Biliary Tract Pathology

Front 1

Galbladder wall inflammation due to cystic duct obstruction by a gallstone

Back 1

acute cholecystitis

Front 2

associated with RUQ pain, fever and leukocytosis

Back 2

Acute cholecystitis

Front 3

Patient presents with gallstones, positive Murphy's sign, diffuse wall thickening , GB dilation and sludge

Back 3

acute cholecystitis

Front 4

what are some complications with acute cholecystitis

Back 4

Empyema, gangrenous cholecystitis, perforation, pericholecystic abscess, bilioenteric fistula

Front 5

with acute cholecystitis a bacterial infection will occur secondary to ?

Back 5

the initial obstruction and ischemia

Front 6

acute cholecystitis is acalculous in what percent of pts. What percent is associate with stones?

Back 6

acalculous in 5-10% stones in 90-95%

Front 7

amylase elevation suggests obstruction at the level of the?

Back 7

ampulla of vater

Front 8

chronic gallbladder disease characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis

Back 8

chronic cholecystitis

Front 9

findings may include a thick walled, fibrotic contracted gallbladder. Sludge and a cystic duct stone may be present

Back 9

chronic cholecystitis

Front 10

occurs more commonly in diabetic men; gas produced by aneorbic bacteria (e coli)

Back 10

emphysematous cholecystitis

Front 11

gas found in the wall of the gallbladder , lumen or biliary tree. Comet tail artifacts seen due to presence of gas

Back 11

emphysematous cholecystitis

Front 12

with ___________ cholecystits, perforation is inevitable resulting in pneumoperitoneum and peritonitis

Back 12

gangrenous cholecystitis

Front 13

purulent material withing the gallbladder due to bacteria containing bile; associated with acute cholecystitis

Back 13

empyema of te gallbladder

Front 14

symptoms are the same as with acute cholecystitis with the additon of fever

Back 14

empyema of GB

Front 15

empyema of the GB is initiated with obstruction of the ____ duct

Back 15

cystic

Front 16

should be suspected if if atypical bile echoes are seen

Back 16

empyema of the GB

Front 17

localized fluid collection in the GB fossa; a complication of acute cholecystitis

Back 17

GB perforation

Front 18

what are the complication of GB perforation

Back 18

peritonitis
pericholecystic abscess
biliary fistula

Front 19

inflammation of the GB without stones; usually secondary event in critically ill hospitalized patients

Back 19

acalculous cholecystitis

Front 20

acalculous cholecystitis is assocciated with

Back 20

post operative abdominal surgery,
severe trauma,
severe burns
sepsis
HIV/AIDS
blood transfusion reaction
high dose opiod analgesics
parenteral nutrition > 3 months

Front 21

what are the 3 main causes of acalculous cholecystitis

Back 21

Bile stasis (viscous bile)
decreased GB contraction
infection (secondary event)

Front 22

sonographic findings include gb wall thickening, positive murphy sign and pericholecytic fluid

Back 22

acalculous cholecystitis

Front 23

what are some "other" causes of gb wall thickening

Back 23

increased hypoalbuminemia causing ascites
congestive heart failure

Front 24

aka limey bile

Back 24

milk of calcium bile

Front 25

sludge like material with high concentration of calcium

Back 25

milk of calcium bile

Front 26

associated with chronic cholecystitis and gallbladder obstruction of the cystic duct

Back 26

milk of calcium bile

Front 27

May be seen as layering sludge that results in distal acoustic shadowing

Back 27

milk of calcium bile

Front 28

calcification of the Gb wll, associated with chronic cholecystitis

Back 28

porcelain Gb

Front 29

also known as mucocele of the Gb

Back 29

hydrops of the gallbladder

Front 30

a round distended , non inflamed gallbladder due to obstruct of the cystic duct. Bile is reabsorbed and the gallbladder is filled with an anechoic secretion from the mucosa

Back 30

hydrops of the gallbladder

Front 31

a symptomatic patient presents with a palpable RUQ mass, you see a distended gallbladder absent clinical signs associated with cholecystitis

Back 31

hydrops of the gallbladder

Front 32

hydrops of the gallbladder is suggested when the transverse diamter measures > ___ cm

Back 32

5 cm

Front 33

When lipids (triglycerides and cholesterol ) are deposited in the gallbladder wall. They appear as polyps and can be as large as 1 cm

Back 33

cholesterolosis

Front 34

this condition is referred to as "strawberry gallbladder"

Back 34

cholesterolosis

Front 35

this GB disease is usually clinically silent however may cause colicky abdominal pain

Back 35

cholesterolosis

Front 36

This GB disease may appear similar to adenomyomatosis with out the reverberation artifact.

Back 36

cholesterolosis

Front 37

GB ultrasound reveals an intraluminal mass, asymmetric wall thickening or a mass that fills the GB (most common)

Back 37

Gallbladder carcinoma

Front 38

what are the associated findings with GB carcinoma

Back 38

liver metastases, lymphadenopathy, Bile duct dilatation, cholelithiasis, and porcelain gallbladder

Front 39

GB disease with a mean survival rate of 6 months, affects older persons with long standing cholecystitis

Back 39

Gallbladder carcinoma

Front 40

incidence is 3 per 100,000 and found incidentally in 1-3% of cholecystectomys

Back 40

Gallbladder carcinoma

Front 41

Hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall and formation of diverticula

Back 41

adenomyomatosis

Front 42

diverticula within the gallbladder wall (Rokitansky-Ashoff sinuses) accumulate stones or sludge within them

Back 42

adenomyomatosis

Front 43

sonographically seen as hyperechoic foci within a thickened gallbladder wall; associated with reverberation (comet tail) artifact

Back 43

adenomyomatosis

Front 44

In the majority of patients, biliary obstruction is due to pathology where in the CBD?

Back 44

distal CBD

Front 45

what are two of the most common lesions that cause biliary obstruction?

Back 45

Gallstones and Carcinoma of the head of the pancreas

Front 46

biliary obstruction is considered clinically when the patient presents with __________

Back 46

jaundice

Front 47

what labs will be elevated with biliary obstruction

Back 47

alkaline phosphatase (ALP)
conjugated bilirubin
Gamma glutamyl transpeptidase (GGT)

Front 48

what are the causes of biliary obstruction

Back 48

choledocholithiasis
mirizzi syndrome
cholangiocarcinoma
cholangitis
biliary atresia
choledocl cyst
caroli's disease
pancreatic adenocarcinoma
GB carcinoma

Front 49

what is a normal cbd measurement?

Back 49

less than or equal to 5 mm
equivocal 6-7 mm
dilated greater than or equal to 8mm

Front 50

what is the upper limit of normal measurement for the cbd in elderly patients?

Back 50

10mm

Front 51

post cholecystectomy the common duct acts as a reservoir for bile storage and may measure up to __ mm

Back 51

10mm

Front 52

dilated intrahepatic ducts my demonstrate what sonographic features

Back 52

parallel channel sign/ shotgun sign
irregular and tortuous bile ducts
stellate confluence
acoustic enhancement

Front 53

____________, a hormone that is released into the blood by the ingestion of fatty foods, causes gallbladder contraction

Back 53

cholecystokinin

Front 54

gallbladder contractility or obstruction can be assessed by administering a ?

Back 54

fatty meal

Front 55

what are reasons to administer a fatty meal

Back 55

equivocal biled duct dilation or abnormal lab values

(Neg result= unchanged or decrease in size
Pos result+ duct increases in size)

Front 56

what is the most common location for an obstructing stone

Back 56

distal common bile duct

Front 57

where is the obstructing stone if the entire system distends, even the gallbladder

Back 57

distal common bile duct

Front 58

when a stone obstructs this location, only the common hepatic duct and intrahepatic duct will dilate. GB will be contracted

Back 58

common hepatic obstruction

Front 59

at this level of obstruction only the intrahepatic ducts dilated, the gallbladder will be contracted

Back 59

obstruction at the junction of the right and left hepatic ducts

Front 60

formation or presence of claculi in the bile ducts

Back 60

choledocholithiasis

Front 61

most common cause of extrahepatic obstrutive jaundice

Back 61

choledocholithiasis

Front 62

what are symptoms of choledocholithisasis?

Back 62

biliary colic (RUQ pain)
Jaundice

Front 63

what are complications of choledocholithiasis

Back 63

biliary cirrhosis
cholangitis
pancreatitis

Front 64

Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechaical compression of the common hepatic duct

Back 64

Mirizzi Syndrome

Front 65

associated findings include:
Intrahepatic duct dilatation
cystic duct stone
curved segmental stenosis of CHD
cholecystocholedochal fistula

Back 65

Mirizzi syndrome

Front 66

malignant mass that typically originates in the extrahepatic bile ducts (CHD or CBD)

Back 66

cholangiocarcinoma (Bile Duct Carcinoma)

Front 67

A _______ _________ is a cholangiocarcinoma located at the hepactic hilum (junction of right and left hepatic duct) resulting in intrahepatic but not extrahepatic biliary dilation

Back 67

klatskins tumor

Front 68

what is the most common predisposed condition to cholangiocarcinoma?

Back 68

primary sclerosing cholangitits

Front 69

what is the most common finding in a patient with cholangiocarcinoma?

Back 69

intrahepatic bile duct dilatation

Front 70

juandic, weight loss an abdominal mass are symptoms of

Back 70

cholangiocarcinoma

Front 71

bacterial infection superimposed on an obstruction of the biliay tree

Back 71

cholangitis

Front 72

what is the most common cause of cholangitis

Back 72

choledocholithiasis

Front 73

what obstructive tumors can cause cholangitis

Back 73

pancreatic cancer (head of panc especially)

Front 74

what are symptoms associated with cholangitis

Back 74

RUQ pain, fever and jaundice

Front 75

what labs will increase with cholangits

Back 75

conjugated bilirubin
alkaline phosphatase (ALP)
Gamma glutamy transpeptidase (GGT)
Amylase and lipase
White blood cell

Front 76

suspected when juandice (hyperbilirubinemia) persists beyond 14 days of age

Back 76

biliary atresia

Front 77

absence of extraheptic bile ducts (CHD and CBD)

Back 77

biliary atresia

Front 78

associated with polysplenia, absent IVC, situs inversus or situs ambiguous, and cardiac anomalies (ASD, VSD)

Back 78

biliary atresia

Front 79

surgical drainage with the ________________ is the most succesfull treatment of biliary atresia if performed in the first 90 days of life

Back 79

Kasai poroenterostomy

Front 80

air in the biliary tract commonly associated with an ERCP (endoscopic retrograde cholangiopancreatogram)

Back 80

pneumobilia

Front 81

what are causes of pneumobilia

Back 81

ERCP
sphicter of Oddi papilotomy
GB fistula
emphysematous choecystitis

Front 82

congenital bile duct anomalies consisting of cystic duct dilitation of the intra or extrahepatic bile ducts, there are five classes

Back 82

choledochal cyst

Front 83

sonograhic findings include 2 cystic structures in the ruq, the GB and the dilated CBD

Back 83

choledochal cyst

Front 84

more prevelant in Asia. 33% of cases are from Japan and symptoms usually occur before age 10

Back 84

choledocal cyst

Front 85

congenital anomaly of the biliary tract characterized by multifocal segmental dilation of the intrahepatic bile ducts

Back 85

Carolis disease

Front 86

associated with congenital hepatic fibrosis, portal hypertension and renal tubular ectasia

Back 86

caroli's disease

Front 87

ultrasound reveals multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts. Sludge and calculi may accumulate in these ectatic ducts resulting in posterior acoustic shadowing

Back 87

Caroli's disease

Front 88

what are some complications of Caroli's Disease

Back 88

cholangitis, choledocholithiasis, hepatic abscess/sepsis and cholangiocarcinoma

Front 89

what is the most common cause of malignant neoplasm obstructing the biliary tree

Back 89

pancreatic adenocarcinoma

Front 90

pancreatic adenocarcinoma at the head of the pancreas typically cause

Back 90

courvoisier gallbladder

Front 91

a patient presents with a non diseased enlarged gallblader with painless jaundice and no stones. You suspect it is ____________ gallbladder and the most likely cause of this is _________

Back 91

courvoisier gb, pancreatic adenocarcionma in head of pancreas

Front 92

inflamation and fibrosis of the intrahepatic and extrahepatic bile duts. Results in liver failure leading to liver transplantation

Back 92

primary sclerosing cholangitis (PSC)

Front 93

primary sclerosing cholangitis is most commonly associated with?

Back 93

cholangiocarcinoma but also with ERCP and Inflammatory bowel disiase

Front 94

ultrasound findings inlude a thickening of the bile duct walls and other findings associated with cirrhosis

Back 94

primary sclerosing cholangitis

Front 95

a chronic progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end stage liver disease.

Back 95

Primary biliary cirrhosis

Front 96

the "hallmark" lab finding of this disease is an elevated antimitochondrial antibodies (AMA's)

Back 96

primary biliary cirrhosis

Front 97

the end product of hemoglobin breakdown

Back 97

bilirubin

Front 98

total bilirubin =

Back 98

conjugated bilirubin + unconjugated bilirubin

Front 99

another word for conjugated bilirubin

Back 99

direct bilirubin

Front 100

increased direct bilirubin results from

Back 100

decreased biliary excretion (bile duct obstruction)

Front 101

increased unconjugated (indirect) bilirubin results from

Back 101

increased bilirubin production (hemolysis)
decreased liver conjugation (Gilber syndrome)