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97 Cards in this Set

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  • Back
Where is AST (SGOT) is produced? When does it increase?
Aspartate aminotrasferase is produced by the liver, muslce, & heart. It increases with hepatocyte damage & bile duct obstruction.
Where is ALT (SGPT) produced? When does it increase?
Alanine aminotransferase is produced by the liver ONLY. It increases with hepatocyte damage and bile duct obstruction.
When does Serum Protein decrease/increase?
-It increases with Globulin (inflammatory & neoplastic disease).
-It decreases with Albumin (hepatocyt damage).
What is prothrombin time (PTT) and how can you decrease it?
PTT is clotting time.
It decreases with hepatocyte damage.
Fetal antigen is present in 50% f patients with ________.
Cholesterol decreases with ___ ____ disease and increases with ____ _____.
DECREASES: chronic liver disease
INCREASES: bile duct obstruction
Where is Serum Alkaline Phosphatase (ALK PHOS; AP) produced? When is it increased?
It is produced by biliary ducts when damaged, the liver, bone, kidney, placenta, & intestines.
It increases with biliary obstruction, biliary neoplasm, liver damage, or liver mets.
How many mm total Serum Bilirubin should a NL person have?
0.1-1.2 mg/dl
DIRECT Serum Bilirubin increases with ___ ___ and INDIRECT Serum Bilirubin increases with ___ ___.
DIRECT: biliary obstruction
INDIRECT: hemolytic anemia
What is urbilinogen?
Urbilinogen is a bacterial by-roduct from bilirubin in the intestine
When is urine production increased/decreased?
INCREASED: hemolytic jaundice (too many RBCs are broken down)
DECREASED: biliary obstruction
When does LDH increase?
Lactic dehydrogenase increases with obstructive jaundice
What is the difference btwn medical jaundice d/t a HEMOLYTIC DISORDER vs. a HEPATOCYTE DISORDER?
HEMOLYTIC: increase in amount of breakdown of RBCs done by hepatocytes and creates an increase in by-products
HEPATOCYTE: bilirubin is processed by liver, but is regurgitated back into blood stream
What lab values increase d/t medical(hepatic) jaundice?
Both direct & indirect bilirubin.
What lab values increase d/t obstructive (surgical) jaundice?
Direct bilirubin increases & AP (as a result of epithilial damage of obstruction of bile duct)
Is it possible to have both medical (hepatic) AND obstructive (surgical) jaundice at the same time???
Obstructive jaundice can occur at what 3 main areas?
Intrahepatic, @ porta hepatis, @ common bile duct (prox & dist)
Indirect bilirubin is taken from blood and is conjugated with _____ acid in order to be secreted into bile (water soluble/direct).
Urobilinogen is created after bile enters the ____, where it is combined with bacteria. Some is excreted as ___.
intestines, feces
Normal Bile Duct measurements in mm:
1) At Porta Hepatis
2) At Panreatic Head
3) After cholecystectomy
1) 2-4 mm
2) 7 mm
3) 10 mm

*remember to add 1 mm to each measurement for each decade over 50 yrs old!
What 3 vessels create "mickey mouse"?
CBD - left ear
PHA - right ear
MPV - head
What is another name for the proximal CBD?
Common Hepatic Duct
How long is a NL GB?
10-13 cm long
(4 cm A-P)
What is the capacity of a NL GB?
30-50 ml
The GB is ____ to the caudate lobe.
The GB fossae is found _____ to the GB.
A Phyrigian cap is a fold in the GB _____, while a Hartmann's pouch is a fold in the GB _____.
Phyrigian cap- FUNDUS
Hartmann's pouch- NECK
What valves are found in the neck/cystic duct?
Spiral valves (aka Valves of Heister)
The NL GB wall measures ____ mm.
3 mm or less
(4 mm with ascities)
The portal vein is found _____ to the CBD.
Porcelain GB can cause non-visulization of the GB. T/F?
What type of biliary tree pathology is ATRESIA?
obliteration of the extrahepatic ducts (can extend into the prox intraheptatic duct system)
What type of biliary tree pathology is INTERPOSITION OF GB?
absense of the CHD & cystic duct (CBD is NL)
What type of biliary tree pathology resembles a "string of pearls" on a sonogram d/t to non-obstructive dilitations of ducts?
Caroli's disease (can have a stone, but usually hereditary)
What causes a choledocal cyst?
A choledocal cysts is caused by congenital weakness of the duct wall OR an obstruction
A patient comes in with pain, jaundice, and a palpable mass. What could his pathology be?
Choledochal cyst
What are the 4 types of choledocal cysts? Which 1 is most common?
1) CYSTIC DILATATION (most common)-dilatation begins/ends sharply
2) CHODEOCHOCELE-in intraduodenal part of CBD
3) DIVERTICULUM-outpouching
What is the surgical treatment for choledochal cysts?
Choledochojejunostomy (connecting of the bile duct to the jejunum)
What is the most common biliary tree pathology?
Choledocholithiasis (stones in the bile duct)
A patient comes in with RUQ pain/tenderness, nausea, vomiting, fever, jaundice, and weight loss. What could his pathology be?
Choledocholithiasis (stones int he bile duct)
Labs for choledocholithiasis reveal an increase in what 2 areas?
AP, serum bilirubin, (& WBCs)
Bile ducts respond to respiration or a Valsalva's Maneuver. T/F?
A shot-gun or double-barrel sign is indicative of what?
Choledocholithiasis (CBD & MPV parallel each other and do NOT move b.c they are lodged in CBD)
What is cholangitis?
Cholangitis is acute inflammation of bile ducts d/t bacteria(associated with the inflammation of the GB, liver, panc, intestine, and choledocholithiasis)
Cholangitis is inflammation of the bile duct d/t to bacteria originating from...?
PV, liver, lymphatics, regrug of intestinal contents, trauma/surgery, edma
A patient comes in with RUQ pain, jaundice, & fever w/ chills. What could his pathology be?
Sonographically, cholangitis is associated with...
-bile duct narrowing
-marked ductile dialation
-intrahepatic bile stasis
-local hepatic damage
What surgical treatment is available for cholangitis?
Decompression with a permanent drain replacement
SCLEROSING cholangitis is associated with _____ disease.
Crohn's disease
What are papillomas, polyps, and adenomas?
benign tumors
What is the most common type of benign tumor?
A patient comes in with pain, jaundice, weight loss, & dyspepsia. What pathology could he have?
A benign tumor
Sonographically, abenign tumor appears...
hypoechoic, non-shadowing, non-gravity dependent
The most common type of carcinoma is _____, which arises from the _____.
Adenocarcinomas arise in large ducts (and metastasize to lymph nodes & liver)
A patient comes in with jaundice (painless), weight loss, vomiting, anorexia, & RUQ pain. What could his pathology be?
Sonographically, carcinoma may appear as a...
soft-tissue lesion w/in the ductile lumen
70-90% cases of carcinoma include gallstones. T/F?
The _____ tumor is found at the confluence of the left & right hepatic ducts.
What biliary tree pathology is PNEUMOBILIA?
Pneumobilia is air in the biliary tree (d/t surgery or reflux)
What biliary tree pathology is BILOMA?
Biloma is a collection of bile (d/t surgery or rupture)
GB pathology is usually characterized by what classic symptoms?
Pain/nausea after eating (up to 3 hrs), positive Murphy's sign (pain: RUQ, chest, rt subscapular, upper gastric), fever, RUQ mass
What is the mos common GB disease?
Cholelithiasis (gallstones)
What are 3 reasons for cholelithiasis?
1) ABNL bile composition
2) bile stasis
3) infection
Gallstones of cholelithiasis are composed of what 3 things?
1) cholesterol
2) bile pigment
3) calcium
Cholelithiasis is more common in African Americans. T/F?
Flase, it is more common in American Indians
Cholelithiasis increases with age, diabetes, and pregnancy? T/F?
What lab values increase with cholelithiasis?
AP (somewhat AST & ALT)
A patient comes in with RUQ pain, chest pain, & nausea/vomiting after meals. What could his pathology be?
Sonographically, we can diagnosis cholelithiasis based on if it exhibits WES sign. What does this stand for?
A cholecystogram causes stones to float
Sludge is associated with pain. T/F?
Sludge is mainly composed of ____ ____.
Calcium bilirubinate
Predisposing factors for sludge include...
-IV therapy
-duct obstruction
Sonographically, sludge exhibits...
non-shadowing, gravity dependency, layering effects, mimics neoplasms (or blood or pus)
Cholecystitis is inflammation of the GB. (95% of patients have gallstones)
What lab values will increase with cholecystitis?
AP, Serum bilirubin, AST/ALT (& WBCs)
A patient comes in with fever, leukocytosis, RUQ pain, nausea/vomiting, postitive Murphy's sign, & jaundice. What pathology could he have?
Of the 2 types of acute cholecystitis, is acalculous or calculou more common in males?
Acalculous (and it's more fatal!)
Acute ACLACULOUS cholecystitis is d/t changes in ___ or ___, while acute CLACULOUS cholecystitis is d/t an ____
ACALCULOUS: vascularity or stagnant bile
CALCULOUS: obstruction
The HALO SIGN is classic echo feature of _____.
Cholecystitis can lead to what type of complications?
-empyema of GB (pus)
-gangernous GB (no pain)
-perforated GB (peritonitis)
Chronic cholecystitis is associatied with an enlarged GB. T/F?
False, chronic causes GB to become small in size
Chronic cholecystitis may develop into Porcelain GB. T/F?
_____ syndrome is a biliary-enteric fistula that forms btwn the GB and duodenum.
Bouveret's syndrome
____ syndrome is a stone impacted in the neck/cystic duct and erodes into adjacent CBD.
Mirizzi's syndrome
What is Porcelain GB?
Porcelain GB is calicified GB walls.
What causes porcelain GB?
Chonic cholecystitis, toxic bile, chronic irritation of GB wall (stones), infection
What is Hydropic GB?
Hydropic GB is an enlarged GB containing pus, mucus, or pus d/t an obstruction of the cystic duct.
What is Courvoisier GB?
Courvoisier GB is enlarged d/t CBD obstruction & panc cancer.
How does HIV GB appear sonographically?
HIV GB has thickened walls, striations, dilation, pericholic fluid, & sludge (w/o stones)
Polyps are benign neoplasms that shadow. T/F?
False, they are benign neoplasms but they do NOT shadow b/c they are made of cholesterol
(these are benign non-inflammatory conditions that cause proliferation to GB wall)
The hyperplastic cholecystosis ADENOMYOMATOSIS is excesssive proliferation of ____ tissue characterized by formation of mucosal outpouchings called ____.
epithelial, diverticula (aka Rokitansky-Aschoff sinuses)
What is "Strawberry GB" also known as?
What is Cholesterosis?
Cholesterosis is cholesterol deposits in the GB wall. (May be diffuse or localized)
______ is the most common type of malignant lesion.
Sonographically, Adenocarcinoma can be recognized by...
stones, irreg wall thickness, polypoid masses > 1 cm, intrinsic vaculature (shown with color Doppler), non-shadowing