Biliary System

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For pts over 60, or without a GB, a maximum diameter of _______ may be considered normal

1 cm (10 mm)

The biliary duct wall should never measure more than

2 mm

Normal limit for the common bile duct

4-7 mm; over 50 add 1mm/decade

List the forms of cholangitis

Acute bacterial AIDS (infection) Oriental - (Asian Endemic) Sclerosing - (IBD/UC)

Central dot sign

Caroli's disease. Dot represents portal vein surrounded by dilated duct

A Klatskin tumor is a form of

Cholangiocarcinoma

What is Charcot triad associated with?

Cholangitis

What are possible causes of a bile duct obstruction in adults?

Choledocholithiasis Chronic pancreatitis Pancreatic carcinoma

If an obstructive biliary calculus is located within the distal common duct, which of the following could ultimately dilate?

Common bile duct, GB, common hepatic duct (all of these!)

Choledocal cyst

Cystic growth on the common duct that may cause obstruction usually found in infants/children Clinical findings - fever, pain, jaundice

Choledocal cyst (sono findings)

Cystic mass in the area of the porta hepatis (separate from the gb) Biliary dilation

Choledocholithiasis (sono findings)

Echogenic foci within the bile duct that may or may not shadow May have biliary dilation but not always

What could accidentally introduce bacteria into the biliary tree and cause cholangitis?

Endoscopic retrograde cholangiopancreatography

Which segment of the biliary tree tends to dilate first with obstruction

Extrahepatic

If a gallstone, causing an obstruction, is located within the distal common hepatic duct, what would become dilated?

Intrahepatic ducts

What is the most proximal portion of the biliary tree?

Intrahepatic radicles

Cholangiocarcinoma (clinical findings)

Jaundice Pruritus (itching) Unexplained weight loss Abdominal pain Elevated bilirubin Elevated ALP

Ampulla of Vater

The area in the duodenum where the common bile duct and the pancreatic duct empty

Mirizzi Syndrome

a clinical condition when the patient presents with jaundice, pain, and fever secondary to a lodged stone in the cystic duct

Biliary atresia

a congenital disease described as the narrowing or obliteration of all or a portion of the biliary tree

Caroli disease

a congenital disorder characterized by segmental dilatation of the intrahepatic ducts

Pneumobilia

air within the biliary tree associated with ring down artifact

Location of a Klatskin Tumor

at the junction of the right and left hepatic ducts intrahepatic ducts dilate

associated with the sonographic triangular cord sign

biliary atresia

Cholangitis (sonographic findings)

biliary dilation biliary sludge or pus choledocholithiasis bile duct wall thickening

Yellowish pigment found in bile that is produced by the breakdown of old red blood cells by the liver

bilirubin

Ascariasis

caused by a parasitic roundworm

sclerosing cholangitis

characterized by fibrotic thickening of the bile ducts most often affects young men associated with IBD or UC Increased risk for cholangiocarcinoma

Cholangitis (clinical findings)

charcot triad (fever, RUQ pain, Jaundice) Leukocytosis Elevated ALP, ALT, GGT and Bilirubin (with obstruction)

What is NOT a plausible cause of common bile duct obstruction in adults?

choledochal cyst (they are usually found in infants/children)

Typically found in pediatric patients and is described as the cystic dilation of the common bile duct

choledochal cysts

Most common cause of obstructive jaundice

choledocholithiasis

What part fo the biliary tree is most distal?

common bile duct

Where are the spiral valves of Heister located?

cystic duct

Shotgun sign

describes the enlargement of the common duct to the size fo the adjacent portal vein within the porta hepatis aka parallel tube sign

Cholangiocarcinoma (sono findings)

dilated intrahepatic ducts that abruptly terminate at the level of the tumor A solid mass may be noted within the liver or ducts

The most common level for biliary obstruction to occur is the:

distal common bile duct

Which labs should I look at when suspecting biliary tree obstruction or disease?

elevation in ALP, ALT, serum bilirubin, GGT and urobilirubin

Choledocholithiasis

gallstone located within the biliary tree

Cholangitis

inflammation of the bile ducts

Choledocholithiasis (clinical findings)

jaundice elevated ALP, ALT, GGT, bilirubin (w/ obstruction) RUQ pain

Cholangiocarcinoma

primary biliary tree cancer

What kind of artifact will pneumobilia produce?

ring down artifact

Sphincter of Oddi

the muscle that controls the emptying of bile and pancreatic juices into the duodenum

Jaundice

the yellowish staining of the whites of the eyes and skin secondary to liver disorder or biliary obstruction


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