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301 Cards in this Set
- Front
- Back
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Gallstones affect ____% of the adult population & ____% of children.
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8-10, 2
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Gallstones are predominantly found in ____ w/ a ratio of ____.
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females, 4:1
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Gallstones increase in frequency w/ ____.
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age
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What makes up the etiology of gallstones?
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abnormal bile composition, stasis & infection (most common)
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What is the most common surgical procedure in the US?
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GB removal
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What are the 5 f's?
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risk factors- fat, female, forty, fertile, and fair
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What are the predisposing factors for stone formation?
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obesity, diabetes, pregnancy, cirrhosis, anemia, pancreatitis, and estrogen replacement
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What % of gallstones contain cholesterol?
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80%
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Excess cholesterol is removed by the ____ & secreted into ____.
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liver, bile
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When bile has too much cholesterol what happens?
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small crystal form in the bile & fuse to form stones
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What are the 3 stages of stone formation?
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1. saturation of bile
2. nucleation (initiation) 3. Stones grow to detectable size |
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About ____% of gallstone composition is mixed.
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80%
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What 3 things make up the gallstone composition?
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cholesterol, calcium bicarbonate, and calcium carbonate
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Cholelithiasis is asymptomatic in ____% of cases.
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65-80%
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What are the signs & symptoms of cholelithiasis?
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acute RUQ pain 6 hrs after eating, nausea, vomiting, fever
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What type of gallstones are the most dangerous?
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tiny stones
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What is the most serious complication w/ cholelithiasis?
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obstruction of the cystic duct or CBD
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Complete blockage of the cystic duct leads to an enlarged ____ AKA ____.
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gallbladder, hydrops
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Cholelithiasis has ____ ____ densities.
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echogenic intraluminal
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With gallstones there is well defined ____ ____ ____.
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distal acoustic shadowing
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Gallstones are very ____ when changing position.
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mobile
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Cholelithiasis is typically ____ dependent.
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gravity
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What 3 things cause floating stones?
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increase in specific gravity of bile from fasting, use of oral cholecystogram contrast, or air in stone
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What structures can mimic stones?
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gas in duodenum, shadow from spiral valves of heister, air in biliary tree clips, & the GB lumen
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With oral cholecystogram, calculi appear as ____ ____ w/in the contrast filled GB.
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filling defects
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What are gallstone in children associated with?
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sickle cell, cystic fibrosis, crohn's,hepatitis, biliary atresia, & choledochal cysts
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What are 2 congenital biliary anomalies?
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choledochal cyst, and biliary atresia
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US is more sensitive for diagnosing stones in the ____ ____ than in the ____ ____.
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gallbladder neck, cystic duct
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GB neck calculi is ____ w/ highly reflective ____ ____ & ____ ____.
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curved, intraluminal echoes & acoustic shadowing
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T or F. With GB calculi, there is no change in position of the stone w/ patient position change.
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TRUE
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A lack of ____ in the cystic duct limits visualization of stones.
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bile
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To find cystic duct stones you would scan ____ to the GB neck in search of ____ ____.
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medial, echogenic foci
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What are the 4 non-biliary structures that may mimic a cystic stone?
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shadow from spiral valves of heister, bowel gas in duodenum, echogenic fat, calcification in mass w/in the porta hepatis
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What is Mirizzi syndrome?
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when gallstones lodged in the CD or hartman's pouch externally compress the CBD causing obstructive jaundice
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What are the characteristics of Mirizzi syndrome?
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stones obstructing the CD, dilatation of the CHD & intrahepatic ducts w/ normal CBD
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Mirizzi syndrome is considered to be ____ but has the same risk factors as cholelithiasis.
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rare
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What are the clinical signs associated w/ mirizzi syndrome?
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RUQ pain, jaundice, recurrent cholangitis, and cholangitic cirrhosis
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What is the sono appearance of mirizzi syndrome?
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dilated CHD and intraheaptic ducts ABOVE the level of the stone in the CD
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What other imaging can be used to rule out mirizzi syndrome?
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cholangiography, and radiographic oral cholecystogram
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What are 2 differential abnormalities that may be confused w/ mirizzi syndrome?
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lymph node in the porta hepatis, or fistula formation b/t the GB & CHD
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There is non-visualization of the GB in ____% of patients w/ stones.
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15-25%
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A fasting GB is considered to be contracted when its diameter is less than ____.
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2 cm
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What signs may be seen w/ a contracted or non-visualized GB?
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double arc or WES triad (Wall,echo,shadow)
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The most common predisposing factor of GB sludge is ____ ____.
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bile stasis
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About ____% of patients w/ sludge become symptomatic.
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10-15%
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GB sludge is an indicator of abnormal ____ ____ & a possible precursor for ____.
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biliary dynamics, cholecystitis
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GB sludge appears as ____ ____ echoes that are ____.
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low amplitude, non-shadowing
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What type of sludge does not layer evenly, is not mobile, & may represent a polyp?
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tumefactive sludge
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If the GB is completely filled with sludge than it may appear ____ to the liver.
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isoechoic
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What can be sludge be mistaken for?
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pseudosludge, hematobilia, or GB carcinoma
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What echoes in the GB do not shadow or move?
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polyps, cholesterosis, septi (junctional fold), GB cancer
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An inflammatory process of the GB which may be acute or chronic is called ____.
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choelcystitis
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Inflammation of the GB wall w/ decreased GB function is ____ ____.
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acute cholecystitis
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What 3 things usually cause acute cholecystitis?
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obstruction at level of cystic duct, bacterial infection in biliary system, or pancreatic enzyme reflux
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What are the 3 most common offending microorganisms associated w/ cholecystitis?
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staphylococci, enterococci, and gram-negative rods
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When is the peak incidence of cholecystitis?
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40-50 yrs
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T or F. Cholecystitis is 3 times more frequent in females.
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TRUE
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At least ____% of people w/ acute cholecystitis have gallstones.
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90%
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What are the common symptoms of acute cholecystitis?
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RUQ pain, fever, nausea, jaundice (25%), leukocytosis
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What lab values are increased w/ acute cholecystitis?
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bilirubin, AST, ALT, ALP, WBC, and amylase (w/ pancreas)
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Cholelithiasis is found in ____% of patients w/ acute cholecystitis.
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90-95%
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What is the sono appearance of acute cholecystitis?
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thick GB wall (>3mm), hydrops, pericholecystic fluid, & increased flow
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GB hydrops is considered if greater than ____.
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> 4 cm (or 5)
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Spreading of the inflammation of the GB can cause ____ ____.
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ascending cholangitis
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Pus in the GB is known as ____.
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empyema
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A rare, gas-forming bacteria in the GB wall yielding echoes & comet tail artifacts is ____ ____.
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emphysematous cholecystitis
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Emphysematous cholecystitis is a ____ ____ and may or may not present w/ ____.
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surgical emergency, stones
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A complication of acute cholecystitis causing a death of tissue from a lack of blood is ____ ____.
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gangrenous gallbladder
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What does gangrenous GB look like on US?
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thick wall, irregular contour, internal debris & septations
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A complication of cholecystitis associated w/ mortality is known as ____.
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perforation
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A complex fluid collection w/ septations is the sono appearance of a ____.
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perforation
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What are the 3 classifications of a perforation?
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acute, subacute, and chronic
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Approx 5-10% of all acute cholecystitis is classified as ____ ____.
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acalculous cholecystitis
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T or F. Acalculous cholecystitis is more serious than other types of cholecystitis.
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TRUE
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Inflammation of the GB wall in the absence of stones is called ____ ____.
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acalculous cholecystitis
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What is the cause of acalculous cholecystitis?
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a combination of bile stasis & direct vascular change (etiology is trauma & NPO)
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T or F. Acalculous cholecystitis can occur in young children.
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TRUE
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What are the symptoms of acalculous cholecystitis?
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swollen, tender abdomen, RUQ pain, nausea & vomiting
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What are the risk factors for having acalcous cholecystitis?
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surgery, starvation, CHF, diabetes, obstruction of CD, infection (kawasaki's)
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Recurrent or chronic inflammatory changes of the GB is known as ____ ____.
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chronic cholecystitis
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Chronic changes of the GB lead to ____ of the GB wall.
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fibrosis
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What is the most common cause of symptomatic GB disease?
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chronic cholecystitis
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When is chronic cholecystitis more common?
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more common in the elderly
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What are the symptoms of chronic cholecystitis?
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intermittent RUQ pain, nausea & vomiting, & intolerance to fatty food
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What lab values are increased w/ chronic cholecystitis?
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AST, ALT, alk phos, and direct bilirubin
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A ____ or ____ size GB is seen w/ chronic cholecystitis.
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small or normal
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A positive ____ sign as well as ____ may be present in chronic cholecystitis.
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WES, sludge
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Usually the GB is ____ w/ a ____ wall with chronic cholecystitis.
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contracted, thickened
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What are 3 complications associated w/ non-treatment of chronic cholecystitis?
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mirizzi syndrome, GB ileus, and bouveret's syndrome
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What is GB ileus?
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a fistula between the GB & duodenum
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Obstruction of the stomach or duodenum from a gallstone is known as ____ ____.
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bouveret's syndrome
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What is the treatment for cholecystitis?
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cholecystectomy
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Gallbladder hydrops is also known as ____ or ____.
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cholecystomegaly or mucocele
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What is GB hydrops?
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Gb distention w/o wall thickening
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GB hydrops is most often due to ____ ____ of the ____ ____.
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prolonged obstruction, cystic duct
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What are the possible causes/risks factors for hydrops?
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prolonged fasting, biliary stasis, kawasaki's, post surgery, & scarlet fever
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GB hydrops may be ____ & has a ____ GB wall.
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asymptomatic, thin
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With hydrops the GB is markedly ____.
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dilated (>4-5cm)
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What is used to evaluate GB hydrops?
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NM
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How does GB hydrops differ from couvoiser's GB?
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couvoiser's GB enlargement is secondary to obstruction @ the CBD or below cystic duct level
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In both hydrops & couvoiser's the GB is ____ & has a ____ wall.
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enlarged, thin
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Couvoiser's GB obstruction is usually caused by a ____ in the area of the ____ CBD.
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malignancy, distal
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What are the risk factors for courvoiser's GB?
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diabetes & post-vagotomy
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Courvosier's GB may be asymptomatic but may also cause ____ ____ & a ____ ____.
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RUQ pain, palpable mass
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There is an elevated ____ ____ & abnormal ____ w/ courvosier's GB.
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serum bilirubin, LFT's
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What are the treatment options for courvosier's GB?
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percutaneous transhepatic biliary drain, surgical excision, or palliative biliary stent
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A patchy or complete calcification of the GB wall is known as ____ ____.
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porcelain GB
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Porcelain GB is considered to be ____ & is more common in ____.
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rare, females
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Porcelain GB is associated w/ an increased incidence of ____ ____ & in 95% of patients ____ are present.
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GB cancer, stones
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A curvilinear, biconvex echogenic structure in the GB fossa is the sono appearance of a ____ ____.
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porcelain GB
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A porcelain GB may mimic a gallbladder full of ____ but lacks a ____ sign.
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stones, WES
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With a porcelain GB there is an irregular ____ and areas of ____.
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wall, shadowing
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What are 4 benign neoplasms of the GB?
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adenomas, adenomyomatosis, cholesterolosis, and polyps
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T or F. Benign GB tumors are rare.
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TRUE
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GB polyps are _____ and do not ____.
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non-mobile, shadow
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What is the typical size of a GB polyp?
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5-10 mm
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The most common polyp is a ____ polyp.
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cholesterol
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What produces GB polyps?
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metastatic melanoma
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A benign epithelial tumor representing overgrowth of tissue is an ____.
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adenoma
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Adenomas are ____ & represent ____% of all GB polyps.
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asymptomatic, 5%
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What are the 2 risk factors for adenomas?
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cholelithiasis, chronic cholecystitis
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What is the sono appearance of a GB adenoma?
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solitary, small, non-mobile & non-shadowing & < 1 cm
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Where are adenomas typically located?
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in or near the fundus
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Thickening of the GB wall adjacent to polyp increases the suspicion for ____.
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malignancy
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The term used to describe adenomyomatosis & cholesterolosis is ____ ____.
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hyperplastic cholecystosis
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A common tumor-like lesion of the GB w/ no malignant potential that is a form of hyperplastic cholecystosis is _____.
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adenomyomatosis
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T or F. The etiology of cholesterolosis is unknown.
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TRUE
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With hyperplastic cholecystitis the GB wall has a _____ appearance.
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strawberry (strawberry gallbladder)
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What is diverticulosis of the GB called?
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adenomyomatosis
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Focal, segmental, or diffuse smooth muscle proliferation w/ extensions of rokitansky-aschoff sinuses in the GB is _____.
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adenomyomatosis
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What are the different types of adenomyomatosis?
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localized, segmental, and diffuse
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Localized adenomyomatosis is confined to the ____.
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fundus
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What is segmental adenomyomatosis?
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prox, mid or distal segment of the GB wall
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An hourglass-shaped GB w/ TRV septum is ____.
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annular
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Diffuse adenomyomatosis involves all ____ ____.
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mucosal walls (entire GB)
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What is the sono appearance of adenomyomatosis?
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thick GB wall, intraluminal diverticula, ring down/comet tail, non-mobile
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What is the most specific finding for adenomyomatosis?
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cystic spaces w/in the muscular wall (rarely seen on US)
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What are the 2 types of cholesterolosis?
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focal & diffuse
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Proliferative or degenerative changes due to deposits of cholesterol in the GB is called _____.
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cholesterolosis
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Cholesterolosis usually appears ____ & ____.
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small (2-10mm) & oval
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What is the sono appearance of cholesterolosis?
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GB appears normal w/ fixed echodense polypoid masses that are immobile & non-shadowing
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Small echodensities attached to the GB wall by a stalk is a ____.
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polyp
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Malignant neoplasms of the GB wall may be ____ or ____.
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focal or diffuse
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About 98% of carcinoma of the GB is _____.
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adenocarcinoma
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What is the most common biliary malignancy?
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primary carcinoma of the GB
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GB carcinoma is more common in ____ and occurs in patients ____ yrs or >.
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females, 50
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When is GB carcinoma more common?
|
in hispanics & native americans
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Gallstones are present in ____% of GB carcinoma cases.
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65 - 95%
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What are the precursors to the development of GB carcinoma?
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cholelithiasis & inflammation
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Up to ____% of GB carcinoma patients will have direct extension into the liver & adjacent structures
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80%
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There are elevated ____ w/ GB carcinoma.
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LFT's
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GB carcinoma may be asymptomatic for many years but when symptoms show what do they include?
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weight loss, nausea, vomiting, jaundice, pain, & fatty food intolerance
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The sono appearance of GB CA depends on what 3 things?
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the size of the tumor, the extent of secondary spread, and its morphologic character
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Early findings of GB CA include ____ ____ with ____ borders.
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polypoid masses, irregular
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Most often, GB CA appears as a ____ mass with ____ in the GB.
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solid, flow
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What is a fungating mass?
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a type of lesion that is marked by ulcerations & necrosis (has bad smell)
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What are 4 other US findings with GB carcinoma?
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direct extension into liver, liver mets, regional lymphadenopathy, and ascites
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The treatment for GB CA is ____ but ____% are unresectable.
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cholecystectomy (resection), 75%
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What is GB metastasis usually accompanied by?
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liver metastasis
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Usually there are no ____ with GB metastasis.
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stones
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What is the sono appearance of GB mets?
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focal wall thickening, intraluminal mass w/o shadowing, low level echoes, & indistinct walls
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What are some non-inflammatory causes of diffuse GB wall thickening?
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contraction, hepatitis, cirrhosis, ascites, pancreatitis, renal disease, CHF, AIDS, sepsis, portal obstruction, hypoalbuminea
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What are the non-inflammatory causes of FOCAL thickening?
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adenomyomatosis, polyps, papillary adenoma, GB CA, and mets
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What 3 things cause pseudo wall thickening?
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gain too high, artifacts, tumefactive sludge
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Where does extrahepatic biliary ductal dilatation occur?
|
in the cystic duct, CHD, or CBD
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Where does intrahepatic biliary ductal dilatation occur?
|
w/in the peripheral liver parenchyma, RHD, and LHD
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What is the clinical presentation of biliary ductal dilatation?
|
RUQ pain, jaundice, and elevated LFT's
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Benign or malignant obstruction along the biliary tree is known as ____ ____.
|
obstructive jaundice
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What may non-obstructive jaundice be due to?
|
metabolic or hematologic abnormalities or liver dysfunction
|
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In the jaundice patient, demonstration of biliary duct dilatation = ____ ____.
|
obstructive jaundice
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What is mandatory to determine biliary dilatation EVEN when the CHD's appear normal?
|
The CBD measurement
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In normal patients, ducts remain the same or ____ in size after a fatty meal.
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decrease
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If a normal-sized duct increases in size it is considered ____.
|
abnormal
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Even if a CHD seems mildly dilated before a fatty meal, if it decreases after the meal it may be _____.
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normal
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Peripheral lucencies w/in the liver w/ posterior enhancement is a sono appearance of ____ ____.
|
biliary dilatation
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Biliary dilatation appears as an ____ ____ structure in the liver w/ a ____ pattern.
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anechoic tubular, stellate
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Biliary dilatation occurs if there is a dilated CHD >___ or a dilated CBD > ____.
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5 mm, 8 mm
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A dilated CHD is considered biliary dilatation if > than ____% of the diameter of the ____ ____.
|
40%, portal vein
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More than 2 tubular lucencies seen longitudinally in the porta hepatis region is an example of ____ ____.
|
biliary dilatation
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When the ducts are dilated what sign is seen?
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parallel channel sign/double channel sign/ shotgun sign
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EHD measurements in neonates are < ____ & < ____ in infants.
|
1 mm, 2 mm
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In older children EHD measurements are < ____.
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4 mm
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In the adolescent & adult, EHD measurements = to or less than ____ is considered normal.
|
5 mm
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If there is a EHD > than or equal to ____ in an adolescent or adult it is considered dilated.
|
8 mm
|
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The distal end of the EHD can become ____ in the elderly.
|
ectatic
|
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You should add ____ to the normal EHD measurement for each decade over 60 yrs.
|
1 mm
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After a cholecystectomy, the EHD is normal if < ____.
|
10 mm
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Ducts dilate ____ to the level of obstruction.
|
proximal
|
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Bile duct stones which may cause partial or complete CD obstruction is known as _____.
|
choledocholithiasis
AKA choledoctolith |
|
|
Choledocholithiasis is found in ____% of chronic bile duct obstructions.
|
75%
|
|
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When is the incidence of choledocholithiasis the greatest?
|
at the time of a cholecystectomy
|
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What are the 3 signs of choledocholithiasis?
|
RUQ pain, jaundice, and cholelithiasis
|
|
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What lab tests are increased with choledocholithiasis?
|
serum bilirubin, alk phos, AST, ALT, and bacteremia
|
|
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What might choledocholithiasis be difficult to diagnose?
|
CBD is more posterior than the GB, overlying gas, small amount of fluid surrounding stone
|
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What are examples of structures that may mimic choledocholithiasis?
|
air, RHA, clips, beam refraction, calcifications in the pancreatic head
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What is the sono appearance of choledocholithiasis?
|
echogenic densities w/in the duct, small stones may be mobile, dilated duct prox to obstruction
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There is acoustic shadowing in ____% of choledocholithiasis cases.
|
20%
|
|
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What is ESWL?
|
Biliary extracirporeal shock wave lithotripsy, a treatment for choledocholithiasis.
|
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Inflammation of the bile duct walls is known as ____.
|
cholangitis
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|
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What are the 4 different types of cholangitis?
|
acute bacterial, recurrent pyogenic, HIV cholangiopathy, sclerosing (> in men)
|
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The majority of those affecting by cholangitis are less than ____ yrs of age.
|
45
|
|
|
Cholangitis can be caused by one or a combination of the following factors:
|
stricture, bacterial infection of biliary tract, parasitic infection, ulcerative colitis
|
|
|
What is ERCP?
|
a radiologic procedure in which radiopaque material is injected into the ampulla of vater
|
|
|
What is cholangitis associated with?
|
associated w/ biliary stasis caused by obstruction & inflammatory bowel disease
|
|
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Classic presentation of cholangitis is known as ____ ____.
|
charcot triad (fever, RUQ, pain, jaundice) & epigastric pain
|
|
|
What lab values are increased w/ cholangitis?
|
bilirubin, ALP, AST, ALT, & WBC
|
|
|
There is a marked increased level of ____ & ____ w/ sclerosing cholangitis.
|
bilirubin & ALP
|
|
|
The sono appearance of cholangitis may include:
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dilated ducts (3-4cm), GB hydrops, thick walls, air in biliary system, portal hypertension & sludge/stones
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What are the 2 treatments for cholangitis?
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antibiotic therapy, and dilation of ductal strictures
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An infection by roundworm ascariasis lumbricoides is known as ____.
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ascariasis
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The risk factor for ascariasis is ____ ____.
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poor hygiene
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Ascariasis is usually ____ but may cause abnormal ____.
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asymptomatic, LFT's
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What is the sono appearance of ascariasis?
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intraductal parallel echogenic lines (w/ worms)
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Intermittent biliary obstruction & inflammation is seen w/ _____.
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ascariasis
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What is used to kill worms w/ ascariasis?
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mebendazole
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Blood within the biliary tree is known as ____.
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hemobilia
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What are the risk factors involved w/ hemobilia?
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interventional procedures, infection, vascular malformation, trauma, & malignancy
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Approx ____% of hemobilia infections are caused by liver biopsies/procedures.
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65%
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What are the 2 symptoms of hemobilia?
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pain & hematemesis
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The sono appearance of hemobilia includes ____ or ____ within the biliary tree.
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blood or clot
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Blood & thrombus w/in the ____ is a common finding w/ hemobilia.
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gallbladder
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Air or gas within biliary tree is called ____
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pneumobilia
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What are the different risk factors for having pneumobilia?
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post-biliary surgery, incompetent spincter of oddi, GI tract fistula, trauma, duodenal ulcer perforating into CBD
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Pneumobilia is ____.
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asymptomatic
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What is the sono appearance of pneumobilia?
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hyperechoic linear (hair-like) foci w/in the biliary tree radicals (may include dirty shadow/ring down)
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Primary cancer of the bile ducts is known as _____.
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cholangiocarcinoma
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Cholangiocarcinoma is typically ____ arising from the ____ of the bile ducts.
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adenocarcinoma, epithelium
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What are the different risk factors for cholangiocarcinoma?
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stones, colitis, cholangitis, caroli's disease, & pancreatitis
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Cholangiocarcinoma makes up ____ of all malignancies in the liver.
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1/3
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Cholangiocarcinoma is considered to be ____. What is the occurence?
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rare, 2 out of 100,000 people
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Cholangiocarcinoma occurs more freq in ____ & occurs in the ____ decades.
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males, 6-7th
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The ____ is the most common site affected by cholangicarcinoma.
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CBD
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Stones are found in ____ of all cholangiocarcinoma cases.
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1/3
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Cholangiocarcinoma lesions are ____.
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insidious
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What are insidious lesions?
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slowly & subtly harmful or destructive in their development
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What are the 3 types of cholangiocarcinoma?
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intrahepatic, hilar (klatskin's), and distal
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Hilar (klatskin's) cholangiocarcinoma is located at the ____ ____.
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porta hepatis
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Distal cholangiocarcinoma is considered ____.
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extrahepatic
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What are the 4 common tumor sites for cholangiocarcinoma?
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CBD (distal), hepatic ducts, cystic duct, and duodenal portion of CBD
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Cholangiocarcinoma causes ____ ____, ____, & ____ pain.
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weight loss, fatique, RUQ
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Biliary dilatation w/o evidence of obstruction or obstruction that terminates @ the tumor is a sono appearance of _____.
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cholangiocarcinoma
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Cholangiocarcinoma can appear as a ____ ____ mass.
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intraductal polypoid
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When a cholangiocarcinoma mass is seen it can be ____ or ____.
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hyper or hypoechoic
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Cholangiocarcinoma causes ____ ____ ____ & nodal extension into the ____ ____.
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focal biliary stricture, porta hepatis
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On US cholangiocarcinoma appears ____ defined w/ ____ ____ across the lumen.
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irregularly, echogenic bands
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What 2 things may be seen w/ cholangiocarcinoma?
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hepatomegaly & ascites
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When dilated ducts & a main pancreatic duct are demonstrated w/ a normal pancreatic head than what should be suspected?
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primary bile duct cancer (but don't exclude pancreatic or ampullary cancer)
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A bile duct cancer that arise @ the union of the RT & LT hepatic duct bifurcation is a:
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klatskin tumor
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A klatskin tumor is considered to have the ____ ____.
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worst prognosis
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What is the sono appearance of a klatskin tumor?
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a solid mass @ the junction of the RT & LT hepatic ducts
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Klatskin tumors cause ____ ____ dilatation w/o ____ ____ dilatation
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intrahepatic duct, extrahepatic duct
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A klatskin tumor is hard to distinguish from ____.
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lymphadenopathy
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What is the most fatal liver disorder in children in the U.S?
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biliary atresia
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Congenital fibrotic obliteration of one or more components of the biliary tree is known as ____ ____.
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biliary atresia
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T or F. It is very difficult to distinguish b/t biliary atresia & neonatal hepatis.
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TRUE
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What are the 2 types of biliary atresia?
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intrahepatic & extrahepatic
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With intrahepatic biliary atresia there is non-visualization of the ____ ____ & ____ on US.
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biliary radicles & GB
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Anastomosis of the biliary tree to the jejunum w/ dilatation of the intrahepatic radicles is known as ____ biliary atresia.
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extrahepatic
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What are the 4 symptoms of biliary atresia?
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persistent jaundice, portal hypertension, cirrhosis, hepatic failure
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Biliary atresia causes ____ ____ dilatation & ____ ____.
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biliary duct, portal hypertension
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If a normal GB is seen on US = to or > than ____ cm than the diagnosis of neonatal hepatis is supported.
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1.5 cm
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Gallbladders are present in ____% of patients w/ extrahepatic biliary atresia.
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20%
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With biliary atresia the liver may be ____ or ____.
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echogenic or normal
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With biliary atresia, the hepatic parenchyma is often ____ w/ a marked increase in ____ ____.
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inhomogeneous, periportal echoes (due to fibrosis)
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US in infants w/ biliary atresia often show a ____, ____, ____ echogenic density.
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circumscribed, focal & triangular
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The ____ ____ sign is seen w/ biliary atresia cranial to the ____ ____ bifurcation.
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triangular cord, portal vein
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The triangular cord sign corresponds to ____ of the ____ biliary system.
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fibrosis, extrahepatic
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An autosomal recessive disorder causing congenital biliary dilatation is known as ____ ____.
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caroli's disease
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Segmental saccular dilatations of intrahepatic ducts a symptom of ____ ____.
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caroli's disease
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What can caroli's disease lead to?
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bile stasis, bacterial growth, abscesses, cholangitis, & formation of stones
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With caroli disease, ____ function may be impaired due to compression of ____.
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liver, hepatocytes
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What symptoms does caroli's disease cause?
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cramping (from stone formation), pain, fever, & intermittent jaundice
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Caroli's disease has a ____ appearance on US w/ ____ ____ seen in the ducts.
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beaded, echogenic foci
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Caroli's disease can appear as mulitple ____ ____ w/in the liver that communicate w/ the ____ ____.
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cystic structures, intrahepatic ducts
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There is no ____ seen w/in the dilated structures w/ caroli's disease.
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flow
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Congenital dilatation of the CBD is known as a ____ ____.
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choledochal cyst
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What is a choledochal cyst characterized by?
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cystic dilatation & outpouching of the CD walls w/ anomalous insertion into the pancreatic duct
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What can choledochal cysts lead to?
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cholangitis & dilatation due to reflux of pancreatic juices
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Signs & symptoms seen w/ a choledochal cyst in the 1st decade of life include:
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failure to thrive, intermittent jaundice, RUQ pain/ palpable mass, fever
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A choledochal cyst appears as a ____ ____ mass in the ____ ____.
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large cystic, porta hepatis
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There is a dilated ____ or ____ entering a choledochal cyst.
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CHD or CBD
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There is no ____ seen w/in the dilated structures w/ a choledochal cyst.
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flow
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Three possible differential diagnoses of a choledochal cyst include:
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liver cyst, hepatic artery aneurysm, pancreatic pseudocyst
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What are the 3 types of choledochal cysts?
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1-fusiform, 2-diverticular, 3-choledocholcele
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What is the most common type of choledochal cyst?
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fusiform
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A diverticular choledochal cyst causes ____.
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outpouching
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With a choledocholcele, the ____ portion of the CBD protrudes into the ____.
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distal, duodenum
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T or F. Agenesis of the GB is very rare.
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TRUE
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What are the causes of a small GB?
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pt isn't NPO, intrahepatic biliary obstruction, chronic cholecystitis, liver disease, hypoplasia of GB (RARE)
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What are some causes of pericholecystic fluid?
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acute cholecystitis, pericholecystic abscess, ascites, pancreatitis, peritonits, AIDS
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When does serum bilirubin increase?
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in cases where biliary system becomes obstructed, or GB CA
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There is an increased WBC in cases of ____, ____ or ____.
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infection, cholecystitis, or cholangitis
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ALP increases in cases of ____ ____.
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post-hepatic jaundice
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AST & ALT are abnormal in cases of ____, ____ & ____ to the bile ducts.
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cholecystitis, GB CA, injury
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When is the PT (prothrombin) clotting time longer?
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Longer in pts w/ acute cholecystitis, GB CA, & prolonged CD obstruction
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What ducts are usually not seen unless dilated?
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cystic ducts & intrahepatic ducts (RT & LT hepatic)
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The CHD is always ____ to the right portal vein.
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anterior
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The ____ ducts are the ones seen on US.
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extrahepatic
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A normal CHD is ____ mm or less.
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6
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A normal CBD is ____ mm or less.
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8
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What is not included when measuring the ducts?
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the walls of the ducts
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