Biliary System
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
