Pediatric Sonography- Gallbladder & Biliary System

why can a multiseptated gallbladder be problematic?

septations can cause bile stasis, which can lead to the formation of gallstones

what are the two major causes of conjugated hyperbilirubinemia in newborns?

1- liver diseases

2- biliary tract abnormalities

what 3 ways can biliary atresia manifest?

Absence of biliary tree

Rudimentary GB and cystic duct

Visible GB, cystic duct and CBD

with biliary atresia, newborns will develop jaundice at ____-____ weeks old

3-4

what is the sonographic appearance of biliary atresia?

Gb, cystic duct, CBD and IHBD may be seen incompletely, depending on degree of severity

Early signs of cirrhosis

what are the 2 important sonographic signs/findings to diagnose biliary atresia?

1- triangular cord sign

2- GB length under 1.5cm or absent GB

what is the treatment used for biliary atresia?

kasai procedure

what is done during a kasai procedure?

a connection is made between the duodenum and gallbladder, CBD and liver to drain the bile

how often is a kasai procedure successful?

in 1/3 cases

2/3 unsuccessful kasai procedures will require what other intervention?

liver transplant

what pathology is described as a rare, incidental cystic dilation of the biliary tree?

choledochal cyst

what is the triad of symptoms for a choledochal cyst?

abdo pain

abdo mass

jaundice

how many types of choledochal cysts are there?

5

what is the most common type of choledochal cyst?

type 1- concentric dilation of the CBD

a type 5 choledochal cyst is known as what pathology?

caroli disease

what is caroli disease?

saccular dilation of the IHBDs with calculus formation and bacterial cholangitis

what is the sonographic appearance of choledochal cysts?

cystic structure near GB continous with bile ducts

large cysts containing sludge

in type 4 and 5- IHBD dilations

what are some possible complications of choledochal cysts?

stone formation anywhere

biliary obstruction

chronic cholangitis

cirrhosis

biliary rupture/peritonitis

gallbladder wall thickening is diagnosed when the wall measures over ____mm

3

what pathology is described as the presence of one or more calculi in the GB, cystic duct or CBD

cholelithiasis

pediatric cholelithiasis is associated with what other pathologies?

Cystic fibrosis

Malabsorption

Crohn's disease

Bowel resection

Sickle cell anemia

neonatal cholelithiasis is associated with what other pathologies?

Anomalies of the biliary system

Dehydration

TPN - causes bile stasis

Infection

Hemolytic anemia

what are the clinical presentations of cholelithiasis in young children?

jaundice or irritability, but these are non-specific

what are the clinical presentations of cholelithiasis in older children?

RUQ pain

fatty food intolerance

N & V

true or false- stones seen in utero usually resolve in the first year of life

true

what is the sonographic appearance of cholelithiasis?

Mobile echogenic intraluminal structures with PAS

may have twinkle artifact with colour doppler

what patho appears as low level echoes in the GB that may layer?

sludge

what are the causes of sludge?

prolonged fasting

TPN

extrahepatic bile duct dilation

what are the causes of cholecystitis?

Hypoalbuminemia

Acute Viral Hepatitis

Heart and renal failure

Cystic duct obstruction from external source

what are the signs/symptoms of cholecystitis?

RUQ pain

Fever

Vomiting

Palpable RUQ lump

gallbladder hydrops occurs in what demographic of peds patients?

acutely sick children on TPN

what are the clinical presentations of GB hydrops?

RUQ pain

Fever

Dehydration

Abdo distention

what is the sonographic appearance of GB hydrops?

enlarged anechoic GB

thin GB walls

if a biliary obstruction causes a rupture, what complications can occur?

neonatal jaundice

biliary ascites

biloma

what is a chronic disease with inflammatory fibrosis that obliterates the intra and extra hepatic bile ducts?

sclerosing cholangitis

sclerosing cholangitis results in what 3 complications?

biliary cirrhosis

portal hypertension

liver failure

sclerosing cholangitis is almost always associated with what other patho?

IBD

what are the clinical presentations of sclerosing cholangitis?

RUQ pain

Jaundice

Abnormal LFTs and ↑ bilirubin

what is the sonographic appearance of sclerosing cholangitis?

thickened bile duct walls

choledocholithiasis

ductal strictures

where does rhabdomyosarcoma arise from?

the biliary tract

what are the clinical presentations of rhabdomyosarcoma?

Increasing abdo girth

Jaundice

Pain

Weight loss

what is the sonographic appearance of rhabdomyosarcoma?

Solid

Hyperechoic

Within bile ducts

does rhabdomyosarcoma have a good prognosis?

no- they reoccur frequently

true or false- rhabdomyosarcoma is the 2nd m/c cause of obstructive jaundice after biliary atresia for neonates and choledochal cyst in older children

true