Term
|
Definition
Septated Gallbladder:
Multiple septations and honeycomb appearance |
|
|
Term
|
Definition
junctional fold:
a fold in the GB located between the body and neck |
|
|
Term
|
Definition
Hartman's pouch:
a bulbous region of the neck of the GB where stones can get lodged |
|
|
Term
|
Definition
| This type of congenital anomaly is asymptomatic or has GB disease symptoms |
|
|
Term
|
Definition
| Incomplete development of the gallbladder/biliary tract; Associated with cystic fibrosis |
|
|
Term
|
Definition
Rare; Two separate lumens and two separate cystic ducts uniting into CBD
OR two cystic ducts opening separately into the biliary tract |
|
|
Term
| floating gallbladder (wandering) |
|
Definition
Attached to its surrounding structures by the cystic duct & mesentery
At risk for torsion/necrosis |
|
|
Term
| ectopic GB (Intrahepatic GB) (Intraperitoneal) |
|
Definition
GB lies w/in the liver parenchyma; may cause gallstones because of bile stasis
US: cystic structure seen in liver
Must contract after fatty meal to determine if it is indeed GB |
|
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Term
|
Definition
Phrygian Cap
a fold in the GB located at the fundal aspect |
|
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Term
|
Definition
| Incidence: 10-20% of adults get stones Increases with age 4 F’s = female, fair, 40 and fat (some sources say fertile) Size/Number: Fine gravel to 3-4cm Largest stone on record: 13 lb 4oz 1 to hundreds Most stones are denser than the bile Less dense stones will float |
|
|
Term
| Gallstones are composed of one or more of the following components: |
|
Definition
Cholesterol
Calcium bilirubinate
Calcium carbonate |
|
|
Term
| Stone composition incidence |
|
Definition
Mixed stones (90%)
80% of mixed stones are predominately cholesterol stones
Pure stones (10%)
Cholesterol stones
Calcium bilirubinate
Calcium carbonate (rare) |
|
|
Term
|
Definition
- Abnormal bile composition (most common)
- Bile Stasis: the sluggish movement of bile in the ducts
- Conditions assoc. w/biliary stasis:
GB dysfunction (poor contraction)
Sphincter dysfunction (spasm)
Hormonal changes (pregnancy)
-Infection (may form debris in the bile ducts) |
|
|
Term
| Risk Factors for Developing Gallstones |
|
Definition
| Obesity, Diabetes, Pregnancy, Pancreatitis, Alcoholic cirrhosis |
|
|
Term
|
Definition
- most patients are asx
- most asx patients will develop cholecystitis
- Tenderness on exam |
|
|
Term
|
Definition
An impacted gallstone in the cystic duct, or GB neck that can cause obstruction of the CHD by compression or inflammation around the stone
Clinical Signs: RUQ pain, Jaundice |
|
|
Term
|
Definition
-TWO parallel tubular structures which represent the bile duct above the level of the cystic duct and portal vein; Doppler is used to differentiate between the vascular and biliary structures
-Dilatation of the CHD & intrahepatic ducts above the level of the gallstone impacted in the cystic duct w/normal CBD below the stone |
|
|
Term
|
Definition
-curved surface of stone is hyperechoic
-acoustic shadow posterior
-large stones easily shadow, where small stones may not shadow |
|
|
Term
Most stones are _______ ___________.
As you roll the pt, the stones will move easily. |
|
Definition
|
|
Term
| What is an issue with tiny gallstones? |
|
Definition
| Numerous tiny stones may layer evenly along the posterior GB wall; may mimic GB wall; tiny stones can easily be missed |
|
|
Term
|
Definition
| seen due to an increase in the viscosity of the bile from prolonged fasting or from air in the stone |
|
|
Term
|
Definition
Echogenic concentrated bile within the GB associated with bile stasis
Symptoms:
-RUQ pain
-Asymptomatic
Sludge may be a sign of biliary tract disease:
gallstones
cholecystitis
GB obstruction
extrahepatic biliary obstruction |
|
|
Term
|
Definition
TYPICAL Findings:
-low level echoes
-no shadowing
-may be present w/stones
-gravity dependent |
|
|
Term
| What are some atypical US sludge findings? |
|
Definition
Tumefactive Sludge:
tumor-like, does not layer or move
Sludge Balls: Round balls of sludge, mobile, non shadowing
Hepatization: Sludge completely fills the GB so that the GB and its contents become isoechoic to the liver |
|
|
Term
|
Definition
|
|
Term
| What are the two types of acute cholecystitis? |
|
Definition
Acute Calculous Cholecystitis
-stone is causing acute inflammation of GB; more common in females than males
Acute Acalculous Cholecystitis
- inflammation isn’t caused by a stone |
|
|
Term
|
Definition
gallbladder WES sign
Also Called: Double Arc Sign -Purpose: Identify stones when no bile is present WES Sign Pattern: Best seen on TRANS image W: Gallbladder Wall E: Echogenic Stone S: Acoustic Shadow |
|
|
Term
| What are some symptoms of Acute Calculous Cholecystitis? |
|
Definition
| Nausea (90%), Vomiting, Fever, Acute onset of RUQ pain & tenderness, radiates to shoulder (irritates diaphragm), + Murphy’s sign (pain in RUQ w/deep palpation during inspiration- pressing on tender GB), postprandial pain (fatty food) 90%, Bowel gas (flatulence, abdominal distention), Jaundice (CBD obstruction) |
|
|
Term
| What is the ultrasound appearance of Acute Calculous Cholecystitis? |
|
Definition
- + Murphy’s sign
- stones in CD or GB neck
- GB diameter greater or equal to 5cm in a fasting patient
-thickened GB wall with edema, hypoechoic & striated (Halo sign),greater than or equal to 3mm in a fasting patient |
|
|
Term
| Acute Acalculous Cholecystitis |
|
Definition
Etiology:
Occurs in 10% of acute cholecystitis patients
Caused by stasis or vascular changes in GB
Stasis/obstruction + infection
Poor circulation/clotting w/in wall of GB
More commonly found in children and immunocompromised patients |
|
|
Term
| Risk factors of Acute Acalculous Cholecystitis |
|
Definition
Recent surgery
Starvation
Prolonged fasting
CHF
Diabetes
Lymphadenopathy |
|
|
Term
|
Definition
Accute Acalculous Cholecystitis
Same as ACC without stone in neck
May See GB Hydrops: AP Diameter of GB greater than 4 cm |
|
|
Term
|
Definition
(Hepatobiliary iminodiacetic Acid Scan) Nuclear Medicine Dept.
-Tracks flow of bile from liver to small intestine
-Evaluates GB
-Can measure the rate at which bile is released from the GB
-Helps to diagnose: Bile duct obstruction, Bile leakage, Congenital abnormalities of bile duct, Cholecystitis, Gallstones |
|
|
Term
|
Definition
-Repeated/Intermittent obstruction of the cystic duct by gallstones/Repeated acute attacks
-These attacks cause inflammatory changes, wall thickening and fibrosis
-Occurs predominantly in patients who are female, fair, fat & forty (4 F’s) |
|
|
Term
| Most common form of symptomatic GB disease |
|
Definition
|
|
Term
| Symptoms of Chronic Cholecystitis |
|
Definition
| Symptoms: Same as acute cholecystitis patients but less severe Multiple episodes of RUQ, Epi pain Nausea/Vomiting Intolerance to fatty/fried foods Flatulence + Murphy’s sign Jaundice (if CBD is obstructed) |
|
|
Term
|
Definition
Chronic Cholecystitis
- + Murphy’s sign
- stones
- + WES sign
- may contain debris/sludge
- GB may be contracted, normal or enlarged
- Pericholecystic fluid is less common
- GB wall thick measuring greater than 3mm in a fasting pt, hypoechoic w/cystic changes, fibrotic (uniformly echogenic), wall calcifications |
|
|
Term
What is the difference between Cholelithiasis and Cholecystitis on Ultrasound? Can a patient have both conditions at the same time?
|
|
Definition
| The major difference between Cholelithiasis and Cholecystitis is that Cholecystitis presents with a positive Murphy sign. On ultrasound, the cholecystitis generally presents with a stone in the gallbladder neck or cystic duct.Cholelithiasis could present anywhere in the lumen. A patient can have both conditions at the same time. |
|
|
Term
What are the 4 F’s when talking about people who are at risk for GB disease? |
|
Definition
|
|
Term
| A GB wall will measure ___ in a patient with Cholecystitis. |
|
Definition
|
|
Term
|
Definition
| also called supernumerary spleen or speniculi; solitary or multiple round islands of splenic tissue typically located at the hilum (may occur anywhere in the abdomen) |
|
|
Term
|
Definition
accessory spleen US:
small rounded masses (<5cm) located near the splenic hilum |
|
|
Term
|
Definition
| aka wandering spleen; abnormally positioned spleen caused by failure of fusion of the dorsal mesentery with the posterior peritoneum, may undergo torsion causing acute abdominal pain, use color Doppler for evidence of torsion |
|
|
Term
| Asplenia/Polysplenia Syndrome |
|
Definition
Congenital abnormality resulting in an abnormal arrangement of organ:
*situs solitus: normal design
*situs inversus: mirror image, organs reversed
*situs ambiguous: between the extremes |
|
|
Term
| Asplenia / polysplenia syndromes are forms of situs __________. |
|
Definition
|
|
Term
|
Definition
Bilateral right-sidedness
-absence of normal spleen function
-absent spleen
-two right lungs
-midline location of liver
-reversed position of aorta & IVC
-horseshoe kidney |
|
|
Term
|
Definition
Bilateral left-sideness:
-multiple small accessory spleens
-two left lungs
-left sideness azygos continuation of an interupted IVC (hepatic portion absent-hepatic veins drain directly into RA
-Biliary atresia
-absent GB
-cardiovascular abnormalities
-multiple spleens |
|
|
Term
| Normal Spleen Measurements |
|
Definition
Length = < 12 cm
Width = <8 cm
Thickness = < 4 cm |
|
|
Term
|
Definition
~mild/moderate: Portal hypertension, Infection, Aids, Trauma
~moderate: Hemolytic disorders, mono, leukemia, lymphoma, mets
~massive/severe: Myelofibrosis (bone marrow disease) |
|
|
Term
| What is the body's response to infection? |
|
Definition
| Granuloma - the body is unable to kill the infecting agent, fibrotic tissue develops around the organism, fibrotic tissue eventually becomes calcified |
|
|
Term
| What are the most common causes of a granulomatous response to infection? |
|
Definition
| Histoplasmosis Tuberculosis / Sarcoidosis |
|
|
Term
| How does a granulomatous response appear on US? |
|
Definition
| numerous tiny echogenic foci, with or w/out shadowing |
|
|
Term
| How would the spleen react to other infections? |
|
Definition
Mono: splenomegaly
Schistosomiasis: splenomegaly, focal hypoechoic masses
Candidiasis: focal hypoechoic masses, wheel w/in a wheel, bull’s eye or target sign
Hydatid Disease: cysts w/in spleen (possibly calcified walls),cluster of calcifications
Splenic Abscess: complex mass |
|
|
Term
| What are some possible splenic cysts? |
|
Definition
| Epidermoid Cyst, Infectious Cyst, Post-Trauma Cyst, Pancreatic Pseudocyst, Hydatid cyst (worm, need splenectomy) |
|
|
Term
| What is the most common benign neoplasm of the spleen? |
|
Definition
|
|
Term
|
Definition
| lymph filled cystic masses; rare; hypoechoic masses w/septations and/or internal debris; no color flow to mass |
|
|
Term
| Metastatic Tumors of the Spleen |
|
Definition
most spread from malignant melanomas, lymphoma, leukemia
Hodgkins & non Hodgkins lymphoma usually begins in the lymph nodes & spread to the spleen
occurs in late stages of disease |
|
|
Term
| What is it called when there is a loss of blood supply to a portion of the spleen? |
|
Definition
| splenic infarction - hypoechoic, wedge-shaped mass in the periphery of the spleen |
|
|
Term
| Intraparenchymal Hematoma |
|
Definition
-injury is confined to the spleen
-hemorrhage occurs w/in the splenic parenchyma
-capsule remains intact |
|
|
Term
|
Definition
-timing is important to consider after trauma
-immediately after trauma, hematoma is liquid & easy to identify
-24-48 hrs after trauma- blood clots & can be same echogenicity of the spleen
-then it liquifies again & is easier to see |
|
|
Term
| Intraparenchymal Hematoma US Appearance |
|
Definition
-splenomegaly
-normal, inhomogeneous, hypoechoic areas w/in parenchyma
-capsule not seen
-unrepaired intraparenchymal hemorrhage will resolve into a cyst
-the walls of the cyst may become calcified |
|
|
Term
| Subcapsular Hematoma of Spleen |
|
Definition
-injury is confined to the spleen
-hemorrhage occurs beneath the capsule along the periphery of the spleen
-capsule remains intact
Ultrasound appearance:
-crescent-shaped mass
-anechoic to echogenic (depending on age of hematoma)
-capsule not seen |
|
|
Term
|
Definition
-injury to spleen & splenic capsule
-splenic hemorrhage escapes through the capsule into the peritoneal cavity
-blood and clots outside the capsule
-perisplenic and subcapsular hemorrhage can occur simultaneously
-free blood and clot may occur anywhere w/in the peritoneal cavity (subdiaphragmatic, colic gutters, cul de sac) |
|
|
Term
| condition in which portions of or the entire GB wall has calcified |
|
Definition
Porcelain Gallbladder - rare,more common in females & older patients, have stones 95% of the time, assoc. with potential development of GB carcinoma
US: May look like stone filled GB but lacks WES sign |
|
|
Term
| the clinical detection of an Enlarged/Palpable GB that is caused by a Pancreatic Head Mass (patients present with painless jaundice) |
|
Definition
|
|
Term
| Gallbladder Hydrops (Cholecystomegaly) |
|
Definition
a GB distention w/out wall thickening
GB Should not exceed 4 cm in width (transverse diameter)
GB should not exceed 12 cm in length (some texts say 10cm) |
|
|
Term
|
Definition
GB Hydrops
US Appearance:
-marked distended GB (trans or AP diameter greater than 4cm)
- thin walls
-evaluate for Mirizzi’s syndrome |
|
|
Term
| Hemorrhagic Cholecystitis |
|
Definition
| Inflammation/infection can disrupt the blood supply to a portion of or to the entire GB wall Reduced blood supply (ischemia) may lead to a total loss of blood to the area (infarction) If blood supply is lost, vessels may rupture Hemorrhage may form in the GB wall and/or in the lumen |
|
|
Term
|
Definition
Gangrenous cholecystitis:
A condition where inflammatory changes in the GB have resulted in an infarction, necrosis, & putrification (decaying) of GB tissue
+ Murphy’s sign is usually absent because the nerves to the GB wall have been destroyed |
|
|
Term
|
Definition
Adenomyomatosis:
Diverticula within the wall of the Gallbladder (Formation of gland like tissue and exaggerated out pouching of the mucosa)
asx, common in women
Termed Rokitansky-Ascholff Sinuses (RAS) |
|
|
Term
| Emphysematous Cholecystitis |
|
Definition
| Acute Infection of the GB wall Due to vascular compromise, bacteria produces gas within the wall of the GB Stones are usually absent Progressive, possibly fatal Symptoms: fever, increased WBC, tenderness |
|
|
Term
|
Definition
| Large gallstone may be lodged in one portion of the GB Over time, the stone erodes into the GB wall (called decubitus ulcer) Erosion may penetrate through the wall & adjacent intestine creating a hole between the GB & the intestine (hole is called GB fistula) GB collapses Stone may pass through the fistula into the intestine (may be w/out incidence) |
|
|
Term
| Other than cholecystitis, what might cause a thickened GB wall? |
|
Definition
| Contracted normal GB Hepatitis/Cirrhosis CHF Renal Disease AIDS Pancreatitis GB tumors Sepsis |
|
|
Term
|
Definition
Cholesterosis:
Accumulation of triglycerides/cholesterol crystals in GB wall due to disturbance in cholesterol metabolism
W>M; May or may not effect GB function
Forms:
Diffuse: Called “Strawberry GB”
Localized: Cholesterol Deposits form polyps
-Projecting in GB lumen
-2-10 mm in Size
*Cholesterol Polyp is most common polyp
|
|
|
Term
|
Definition
Papillary Adenomas:
Overgrowth of the epithelial lining
Symptoms: Asx
Size: measure <1 cm
US:Only polypoid adenomas are seen
- Usually single/fundal area
-isoechoic to GB wall
-no shadowing
-not gravity dependent |
|
|
Term
| What is the most common benign GB tumor? |
|
Definition
|
|
Term
|
Definition
ADENOCARCINOMA
represents 98% of neoplasms |
|
|
Term
|
Definition
Adenocarcinoma:
Rock-hard mass in RUQ
Focal or diffuse wall thickening, irregular wall thickening
Mass extending into lumen
Mass filling or replacing GB lumen (60%)
Mass poorly defined & isoechoic to liver
Tumor usually has flow (doppler)
Gallstones (80-90%)
Large stone (trapped stone)
Wall calcification (porcelain GB)
Look for mets:
Liver (direct invasion is common) |
|
|
Term
|
Definition
| Occurs in older patients Symptoms: Early stages: Asymptomatic Late stages: Similar to Chronic cholecystitis with a recent change in symptoms; Palpable, hard RUQ mass w/liver invasion & jaundice Prognosis: Best cure: found early (incidentally) at surgery 5 year survival rate: 5% |
|
|
Term
| Adenocarcinoma Risk Factors |
|
Definition
| -Obesity -Cigarette smoking -gallstones -cholecystitis -porcelain GB -Polyp > 2 cm |
|
|
Term
|
Definition
Def: the spread of cancer to the GB (originates somewhere else in the body)
Not very common
Melanoma is the most common
U/S:
Focal thickening of GB wall
Stones unlikely
Multiple, polypoid lesions along GB wall |
|
|
Term
|
Definition
Def: absence or closure of the biliary ducts
Etiology: unknown-affects neonates
Possibly caused by Infection, Immune Disorder
Rare, M>F
Variations of Biliary Atresia:
Total absence of biliary tree
Absent intrahepatic ducts
Absent extrahepatic ducts (most common)
Small or absent GB
Symptoms/Clinical Findings:
-persistent jaundice in a newborn
-elevated Direct & Indirect Bilirubin
-Polysplenia Syndrome (20%)
US Appearance:
Small or absent GB
Fibrotic remnant of CHD (Triangular Cord Syndrome)
Intrahepatic biliary dilatation
Complications: CIRRHOSIS
PORTAL HYPERTENSION
MALABSORPTION
DEATH WITHOUT INTERVENTION
Treatment:Treatment:
Intestine-ductal anastomosis
Liver transplant |
|
|
Term
|
Definition
Definition: cyst within the biliary system
Incidence:
Common in East Asian populations
Rare
Mostly female
Usually detected in children <10 yrs old
Clinical Findings: Failure to thrive-RUQ pain-Jaundice-Fever/Chill
US: -Cystic structure communicating with the bile Ducts
-Large cystic mass in the porta hepatitis which is separate from the GB |
|
|
Term
|
Definition
Type V Choledochal Cyst
-Non-obstructive saccular dilatation of the intrahepatic bile ducts
Incidence: Typically found in childhood through 20’s
Symptoms: Fever, Crampy pain, Intermittent Jaundice
Ultrasound Findings: Multiple cystic structures within the liver that communicate with the biliary tree
- Stones/sludge may be seen
-Doppler the structures to demonstrate no flow |
|
|
Term
|
Definition
Intra-hepatic Biliary Dilatation
Intra-Hepatic Ducts:
Bile ducts from the peripheral parenchyma near the capsule through the right hepatic duct and left hepatic ducts
Risk Factors:
Extrinsic obstruction, Gallstones in the ducts, Mets
US:
“Shot Gun Sign”
“Parallel Channel Sign”
Dilated Bile duct adjacent to a Portal Vein
|
|
|
Term
|
Definition
Abdominal Lymph Nodes –
Normal: not seen
Abnormal: Frequently seen
Neck Lymph Nodes – normal and abnormal will be seen |
|
|
Term
|
Definition
Size Criteria <= 1.5 cm in length
Short/long ratio <.5 (flat) |
|
|
Term
Abnormal Lymph Node US Findings
Clinical Symptoms |
|
Definition
Thickened cortex exceeds fatty hilum
Asymmetric cortical thickening
No fatty hilum
Autoimmune response, “blood poisoning”, reddening & warm skin, fever, pain, swelling
Red lines = course of lymphatic vessels in affected area
Painful enlarged lymph nodes |
|
|
Term
| cyst that contains lymph from diseased lymphatic channels |
|
Definition
Lymphocele
Causes: trauma or surgery |
|
|
Term
| enlarged lymph nodes (>1.5 cm) |
|
Definition
Lymphadenopathy
Causes : inflammation, cancer |
|
|
Term
| inflammation of lymph nodes (or lymphatic channels) |
|
Definition
Lymphangitis
Causes: infection (most common = Group A strep) |
|
|
Term
|
Definition
Clinical symptoms:
May be asymptomatic
Palpable mass, chronic back pain, weight loss, anorexia, fatigue, anemia, fever, leukopenia
Primary: Lymphoma- most common form of “blood cancer”
-Hodgkin's
-NonHodgkins (most Common)
Secondary:Metastatic disease spread to the lymphatic system
Lymph nodes are the most common site for mets
US Appearance:
Size criteria: Length >1.5cm
Long/Trans Ratio <2cm
Short axis to long axis (S/L ratio >.5cm)
round in shape
normal nodes = echogenic hilum, hilar vascularity
malignant = echogenic hilum absent, peripheral or mixed vascularity |
|
|
Term
| Intra-operative Cholangiogram: |
|
Definition
During surgery to remove the GB, a catheter is placed in the cystic duct , contrast is injected into the CBD and images are taken to look for CBD stones
Performed only if ERCP is not done pre-operatively |
|
|
Term
|
Definition
Major abdominal incision
GB is exposed & removed
Cystic duct is stapled
CBD is explored manually or by intraoperative cholangiogram
T-tube may be inserted if CBD stones are present
Hospital stay is 4-5 days
Recovery is several weeks |
|
|
Term
| Laparoscopic Cholecystectomy |
|
Definition
GB removed through a small incision at the umbilicus
Fibro-optic lens is used to guide the procedure
Laser beams may be used for the cutting
Day surgery (short recovery) |
|
|
Term
| Percutaneous Transhepatic Cholangiogram (PTC) |
|
Definition
Inject contrast percutaneously in dilated ducts
Images hepatic & common bile ducts & looks for cause
Needle is inserted through the liver (transhepatic) and into the bile ducts
Contrast media is inserted & the ducts are outlined
Stone extraction
Biopsy
Stent placement (drainage) |
|
|
Term
|
Definition
Magnetic Resonance Imaging (MRI):
MRI able to visualize CBD and PD
Better than CT
Computerized Axial Tomography (CAT scan):
CT better at visualizing the distal CBD than U/S
US better at seeing stones in GB |
|
|
Term
| Magnetic Resonance Cholangiopancreatography(MRCP) |
|
Definition
Imaging technique that uses MRI to visualize the biliary and pancreatic ducts in a non-invasive manner
Less invasive compared to ERCP
Unlike ERCP, MRCP does not require contrast to be administered into the ducts (reduces risks of contrast reactions)
Fluid in the ducts serve as a contrast substance
MRCP does not allow for stone extraction, stent insertion, biopsy
Lower resolution than direct cholangiography and can miss small stones, ampullary lesions, primary sclerosing cholangitis, and strictures of the ducts
Accurate for measurements of the bile ducts and pancreatic duct |
|
|
Term
| Endoscopic Retrograde Cholangiopancreatography (ERCP) |
|
Definition
Combines upper GI endoscopy and x-rays to treat problems of bile and pancreatic ducts
Invasive, requires sedation
Image ducts & look for cause
Tumors, stones, inflammation, scarring, pseudocysts
Biopsy
Stent placement (drainage) |
|
|
Term
|
Definition
A radiologic procedure to diagnose gallstones
Replaced by US
Lipomul (iodine) given the night before to empty the GB
4 tablets of Bilopague given the night before exam
Bilopague contrast will fill the GB & outline the stones (stones usually invisible on xray):
Vis: normal function
Non-vis: slow functioning or non-functioning (obstruction, inflammation) |
|
|
Term
| Most common cause of Intrahepatic dilatation |
|
Definition
| Extra-hepatic Biliary Obstruction |
|
|
Term
| Extra-hepatic Biliary Obstruction |
|
Definition
Involves the Common hepatic Duct, cystic duct, and common bile duct
Causes: Stones, Tumors, Inflammation, Compression of Duct |
|
|
Term
|
Definition
Def:
Most common cause of E-H biliary obstruction
Single or Multiple
Clinical Signs:
- intense, persistent pain (biliary colic)
-jaundice
- N/V
- Intermittent symptoms |
|
|
Term
|
Definition
Choledocholithiasis Ultrasound:
+Murphy’s sign
Round, hyperechoic w/shadowing
Neither hyperechoic or shadowing
Lies within the confines of the CBD wall
Obstruction of the CBD proximal to the stone
Air in CBD may mimic stones
|
|
|
Term
| Tumors That Cause Extra-Hepatic Biliary Dilitation |
|
Definition
Cholangiocarcinomas
Ampullary Tumor
Pancreatic Tumor
Other |
|
|
Term
| Cholangiocarcinoma: Intrahepatic Location |
|
Definition
Def: rare primary malignant tumor of the bile ducts
Symptoms:
Absent Murphy’s sign
+ Courvoisier’s Sign (enlarged GB, non-tender, jaundice, no Gallstones, found on physical examination = possible malignancy)
Labs:
Increased Alk Phos
Mild increase SGOT, SGPT
Increased bilirubin + jaundice |
|
|
Term
| Cholangiocarcinoma: Hilar Klatskin Location |
|
Definition
Klatskin Tumor aka Hilar Cholangiocarcinoma
Mass in the porta hepatis
Negative Courvoisier’s sign
US Appearance:
biliary obstruction
narrowing of PVs
compensatory increased flow in HAs |
|
|
Term
|
Definition
Acute Bacterial Cholangitis:
Caused by biliary obstruction
(usually CBD stone)
US:
Bile duct wall thickening I-H/E-H
Dilatation of bile ducts I-H/E-H
Bile duct stones & sludge
GB wall thickening
Pneumobilia (gas in the biliary system)
Liver abscesses |
|
|
Term
| Cholangiocarcinoma: Distal Location |
|
Definition
US Appearance (Distal):
polypoid mass in CBD
bile duct wall thickening
prox dilatation of bile ducts
dilated GB (+) Courvoisier’s Sign |
|
|
Term
|
Definition
-rare malignant tumor
Symptoms: Same as Cholangiocarcinoma
Absent murphy’s sign
+ Courvoisier’s Sign
Ultrasound Appearance:
-Mass difficult to visualize
-Dilated E-H Ducts
-Look for liver mets |
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Term
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Definition
*Malignant tumor usually in the pancreatic head
Symptoms: Same as cholangiocarcinoma
US Appearance:
Positive Courvoisier’s sign
Hypoechoic mass w/in panc head
Dilated E-H ducts
Dilated I-H ducts
Dilated GB
Liver mets
Adenopathy
Ascites |
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Term
| most common tumor obstructing the CBD |
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Definition
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Term
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Definition
Description:
Inflammation of the Bile Ducts Walls
It can lead to liver inflammation, infection, abscess
Forms of Cholangitis:
Acute Bacterial Cholangitis
AIDS Cholangitis
Recurrent Pyogenic Cholangitis
Sclerosing Cholangitis |
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Term
| U/S Criteria for Biliary Tract Disease |
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Definition
Murphys Sign: Tender GB on deep palpation of RUQ or probe pressure
(+) Sign of Cholecystitis
Courvoisiers Sign: Large palpable non tender GB in a jaundiced pt.
(+) Sign of neoplastic obstruction of CBD
IntraHepatic Dilatation: Tiny tortuous anechoic tubes
-No flow with Doppler
Assoc. with I-H or E-H obstruction
CHD/CBD dilatation: Measure A-P diameter, inside to inside
-Measure CHD, CBD at its largest, CBD distally
Abnormal Preop Critera: > 5 mm or > 5 mm + 1 mm for each decade over 50 |
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Term
| Hepato-Biliary Scan (HIDA |
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Definition
Hepatobiliary iminodiacetic acid scan
Performed in Nuclear Medicine dept.
Imaging procedure that helps track the production and flow of bile from your liver to the small intestine
Creates pictures of your liver, bile ducts and small intestine
Injects Technecium 99mm Disophin
Radioactive material goes directly to the liver & biliary tract
It fills the GB & empties into the duodenum
Hepato-Biliary Scan (HIDA):
Bile ducts:
Normal- contrast in intestine
Obstruction- no contrast in intestine
GB:
Normal- visualized GB
Cholecystitis (A/C)- non-visualized GB |
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Term
Inoperable Obstructing Tumor:
Bypass Surgery (Choledochojejunostomy) |
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Definition
Anastomosis of CBD to jejunum to relieve symptoms of biliary obstruction
Stomach is attached to the jejunum & detached from the duodenum (gastrojejunostomy)
Inoperable tumor (pancreatic tumor) would remain intact |
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Term
| Operable Obstructing Tumor: Whipple’s Procedure |
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Definition
Operable Obstructing Tumor: Whipple’s Procedure:
Remove tumor, pancreatic head, duodenum, gastric antum
Attach CBD, panc, stomach to jejunum
Post-op Whipple Sonogram:
Anatomy has been significantly altered
Air in biliary system
Air in the stent |
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Term
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Definition
AIDS Cholangitis:
Bile duct inflammation is caused by virus or bacteria because the patient is immunally suppressed
US Appearance:
Bile duct wall thickening I-H/E-H
Mild dilatation of bile ducts
Thick walled GB
Liver may be affected |
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Term
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Definition
Recurrent Pyogenic Cholangitis
Cause unknown
Prolonged infection, resulting in soft mud-like pigment (bilirubin) stones
These stones occur in I-H ducts
I-H ducts may also contain debris and pus
Localized inflammation, necrosis, or abscess may occur in the liver
Assoc. w/ Cholangiocarcinoma
Symptoms:
Recurrent attacks of cholangitis; Pain; Fever; jaundice
US Appearance:
Proximal dilatation of I-H ducts
May affect only a liver segment
Stones/sludge in I-H ducts
Stones may be in a row
Stones may or may not shadow (size) |
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Term
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Definition
Sclerosing Cholangitis:
Chronic inflammation of the bile ducts causing fibrosis & scarring
It may do irreversible damage to the liver/bile ducts, leading to cirrhosis & liver failure
Symptoms:
Usually asx.; Fever; Upper abdominal pain; Jaundice; Ulcerative colitis (80%)
US Appearance:
Mild intrahepatic dilatation
Thickened ductal walls
Stones in IH ducts
Air in bile ducts (infection)
Cirrhosis/Portal Hypertension
Evidence of cholangiocarcinoma
GB involved in only 10-15% of cases
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