things:

Back 15

o Surgery
o Incompetent sphincter of Oddi
o ERCP
o Wall erosion by gallstone or ulcer
This can cause a shadowing, comet-tail artifact on ultrasound. You may also see an echogenic focus in the Biliary tree.

Front 16

This is a congenital dilatation or aneurysm of the CBD. This looks sonographically like a separate cystic area from the gallbladder. This is usually found in children and people from Japan.

Back 16

Choledochal cyst

Front 17

This is a non-obstructive ectatic dilatation of the
right and left hepatic ducts as well as the intrahepatic ducts. This disease has a correlation with polycystic kidney disease.

Back 17

Caroli’s disease

Front 18

This is the congenital absence of the hilum of the
liver. The gallbladder may be present, absent, or rudimentary. Look for ducts.

Back 18

Biliary atresia