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85 Cards in this Set
- Front
- Back
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how many classifications of choledochal cyst are there
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five
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what is the most common type of choledochal cyst`
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saccular or fusiform dilatation of the common biliary duct this is also known as a type I
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what is a type IIcholedochal cyst
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this is a isolated diverticula in the common biliary duct
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where do type three choledochal cysts arise from
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they rise from the intra duodenal portion of the common biliary duct
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what is a type 4 choledochal cyst
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a type 4 choledochal cysts is multiple dilatation's of either the intra and extra impact ducts or just the extra bile ducts
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what is it called when there's multiple dilatation of the intrahepatic ducts only
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this is known as type 5 choledochal cysts, also known as caroli disease
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what is a differential diagnosis to choledochal cyst
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a biliary cyst adenoma
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what are some of the findings of biliary cyst adenoma
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the findings include multiloculated fluid collections, enhancing septations and nodules, and calcification ( which is rare)
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who is diagnosed with biliary cyst adenoma more frequently; male or female
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female, there is a 4 to 1 predominance
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was a differential diagnosis of biliary cyst adenoma
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complicated cyst, cystic Mets, abscess, hematoma, enchiococcosis
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what is most sensitive to find gallstones
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ultrasound is the most sensitive followed by mrcp, and finally ct last
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what is the most sensitive modality to evaluate the common bile duct
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mrcp, followed by ultrasound, ct last
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what is the signal intensity of gallstones on MRI
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gallstones usually demonstrate low signal on both T-1, T2 images
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why are gallstones sometimes bright centrally
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this is because occasionally there is water filling which has a high signal
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can gallstones be in lamellated
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yes
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what color are pigment stones on T1
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bright
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will color our cholesterol stones on T1
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dark
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what is Mirizzi syndrome
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this is when the cystic duct at the gallbladder runs parallel to the common hepatic and causes inflammation and results in common bile duct being obstructed
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what is the cause of Mirizzi syndrome
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impaction of the stone in the cystic duct or the neck of the gallbladder
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does Mirizzi syndrome affect the common hepatic duct
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yes there can be mechanical obstruction of the common hepatic duct by the stone itself or by secondary inflammation
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what are some of the signs and symptoms of recurrent Mirizzi syndrome
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jaundice, reccurent cholangitis and secondary biliary cirrhosis
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what are some complications of cholelithiasis
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acute cholecystitis, obstruction, cholangitis, secondary biliary cirrhosis
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what is the name of the condition where a gall stone blocks the duodenum
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bouveret syndrome
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what are some of the possible fistulas that are formed by the gallbladder
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between the colon and duodenum
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what demographic commonly is diagnosed with gallstone ileus
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old ladies
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what is the mortality of gallstone ileus
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10 to 25%
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what is rigley's triad
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small bowel obstruction, pneumobilia, ectopic gallstone
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what are some findings of acute cholecystitis with ultrasound
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cholelithiasis, intra-mural sonoluceny, Murphy's sign, gallbladder wall hyperemia, pericholecystic fluid, gallbladder distention, sludge, gas in gallbladder wall or lumen, pericholecystic abscess
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what is a differential diagnosis of acute cholecystitis
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Mantle cell lymphoma of the gallbladder
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what demographics of patients does reccurent cholangitis occur in
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older patients
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what are some causes for reccurent cholangitis
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intrahepatic pigment stones obstruction
bacterial seeding of the biliary tree parasitic infection |
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was the most common cause of ascending cholangitis
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gram-negative bacteria
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what are some risk factors for ascending cholangitis
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choledocholithiasis, indwelling stents, tumors, acute pancreatitis,
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is primary sclerosing cholangitis more predominate in men or women
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men and usually occurs in males under 45 years of age
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what are some of the complications of primary sclerosing cholangitis
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cirrhosis, recurrent bacterial cholangitis, cholangiocarcinoma
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what is the sensitivity and specificity of mrcp for detecting primaries sclerosing cholangitis
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sensitivities 80% and the specificity is 99%
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well you see on MRCP of primaries sclerosing cholangitis
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stenosis, beaded ducts
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what are some causes of focal gallbladder wall thickening
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hyperplastic cholecystosis, gallbladder polyps, Mets into the gallbladder and gallbladder cancer
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what are two forms of hyperplastic cholecystosis
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cholesterolosis, adenomyomatosis
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what is cholesterolosis
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a rare tumor like legion of the gallbladder with no malignant potential
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do patients with cholesterolosis of the gallbladder present symptomatically
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no the patients are usually asymptomatic unless there is coexisting stones
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what is a strawberry gallbladder
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the description of a bladder with cholesterolosis
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what are two forms of cholesterolosis of the gallbladder
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planar are in polyploid
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does adenomyomatosis have malignant potential
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no
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describe adenomyomatosis
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this isovergrowth of the mucosa, , thickening of muscular wall, formation of intramural diverticula or sinus tracts
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what are the name of the sinus tracts formed from adenomyomatosis of the gallbladder
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rokitansky-aschoff sinuses
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what are some of the criteria for surgery if a patient has gallbladder polyps
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at the polyp is greater than 1 cm, if the patient is greater than 50 years old, if this is symptomatic, if coexisting stones are present
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if you decide not to do surgery on gallbladder polyps what is the alternative choice of management
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surveillance every three months for one year
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what are some of the common causes of gallbladder wall metastatic disease
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melanoma, lung cancer, breast cancer
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true or false: gallbladder cancer is considered an old lady's cancer
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true
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true or false: gallbladder cancer has an association with gallstones
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true
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true false: gallbladder cancer has association with porcelain gallbladder
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true
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where are some common nodal areas of metastasis before gallbladder cancer
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hepatic, pancreaticodoudenal, paraaoritc
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which sex has porcelain gallbladder more frequently; male or female
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female; there is a five to one ratio of female to male
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what is the frequency of adenocarcinoma of the gallbladder is a patient that has porcelain gallbladder
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22%
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what are some of the risk factors for cholangiocarcinoma
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primary sclerosing cholangitis, clonorchis, thorotrast
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what are the tumor morphological patterns that cholangiocarcinoma can present
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mass like, peri-ductal, intra-ductal
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in what portion of the biliary tree do the majority of cholangiocarcinoma presents
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hilar, this is just distal to where the confluence of the left and right hepatic ducts meet to form the common hepatic duct to just proximal to wear the cystic duct meets the common hepatic
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when are biliary ducts most bright TE Is extended or shortened
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biliary ducts are generally higher signal intensity when there is a longer TE
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what is MRCP used
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its uses predominately focus on patients where ERCP might be difficult or if ERCP has been done and the results three choledochal or when the suspicion of choledocholithiasis is well
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What are two techniques for MRCP
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tomographic technique and the Cholangiographic technique
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what is a potential downside of using the cholangiocarcinoma technique
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there is the possibility of missing small filling defects such as stones
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which technique is most commonly employed when using MRCP
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T2 weighted spin echo with and without fat suppression
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What is the name of the agent that can be used to improve visualize of the biliary ducts
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Mn-DPNP
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What is the complication rate of ERCP
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3%
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what is a major disadvantage of MRCP
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inability to provide therapy if needed
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what is the normal TE value used in MRCP
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150 to 200 ms
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what happens if a longer or shorter TE value is used
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one loses the definition of the surrounding structures
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Why does the biliary ducts and pancreatic ducts appear bright whereas the surrounding tissue appears dark
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the biliary ducts and pancreatic ducts have a long T2 relaxation time whereas the liver with its short T2 relaxation time will generate very little signal
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What is the sensitivity and specificity of MRCP
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93% and 91%
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what can lead to false interpretations of a gallstone on MRCP
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air bubbles or surgical clips
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MRCP be used to detect cholecystitis
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the gradient echo sequence will detect gallbladder wall thickening and pericholecystic fluid as well as gallstones
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what should you look for in a patient who is status post cholecystectomy is have MRCP done
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look for biliary duct anomalies because these could be the cause of bile leaks after laparoscopic cholecystectomy's
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what are some bile duct and anomalies that are important to recognize
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low cystic duct insertion, medial cystic duct insertion, long parallel course of the cystic duct in the common hepatic duct, and an aberrant right posterior duct draining into the cystic duct
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what ducts does sclerosing cholangitis affect
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the intrahepatic and extra hepatic ducts
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why is MRCP sometimes more useful than ERCP
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sometimes these patients are difficult to scope because of their small caliber ducts
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What is not another name of the dorsal duct
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Santorini
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what does the dorsal duct also known as the duct of Santorini drain into during pancreatic divisum
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the minor papilla
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what is not another name for the ventral duct
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wirsungs duct
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In pancreatic divisum what duct drains into the major papilla
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the ventral duct also known as the duct of wirsung
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was a complication of pancreatic divisum
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chronic pancreatitis
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what is more sensitive for detecting pancreatic divisum ERCP or MRCP
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MRCP
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What pathology does MRCP have the most difficulty detecting
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is good at detecting stones and dilatation, however, it has difficulty with strictures and sometime will underestimate them
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When would ERCP be chosen over MRCP
Name six reasons |
sphincterectomy, stone removal, manometry, stent placement, balloon dilatation, and occasionally brushing of a suspected malignant lesion
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what are the two major drawbacks to MRCP
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small ductal structures cannot be well visualized( side ranches of the pancreatic duct and peripheral biliary ducts) and dynamic information is not available such as may be needed papillary stenosis
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