Bile Ducts
Measurement of Common Hepatic Duct:
4mm or less
Dilated Common duct measurement:
> 8mm Patients with previous cholecystectomy may be considered normal with maximum diameter of 10 mm (1mm for every 10 years of life) ex 6mm is normal for 60 year old patient
Most common cause of cholangitis:
Bile duct obstruction
From the gallbladder the bile travels to.....
Bile travels from the GB to the cystic duct to the CBD towards duodenum. Meets at pancreatic duct and Ampulla of Vater
Cholangiocarcinoma
Biliary tree cancer
Jaundice is accumulation of ___________ within tissues of the body
Bilirubin (yellowish pigment in bile)
Carolis Disease
Dilatation of INTRAhepatic bile ducts
Cholecystokinin
Hormone released by ingestion of fatty foods, causes GB to contract
Biliary atresia is associated with
Von Hippel Lindau syndrome polysplenia situs inversus cardiac septal defects absent IVC
Stellate confluence
bile ducts branch into star shaped configuration
Extrahepatic ducts include:
cystic duct common bile duct common hepatic duct Everything else is INTRAhepatic
Bile is a _________ fluid produced by the ________
digestive, liver
Most common Choledochal cyst:
dilatation of CBD
"Parallel channel sign" or "Shotgun Sign" refers to:
dilated hepatic duct adjacent to portal vein
Klatskin tumor
is a cholangiocarcinoma located at hepatic hilum- junction of RT and LT hepatic duct. Causes dilatation of intrahepatic ducts
Symptoms of Choledocholithiasis
jaundice* RUQ pain* elevated bilirubin elevated alk phos elevated GGT
Sphincter of Oddi
muscle that allows bile and pancreatic juices to flow through Ampulla of Vater into duodenum AKA hepatopancreatic sphincter
bile is _______________ by the liver
produced
Function of Biliary tree:
provide a conduit for bile to drain from liver into small intestine
Bile is composed of:
*bilirubin, bile acids, cholesterol
Sonographic appearance of Caroli's disease
- multiple intrahepatic cysts - dilated biliary ducts
Mirizzi Syndrome
-uncommon -cycstic duct obstruction (EXTRAhepatic obstruction) leads to INTRAhepatic dilatation
* 2 most common causes of biliary obstruction:
1. Gallstones 2. Carcinoma of the pancreas
Caroli's disease is typically associated with:
1. Polycystic Kidney disease 2. Congenital hepatic fibrosis 3. Choledochal cysts
Biliary atresia
Absence of extrahepatic ducts (CHD and CBD) - may or may not have GB
Choledochal cysts are more prevelant where?
Asia (33% reported cases are from japan)
Pneumobilia
Air within the biliary tree -echogenic linear structure within the ducts Most commonly seen after endoscopic retrograde cholangiopancreatogram (ERCP) (Pneumo= air/ lung)
* Where do cholangiocarciomas typically occur?
Can occur anywhere in biliary tree. *Typically originate in EXTRAhepatic ducts (CBD and CHD)
Choledochal cyst
Congenital BILE DUCT anomalie consisting of cystic dilation of intra or extra hepatic bile ducts. -usually dilated CBD -separate from gallbladder -more common in Asian women -5 classes
Biliary obstruction is most commonly due to pathology in the _______________
Distal CBD
Cholangitis
Inflammation of bile ducts
Choledocholithiasis
gallstones in bile ducts
biled is _____________ in the gallbladder
stored
The most distal segment of the biliary tree
the CBD closest to pancreatic head
Spiral valves of Heister
tiny folds within the cystic duct to prevent it from collapsing