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133 Cards in this Set
- Front
- Back
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What makes up the billiary system
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RHD, LHD, CHD, CBD, CD
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what makes up the portal triad
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HA+CBD+PV
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What makes up the billiary system
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RHD, LHD, CHD, CBD, CD
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Is the CBD intrahepatic or extrahepatic?
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extrahepatic
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The CBD should measure less than ______?
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6mm
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what makes up the portal triad
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HA+CBD+PV
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What is another name for the main pancreatic duct
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Duct of Wirsung
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Is the CBD intrahepatic or extrahepatic?
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extrahepatic
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The CBD should measure less than ______?
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6mm
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What makes up the billiary system
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RHD, LHD, CHD, CBD, CD
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What is another name for the main pancreatic duct
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Duct of Wirsung
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what makes up the portal triad
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HA+CBD+PV
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Is the CBD intrahepatic or extrahepatic?
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extrahepatic
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The CBD should measure less than ______?
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6mm
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What is another name for the main pancreatic duct
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Duct of Wirsung
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what is the name of the secondary pancreatic duct
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duct of Santorini
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Which duct contains the spiral valves of Heister
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CD
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What controls the emptying of bile into the doudenum?
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sphincter of oodi
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What are three parts of the GB
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Fundus
body neck |
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What part of the GB contain Hartman's Pouch and the spiral valves of Heister?
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the neck
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What part of the GB would have a phyrugian cap
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Fundus
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What are the functions of the GB
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Storage and concentration of bile emusification
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What hormone causes the GB to contract?
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cck
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What is echogenic bile seen within the GB which creates a fluid filled level appearance
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GB sludge
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Is there a clinical signifigance to GB sludge
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no
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What causes sludge
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long periods of fasting, alcoholism, and billiary obstruction
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What can cause a diffuse thickened GB wall
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ascites, hepatitus, chemo, cancer
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What is the fluid around the GB wall called
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pericholcystic fluid
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What are three GB wall abnormalities
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adenomyomatosis
cholesterolosis porceline GB |
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increase in the number and height of mucosal folds (rugua) w/GB
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adenomyomatosis
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pockets of diverticula developed during adenomyomatosis
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rokitansky-ashoff sinus'
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If stones or bile collect in Rokitanky-ashoff sinus you get __________
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dirty shadow
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With adenomyomatosis what is the u/s appearance
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ring down and possible shadow
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abnormal depositis of cholesterol with in GB wall (often forming polyps)
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cholesterolosis
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extensive calcification seen with in all or part of the GB wall
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porcelain GB
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what is almost always present with porcelain GB
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gallstones
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what is a differential dx for porcelian GB
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WES sign
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What are asymtomatic lesions with hyperplastic growth of epithelium in the Gallbladder
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GB polyps
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why are polyps easily distinguishable from stones
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not mobile, no shadow, stalk
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formation of gallstones when bile becomes alkalike (pH >7)
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cholelithiasis
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What are gallstones made of
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chrystallized cholesterol (shadow)or calcified bilirubin particles (no shadow)
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What are differential dx for gallstones
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gas, porc. GB, surgical clips
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what are the classic acoustic properties of gallstones
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highly reflective
mobile distal shadow |
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what is another name for WES sign
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double arc sign
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what is choledocholithiasis
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stone in CBD
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if you have a stone in the bile duct what other side affects will you have
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jaundice due to obstruction of bile
CBD is often dilated created shot gun sign |
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blunt trauma or erosion of the duct wall by gallstone
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mirrizzi's syndrome
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If you are an older multiparity woman you are more likely to develop.....
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gallstones
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acute inflammation of the GB
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acute cholecystitis
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What symptoms will you have with acute cholecystitis
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+ Murphy's sign
severe right upper quadrant pain |
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what is the u/s appearance of acute cholecystitis
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gb wall > 2 mm
hypoechoic regions within GB GB halo seen possible pericholecystic fluid 95% of cases will have stones |
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What is the differential dx for acute cholecystitis
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non fasting GB
GB CA |
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what is emphysemetais cholecystities
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rare form of acute cholecystitis
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what is the u/s appearance of emphysemethias cholecystitis
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gb wall with dirty shadow
ring down possible gas in bile ducts |
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inflammation of GB over a long period of time with recurring RUQ pain
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chronic cholecystitis
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What labs will be elevated with chronic cholecystitis
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LFTs elevated
amalayse not elevated |
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congenital billiary tree anomaly of the bil. system that causes focal dilatation of the duct in response to raised intrahepatic pressure
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choledochal cysts
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choloductal cysts would present before what age
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10
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What is the usual cause of cholangitis
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billiary obstruction
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What is a rare benign tumor of the GB wall
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GB adenoma
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Where is the finding of GB adenoma typically found
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near fundus
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What is the most common benign tumor of the body
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adenoma
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What is a differential dx of GB adenoma
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GB polyps
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The following symptoms describe what GB anomaly:
associated w/ gallstones h/o cholecystitis GB contracted Highly malingnant asymtomatic |
GB adenocarcinoma
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Who is most likely to be dx with GB adenocarcinoma
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women over 60
pts w/ porcelin GB |
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malingnant tumors located with in the bile ducts
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cholangiocarcinoma
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what is the most common type of GB cancer
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cholangiocarcinoma
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Cancer located at biforcationof RHD and LHD
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klatskin tumor
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What usually causes metastatic GB cancer
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melanoma
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explain Courvousiers Law
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dilated ducts +enlarged GB= a high probability of Pancreatic CA
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What is the order of dilitation?
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GB dilates
common duct intrahepatic ducts |
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What area of the body is the pancreas located
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Retroperitoneal organ
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The pancreas courses over the _______ and under the _____
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PV and SMV
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The pancreas is an encapsulated or non encapsulated organ
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non encapsulated
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Does the panc. become more or less echogenic with age
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more echogenic
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describe the echogenicity ladder from most to least
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renal sinus, panc, liver, spleen, renal cortex
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What are the endocrine functions of the panc.
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produces hormones such as insulin, glucogen and somatostatin.
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What are the exocrine functions of the panc.
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secrete pancreatic juice containing digestive enzymes that assist the absorbtion of nutrients and the digestion in the small intestine
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What are the primary lab values of the pancreas
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amylase and lipase
trypsin and chymotrypsin |
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What is anterior to the aorta and posterior to the SMV
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uncinate process
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inflammation of all or part of the pancreas
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acute pancreatitis
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Damage to _________ ______ causes pancreatic juices to escape into surrounding tissues
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acini cells
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What are some possible causes of acute pancreatitis
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billiary tract disease/ ETOH abuse, trauma, vascular thrombosis, drugs and infection
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List the symptoms of acute pancreatitis
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sudden onset of pain
nausea and vomitting mild fever increase amylase in 1st 24hrs increase lipase in 72 hours increase WBC increase bilirubin |
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What is the U/S appearance of acute pancreatitis
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enlarged hypoechoic pancreas
enlarged panc. duct possible gallstones |
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Encapsulated collections of the byproducts of panc. tissue destruction which can form with acute pancreatitis
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panc. pseudocyst
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Why is a psuedocyst called a psuedocyst
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It is not a true cyst because it is not lined with epithelieal cells
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A complex to cystic mass with thick irregular walls producing dirty shadows that can be a complication of acute pancreatitis
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panc. abcess
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repeated bouts of acute pancreatitis causing the tissue to become fibrotic and non functioning
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chronic panc.
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With chronic panc. permanant damage is done and what is no longer produced by the panc
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digestive enzymes
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What is the U/S appearance of chronic panc?
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atrophic + hyperechoic panc.
calcifications may be present dilated panc. duct |
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What are clinical symptoms of chronic panc.
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persistant epi pain radiating to back
Nausea and vomiting weight loss ileus jaundice psuedocyst elevated labs |
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What are three benign tumors of the panc.
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panc. cysts
panc adenomas islet cell tumors |
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repeated bouts of acute pancreatitis causing the tissue to become fibrotic and non functioning
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chronic panc.
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With chronic panc. permanant damage is done and what is no longer produced by the panc
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digestive enzymes
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What is the U/S appearance of chronic panc?
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atrophic + hyperechoic panc.
calcifications may be present dilated panc. duct |
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What are clinical symptoms of chronic panc.
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persistant epi pain radiating to back
Nausea and vomiting weight loss ileus jaundice psuedocyst elevated labs |
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What are three benign tumors of the panc.
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panc. cysts
panc adenomas islet cell tumors |
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What are true cysts of the panc and why
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pancreatic cysts because they are lined with epithelium
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T/F Panc. cysts are related to pancreatitis
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false
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What is another name for pancreatic adenoma
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cystadenoma
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Describe macrocystic adenoma
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slow growing
arises from panc. duct may have septations or calcification said to be pre-malingnant |
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What is another name for Microcystic adenoma
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serous cystadenoma
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describe microcystic adenoma
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composed of many cysts (< 2cm)
no malignant potential focal or diffuse |
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what are endocrine tumors that are frequently solid tumor of panc.
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Islet cell tumor
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What type of cell does the Islet cell tumor usually occur in
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beta cells
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what condition does islet cell tumors cause
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hyperinsulinism
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What is the U/S appearance to Islet cell tumors
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usually in panc tail
hypoechoic solid mass encapsulated well defined |
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What is the most common solid tumor of the pancreas
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islet cell tumor
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the following are clinical symtoms of what condition
insulin shock anmesia nausea and vomitng confusion |
islet cell tumors
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what are two types of islet cell tumors
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insulinoma
gastinoma |
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which type of islet cell tumor produces hypoglycemic symptoms
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insulinoma
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what is another name for insulinomas
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B-cell tumors
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which type of islet cell tumor produces diarrhea and Peptic ulcer disease (PUD)
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gastrinoma
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what is another name for gastrinoma?
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G-cell tumor
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What is the most common primary tumor of the panc.
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adenocarcinoma of the panc.
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A focal solid mass in panc, usually found in head of panc. with poor prog.
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adenocarcinoma of the panc
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where does adenocarcinoma usually originate
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in panc. duct
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What are typical symtoms of adenocarcinoma of panc.found in epitheleal cells of duct
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leading cause of death 60-80s
more common in smokers exocrine portion of gland |
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if you have a tumor in the head of the panc. what symtoms will you have
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symtoms will appear earlier
CDB will be dilated |
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What symtoms will you have if the tumor is in the body or tail of panc.
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mass will be larger and more invasive
more likely to metastisize symtoms present later |
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What is u/s appearance of adenocarcinoma of panc.
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poorly defined, irregular
typically hypoechoic in appearance heterogenous panc. duct dilitation dilated intrahepatic ducts hydropic GB |
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what lab finding will be increased with adenocarcinoma of GB
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bilirubin
alk. phos. tripsin |
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what is a rare slow growing tumor usually found in the tail of panc. that is malignant
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cystadenocarcinoma
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What is the us appearance of cystadenocarcinoma
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irregular walls
cystic tumor with thick septations may have areas of solid tissue complex in appearance |
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What is a primary CA of the panc
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cystadenocarcinoma
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If cystadenocarcinoma spreads it will usually spread to what organs?
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liver, lymph, lungs, peritoneum and adreanal glands
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what are the three ways to spread cystadenocarcinoma
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to surrounding structures
lymphatic sys portal system to PV |
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repeated bouts of acute pancreatitis causing the tissue to become fibrotic and non functioning
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chronic panc.
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With chronic panc. permanant damage is done and what is no longer produced by the panc
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digestive enzymes
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What is the U/S appearance of chronic panc?
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atrophic + hyperechoic panc.
calcifications may be present dilated panc. duct |
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What are clinical symptoms of chronic panc.
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persistant epi pain radiating to back
Nausea and vomiting weight loss ileus jaundice psuedocyst elevated labs |
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What are three benign tumors of the panc.
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panc. cysts
panc adenomas islet cell tumors |
