Penny Book Chapter 4: The Bile Ducts

sonographic findings of biliary atresia

- Absent biliary ducts - Triangular cord sign (avascular, echogenic, triangular or tubular structure anterior to the portal vein) - Sonographic signs of cirrhosis and portal hypertension

clinical findings of ascariasis

- Asymptomatic - May have symptoms of inflammation of the biliary tree, gallbladder, or pancreas

sonographic findings of cholangitis

- Biliary dilatation - Biliary sludge or pus - Choledocholithiasis - Bile duct wall thickening

clinical findings of cholangitis

- Charcot triad: fever, right upper quadrant pain, and jaundice - Leukocytosis - Elevated ALP, ALT, GGT, and bilirubin (with obstruction)

sonographic findings of choledochal cyst

- Cystic mass in the area of the porta hepatis (separate from the gallbladder) - Biliary dilatation

sonographic findings of cholangiocarcinoma

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

sonographic findings of choledocholithiasis

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

sonographic findings of pneumobilia

- Echogenic linear structures within the ducts that produce ring-down artifacts and dirty shadowing

clinical findings of choledocholithiasis

- Jaundice - Elevated ALP, ALT, and GGT, and bilirubin (with obstruction) - Right upper quadrant pain

clinical findings of cholecochal cyst

- Jaundice - Pain - Fever

clinical findings of cholangiocarcinoma

- Jaundice - Pruritus - Unexplained weight loss 4. Abdominal pain - Elevated bilirubin - Elevated ALP

clinical findings of biliary atresia

- Neonatal jaundice - Elevated AST, ALT, and bilirubin

clinical findings of caroli disease

- Pain - Fever - Jaundice - Signs of portal hypertension

clinical findings of pneumobilia

- Recent biliary or gastric surgery, emphysematous or acute cholecystitis, or fistula formation - Symptoms of acute cholecystitis

sonographic findings of caroli disease

- Segmental dilatation of the intrahepatic ducts - The patient may also have cystic renal disease - Central dot sign (echogenic dots in the nondependent part of the dilated duct)

sonographic appearance of ascariasis

- The worm will be noted within the biliary duct as an echogenic linear structure in the sagittal plane - Movement of the worm within the duct confirms diagnosis

__________________ is often fatal without surgical intervention.

Biliary atresia

_______________ is often seen in associated with cystic renal disease and may precede the development of cholangiocarcinoma, a hepatic abscess, cholangitis, and sepsis.

Caroli disease

Sclerosing cholangitis

Characterized by fibrotic thickening of the bile ducts Most often affects young men Associated with inflammatory bowel disease or ulcerative colitis • Increased risk for cholangiocarcinoma

_________ tumors are the most common manifestation of cholangiocarcinoma

Klatskins tumors

___________________ may be associated with recent biliary or gastric surgery, emphasematous or prolonged acute cholecystitis, or fistula formation

Pneumobilia

Mirizzi syndrome

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

biliary stasis

a condition in which bile is stagnant and allowed to develop into sludge or stones

biliary atresia

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

Caroli disease

a congenital disorder characterized by the segmental dilatation of the intrahepatic ducts

biliverdin

a green pigment found in bile

Klatskin tumor

a malignant biliary tumor located at the junction of the right and left hepatic ducts

cholangiography

a radiographic procedure in which contrast is injected into the bile ducts to assess the presence of disease

bilirubin

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

pneumobilia

air within the biliary tree

ascariasis

an infection of the small intestine that is caused by ascaria lumbricoides, a parasitic roundworm

ulcerative colotis

an inflammatory bowel disease that leads to the development of ulcers within the bowel

When the bile ducts wall is thickened greater than 5 mm, one should suspect

cholangitis

The most common cause of cholangitis is often some type of obstructive disease such as

choledocholithiasis

inflammatory bowel disease

chronic inflammation of all or parts of the bowel

double-duct sign

coexisting dilation of the common bile duct and pancreatic duct

The point of attachment of the cystic duct to the gallbladder marks the proximal margin of the

common bile duct

portal triad

contains a small branch of the hepatic artery, portal vein and intrahepatic ducts

The gallbladder is attached to the biliary tree by the

cystic duct

endoscopic retrograde cholangiopancreatography

endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas

charcot triad

fever; RUQ pain, and jaundice associated with cholangitis

cholangitis

infection of the bile ducts

acute pancreatitis

inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ

Bile flow

liver → biliary radicles → right or left hepatic duct → common hepatic duct → cystic duct → gallbladder → common bile duct → ampulla of Vater → sphincter of Oddi → duodenum

Common bile duct diameter

no more than 6 mm

biliary colic

pain secondary to a blockage in the biliary tree

cholangiocarcinoma

primary bile duct cancer

The function of the biliary tree is to

provide a conduit for the bile to drain from the biliary tree into the small intestine.

pruritus

severe itchiness of the skin

There are 4 different types of choledochal cysts, with the most common being described as

the cystic dilatation of the common bile duct

parallel tube sign

the enlargement of the common bile duct to the size of the adjacent portal vein within the porta hepatis

shotgun sign

the enlargement of the common bile duct to the size of the adjacent portal vein within the porta hepatis; also referred to as the parallel tube sign

Klatskins tumors are located at

the juction of the right and left hepatic ducts and cause dilatation of the intrahepatic ducts

hepatopancreatic ampulla

the level of the biliary tree where the common bile duct and the main pancreatic duct meet; may also be referred to as the ampulla of Vater

ampulla of Vater

the merging point if the pancreatic duct and the common bile duct just before the sphincter of Oddi; also referred to as the hepatopancreatic ampulla

sphincter of Oddi

the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also also referred to as the hepatopancreatic sphincter

hepatopancreatic sphincter

the muscle that controls the emptying of bile and pancreatic juices into the duodenum; may also be referred to as the sphincter of Oddi

central dot sign

the presence of echogenic dots in the non dependent part of the dilated duct representing small fibrovascular bundles; seen with Caroli disease

chronic pancreatitis

the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring, and the development of calcifications within the gland

AIDS cholangitis

• Associated with advance HIV and AIDS • Most often results from infection with Cryptosporidium or cytomegalovirus

acute bacterial cholangitis

• Caused by bacterial accumulation secondary to obstruction • Bacteria can be introduced during an ERCP for choledocholithiasis • Pus may be noted within the bile ducts as low-level echoes

Oriental cholangitis

• Endemic to Asia • Seen in America because of immigration