Unit 7 Diseases of GB- Colangitis & Pneumobilia ~ Elie

What is the definition of Choledocholithiasis?

Stones in Common Bile Duct

Where does Choledocholithiasis originate from?

•Usually from GB

•Calculous cholecystitis

What are the lab values that are increased with Choledocholithiasis?

•Increased Direct Bilirubin,

•    Alk Phos, WBC’s,

•    Abnormal liver enzymes

What are the differential diagnosis for Choledocholithiasis?

• Cystic Duct remnant,

• Surgical clips

What are the potential causes of shadowing?

• Calcifications in HA

• Calcification in pancreatic head

• Air or gas in duodenum

  • Watch for peristalsis

  • Changes over time

• Air in biliary tree

What is a Pneumobilia?

Air within biliary tree

A pneumobilia is secondary to:

• Intervention

• Emphysematous cholecystitis

• Inflammation from impacted stone in CBD

• Prolonged acute cholecystitis

With Pneumobilia, Emphysematous cholecystitis can have:

• Air in GB

• Air in ducts

  • May be from bacteria or other bowel process

Pneumobilia US findings: What is the echogenicity description?

Bright, echogenic linear structures following portal veins, dirty shadows, reverberation artifacts 

Pneumobilia US findings: What should you look for?

Look for movement of tiny air bubbles when change patient position

What is this image demonstrating?

Choledocholithiasis

What is being shown in this image?

Pneumobilia

With pneumobilia, what can gas within the duodenum or GB be misinterpreted as?

Stones

What is hemobilia described as?

• Biliary trauma secondary to percutaneous biliary procedures or liver biopsy

What are some common symptoms of hemobilia?

• Pain

• Bleeding

• Jaundice

What is the definition of hemobilia?

Blood in the biliary tree

What can the appearance of hemobilia be like?

• Depends on the length of time

  • Acute: fluid with low-level internal echoes

    Look for blood clots that may move in the duct with extension into GB

What is the definition of cholangitis?

Inflammation of bile ducts

With cholangitis, the infected bile can either be _______ or ________ _______

Severe or prolonged infection

What are the symptoms of cholangitis?

• Malaise

• Fever

• RUQ pain

• Jaundice

• Lethargic

• Shock

• Pus in CBD

Cholangitis US findings:

• CBD thickened & dilated

  • Especially at Ampulla of Vater

What are the specific lab values tested for Cholangitis?

• Leukocytosis

• Elevated
   Serum Alk Phos & Bilirubin

What is the arrow above demonstrating?

Cholangitis

Why is Cholangitis a medical emergency?

It develops increasing pressure in the biliary tree with PUS accumulation. 
DECOMPRESSION of CBD is necessary!

What is sclerosing?

Inflammatory response leading to a fibrotic process

What are the early symptoms of sclerosing cholangitis?

• Itching

• Fatigue

Sclerosing Cholangitis can have dialed ducts with ________ ____?

Thickened walls

In patients who have sclerosing cholangitis, what can occur?

Severe or prolonged infections

In patients who have sclerosing cholangitis, how many have ulcerative colitis?

½

What is being shown in the image above?

Sclerosing Cholangitis

What is common to have while having sclerosing cholangitis?

AIDS

What is Ascariasis?

A parasitic roundworm

Where does the parasitic grow in ascariasis?

• In the small bowel before entering biliary tree thru ampulla of Vater

What does the parasitic worm cause in ascariasis?

Acute biliary obstruction

Clinically, what are the symptoms of ascariasis?

•Asymptomatic

•Biliary colic, pancreatitis, biliary symptoms

Ascariasis US findings: It is an enlarged duct with a

Moving tube

Ascariasis US findings: What is the echogenicity in the ducts?

Parallel echogenic lines

Ascariasis US findings: What is the appearance in trans?

• Worm is surrounded by duct walls

• Target appearance

Ascariasis US findings: What should the sonographer do?

Hold still and watch for movement

What is this image showing?

Ascariasis