Biliary System Pathology

Front 1

_______ is gallstones

Back 1

cholelithiasis

Front 2

What are the 5 Fs

Back 2

Things assosciated with gallstones:
female
fat
fourty
fertile
fair skined

Front 3

Stones are _______, _______, and _______

Back 3

mobile
echogenic
shadowing

Front 4

If a stone wont shadow _______

Back 4

go to a higher frequency

Front 5

_______ lies posterior to the GB and can be mistaken for stones

Back 5

duodenum

Front 6

Stones may be asymptomatic. What are some symptoms?

Back 6

sour taste in mouth, belching, pain by obstruction

Front 7

What is the WES sign

Back 7

Wall
Echo
Shadow

Front 8

_______ is extream dilation of the gallbladder

Back 8

hydrops - gallbladder will be palpable, pt has pain, NV

Front 9

What causes hydrops

Back 9

stone in cystic duct, trauma

Front 10

_______ is echogenic or viscous bile. it produces low level echoes attributed to thick or inspissated bile. Produced in any condition causing biliary stasis.

Back 10

Sludge

Front 11

Over time sludge can become sludge balls, or AKA _______

Back 11

TUMEFACTIVE SLUDGE

Front 12

What are some causes of a thickend (over 3mm) GB wall?

Back 12

Ascites, adenomyomatosis, cancer, AIDS, sclerosing cholangitis, diffuse liver disease, pancreatitis, portal hypertension, and heart failure

Front 13

_______ is acute inflammation of the GB. Usually results from obstruction of the neck of the GB or cystic duct.

Back 13

Acute cholecystitis

Front 14

What are the symptoms of Acute Colecystitis?

Back 14

RUQ pain radiates to back
elevated white blood cells
fever
n/v

Front 15

_______ is on physical exam the patient is tender over the GB region. This indicates acute cholecystitis

Back 15

Murphy's Sign

Front 16

_______ is fluid around the GB that is an indicaton of acute cholecystitis.

Back 16

Pericholecystic fluid

Front 17

_______ is a rare complication of acute cholecystitis that is a stone impacted in the cystic duct or CHD and inflames the surrounding structures such as the CBD, causing biliary obstruction above the CBD level.

Back 17

Mirizzis Syndrome
(jaundice, pain, fever)

Front 18

_______ is inflammation of the GB without presence of stones. Seriously ill patients, trauma, burns, sepsis, dehydration

Back 18

Acalculous Cholecystitis

Front 19

_______ is the result of multiple episodes of acute process. The GB appears contracted with many stones and thickened walls.

Back 19

Chronic cholecystitis

Front 20

_______ are small focal developmental lesions of the liver composed of groups of dilated intrahepatic bile ducts set within a dense collagenous stroma. benign less than 1 cm. Usually hypoechoic.

Back 20

Biliary Hamartomas aka Von Meyenburg complexes

Front 21

_______ is a stone in the ductal system which may cause the tree to dialte.

Back 21

Choledocholithiasis

Front 22

_______ is a congenital dilation of the biliary ducts. MC in females. Increased incident in infants.

Back 22

Choledochal Cysts - appears as a true cyst in the RUQ

Front 23

_______ is dilation of the CBD at the Ampulla of Vater

Back 23

Choledochocele

Front 24

_______ is a rare congenital condition in which the intrahepatic bile ducts are irregularly dilated with diverticulae like projections

Back 24

Carolis Disease

Front 25

_______ is inflammation of the bile ducts causing thickening of the ductal walls, biliary dilation adn trapping of air within the duct.

Back 25

Cholangitis

Front 26

_______ is a fatal condition that is MC in males and develops into cirrhosis and ductal carcinoma.

Back 26

Primary Sclerosing Cholangitis
(5 year survival rate)

Front 27

what are the signs of Primary Sclerosing Cholangitis

Back 27

Inflamed Ducts, jaundice, itching, fatigue

Front 28

What are some clinical features of Primary Sclerosing Cholangitis?

Back 28

CBD wall thickening, WBC increased

Front 29

_______ occurs in middle aged females and is inflammatory destruction of the intrahepatic bile ducts. Destruction leads to a band of fibrosis form in a process of cirrhosis. Progression is not preventable.

Back 29

Primary Biliary Cirrhosis (liver transplant)

Front 30

_______ is gas in the biliary tree shadow.

Back 30

Pneumobilia

Front 31

Pneumobilia is often seen post _______

Back 31

ERCP, or surgery

Front 32

_______ is blood in the GB from GI bleed, trauma, endoscopy

Back 32

Hemobilia

Front 33

_______ is hyperplastic change in the GB wall. Diverticulum like pouches project from the thickend wall called Rokitansy Aschoff Sinuses.

Back 33

Adenomyomatosis (comet tail artifact seen) (mild RUQ pain)

Front 34

_______ results from abnormal metabolism of cholesterol within the GB wall.

Back 34

Cholesterolosis (strawberry GB)

Front 35

_______ is an abscessed GB containing pus and hemorrhagic debris.

Back 35

Empyema ( ill defined GB filled with heterogenous low level echos)

Front 36

What symptoms do patients with empyema have?

Back 36

if it leads to gangrene they may develop septicemia, fever, pain, NV

Front 37

_______ is a life threatening condition characterized by gas in the wall and lumen of the GB. MC in males. Can progress to gangrene and perforation.

Back 37

Emphysema

Front 38

_______ is a gallbladder that is completely calcigied. Increases GB carcinoma by 25%.

Back 38

Porcelain GB

Front 39

_______ may be found in the extrahepatic or intrahepatic ductal pathway. Caused by choledocholithiasis.

Back 39

Biliary Obstruction

Front 40

_______ is when the ducts outside the liver are enlarged. Caused by tumors of the CBD, ampulla and panc.

Back 40

Extrahepatic Ductal Dilation. Enlarged CBD, and panc duct

Front 41

_______ is when the ducts within the liver are enlarged.

Back 41

Intrahepatic Ductal Dilation

Front 42

_______ is rare. Seen in elderly. Fatal. Metz quickly.

Back 42

Carcinoma of the GB

Front 43

A polypoid growth greater than _______ should be questioned for GB carcinoma.

Back 43

1cm

Front 44

_______ is distended GB to the point of palpation caused by obstruction of the CBD caused by a malignant tumor in the panc head. Painless jaundice, and palpable RUQ mass.

Back 44

Courvoisier GB

Front 45

_______ is a malignant neoplasm arising from the bile ducts. Diagnosis poor. jandice, weight loss, thickened ductal wall. Soft tissue mass near the ducts.

Back 45

Chlangiocarcinoma

Front 46

What are the 3 types of chlangiocarcinoma?

Back 46

Polypoid, scirrhous, Klatskin tumor

Front 47

_______ develop within the CBD and cause extrensic obstruction

Back 47

Polypoid tumors

Front 48

_______ develop around the CBD and cause extrinsic obstruction

Back 48

Scirrhous tumors

Front 49

_______ ony causes intrahepatic dilation. Develops at the juncton of the right and left hepatic ducts. Slow growing. Metz late.

Back 49

Klatskins Tumor

Front 50

When are gallstones seen in children?

Back 50

usually with sickle cell, liver disease, bowel resectoin, cardiac shunts, hemolytic anemias, blood transfusions, RH incompatibility, cystic fibrosis, Crohns, dehydration, and sepsis

Front 51

_______ in the peds patient is usually diagnosed within the first few years of life

Back 51

choledochal cyst

Front 52

_______ is a rare obstructive disease seen in infants

Back 52

biliary atresia
(fatal if not treated by liver transplant or Kasai procedure)

Front 53

_______ is when a segment of bowel is anastomosed to an exposed area of the liver

Back 53

Kasai procedure

Front 54

_______ is yellowing of the skin and eyes from excessive bili.

Back 54

Jaundice

Front 55

_______ results from breakdown of red blod cells with a consequent increase in bili.

Back 55

Hemolytic jaundice

Front 56

_______ relates to defective liver funtion

Back 56

hepatic jaundice

Front 57

_______ results from obstruction of the bile ducts, and is treated with surgery

Back 57

Obstructive jaundice

Front 58

What are the lab tests of the biliary system?

Back 58

total bili and alk phos: indicate biliary disorders.
Indirect bili: indicates a hemolytic process. RBC, AMY, LFTs