gb and pancreas test

whats the function of the extrahepatic biliary system? (2)

how much does it secrete per day?

transport bile from liver to intestine and regulate flow of bile from liver to intestine.

1-2 liters

food stimulates gb to contract with what

CCK, cholecystokinin

t/f, always measure the gb in two positons

true

elevated wbc means

infection, itis

^ggt and ^alp is ?

billiary obstruction

is the gb intra or retroperitoneal?

intraperitoneal

gb dimensions

length?

diameter?

7-10cm long

3-4 cm diameter

gb >5cm trv diameter is?

hydropic

gb <2cm diameter is?

abnormally contracted

typical gb wall thicknes? greater than this is abnormal.

3mm

connects the gallbladder neck with common hepatic duct to form the common bile duct

cystic duct

duct, typically “s” shaped

cystic duct

cystic duct is how long?

approx 4cm long

spiral folds which control bile flow in the cystic duct, prevent kinking of the duct

valve of heisters

(intra/extra)hepatic ducts aren’t seen unless?

INTRA, obstruction

what forms the common hepatic duct, CHD?

rt and lt hepatic ducts.

chd measurement in diameter

4 mm. lumen only measured

which is smaller? chd or cbd?

chd

chd joins cystic duct and forms?

cbd

cbd diameter?

it increases__mm per ___ of age.

up to 6mm.

1mm, decade.

t/f diameter of cbd is often larger after cholecytectomy

t

the cbd passes _____ to the 1st part of the duodenum

posterior

circular muscle fibers that surround terminal cbd and main pancreatic duct

sphincter of oddi

chd diamter?

~4mm

joins cystic duct to form cbd?

chd

whats a HIDA scan? (hepatobiliary iminodiacetic acid)

is US always supposed to be done before or after it?

nuclear medicine imaging test that evaluates the FUNCTION of your liver, gb, and bile ducts.

before

gb vascular supply:

arterial: rt hepatic artery to cystic artery

venous: cystic vein to pv

agenesis?

no gb

biliary interposition?

absence of chd and cystic duct

biliary atresia

absence of biliary tree from hilium of liver to duodenum (chd and cbd)

type 2A of biliary atresia is?

the common hepatic duct is closed but functional common bile duct

what’s biliary atresia associated with?

-polysplenia syndrome (multiple tiny spleens)

-absent ivc

…

whats the triangular cord sign?

echogenic, triangular cord structure anterior to the pv

a triangular cord thickness greater than ____ mm is a common threshold for a positive sign

3 or 4mm

surgical procedure to facilitate bile drainage (within 60 days). typically on newborns or infants. 38% of children can survive with their own liver for 30 years after kpe.

you’d need a liver transplant

kasao portoenteristomy

KPE

congenital bile duct anomaly consisting of cystic dilation of the EXTRAHEPATIC bile ducts.

choledochal cyst

typically appears as a large cystic mass in porta hepatis

choledochal cyst

a _____ is most prevalent in _____

choledochal cyst, asia

an intrahepatic type of choledochal cyst. “beaded” appearance

caroli’s disease

segmental cystic dilation usually of cbd

choledochal cyst

choledochal cysts are associated with?

pancreatitis

cholangitis

cirrhosis

portal hypertension

cholaniocarcinoma

thickened bile (calcium bilirubinate and cholesterol granules)

often causes by stasis, prolonged fasting, or gallbladder disease.

sludge

sludge balls. mobile, rounded, organization of sludge

tumefactive sludge

whats tumefactive sludge?

mobile, rounded organization of sludge

most common disease of the gb

cholelithiasis

what’s cholelithiasis

stones in the gb.

how is gb pain due to stones caused

after a fatty meal, the gb contracts to release bile; if the outflow tract is block by stones, it results in pain

patients with cholelithiasis may be asymptomatic until?

a stone lodges in the cystic or cbd

RUQ paian with radiation to the shoulder after a high-fat meal is a typical presentation of what?

cholelithiasis

sono appearance of cholelithiasis

echogenic focci

acoustic shadowing (always. if not, it might be a sludge ball)

gravity dependent

five f’s or cholelithiasis risks?

other risks?

fat, female, forty, fertile, and fair (light skinned people)

pregnancy, diabetes, oral contraceptives,,,

what’s cholecystitis?

inflammation of the gb

whats acalculous mean?

inflammation without stones

the most common cause of acute cholecystitis

gallstones

pain w/ abrupt halt in inspiration during palpitation would be?

POSITIVE murphy’s sign

sonographic signs of cholcystitis

gallstones

murphy’s sign

thick walls >3mm

gallbladder dealation >5cm

pericholecystic fluid

sludge

defined clinically as recurring symptoms of biliary colic (pain) due to multiple previous episodes of cholecystitis

chronic cholecystitis

chronic cholecystitis sono findings

same as acute.

may include smaller, contracted gb w/ stones and thick wall

usually no pericholecystic fluid bc its not acute

may not have murphy’s sign

95% of cholecystitis is

calculous

ancalculous

who does it typically occur in

“other than stones”, cholecystitis. often in critically ill patients. stagnant bile, tube feeding >3 months. trauma, infection, or sepsis.

acute inflammation of the gb in the absence of cholelithiasis

mostly likley caused by?

acalculous cholecystitis

decreased blood flow through the cystic artery

torsion of the gb most commonly occurs in?

if it twists more than 180 degrees, there’s a risk of?

older women.

gangrene

what’s mirizzi’s syndrome?

uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct.

mirizzi syndrome symptoms, signs

mechanical obstruction of chd

painful jaundice

large stone in gb neck or cystic duct

chd and intrahepatic duct dilation

chd dilated above level of stone

mechanical obstruction of chd is associated with what

mirizzi’s syndrome

porcelain gb is what?

more common in who?

increased chance of GB CA.

porcelain gb

older women

“looks like egg”

hydrops aka?

mucocele of gb

whats hydrops/ mucocele of gb?

ADD IMG#65

overdistention of gb due to prolongued & total obstruction of cystic duct.

filled w/ musus or clear watery content, HYDOps

LOOKS LIKE WHALE (ISH) has tail.

whats an empyema

infected gb behind an obstructed cystic duct

empyema appearance and symptoms

mixed echoes, atypical bile echoes.

symptoms same as acute cholecystitis, with FEVER

gangrene/emphysematous cholecystitis is what

acute cholecystitis due to gb wall ischemia and infection

what occurs more in diabetic patients, is a surgical emergency, often ecoli

gangrene/ emphysematous cholecystitis

t/f gangrene/ emphysematous cholecystitis

looks slike sudge and moves

f, it doesn’t move

gangrene/ emphysematous cholecystitis

cause shadowing?

gravity dependant?

layering?

no

no

no

localized fluid collection in gb fossa

typically occurs where?

regualar/irregular wall?

gb perforation

fundus

what are the benign neoplasms? (4)

adenoma

adenomyomatosis

cholesterol polyp

cholesterolosis

looks similar to a polyp but has a WIDE base

non shadowing, attached to wall

benign. removed if large for CA concern

usually singular

adenoma

stem/stalk, “ball” shape

polyp

up to what size is a cholesterol polyp not worrisome?

<10mm

hyperplastic changes involving the gb wall causing overgrowth of the mucosa

adenomyomatosis

v-shaped/ comet tail artifact (cholesterol buildups)

adenomyomatosis

develops as result of abnormality in metabolism of cholesterol within gb wall. associated with gb stones.

cholesterolosis

aka strawberry gb, asymptomatic and incidental finding

cholesterolosis

primary carcinoma of the gb

nearly always a rapidly progressive disease with a mortality rate approaching ____

gallbladder carcinoma

100%

gb carcinoma is associated with _______ in approx ___-____% of patients.

most common in?

cholelithiasis.

80-90%

women >60 years

malignant neoplasms? 2

gb adenocarcinoma

metastatic disease

gb adenocarcinoma is usually located where?

body of gb

metastatic disease of the gb has what routes?

direct extension?

is cholelithiasis usually present?

is sono appearance usually similar to primary CA?

blood and lymphatic

stomach, pancreas, bile ducts

no

yes

what elevated labs indicate biliary obstruction?

GGT & ALP, bilirubin

in a majority of patients, biliary obstruction is due to pathology in the ____

most common pathology?

distal cbd.

stones, carcinoma in head of pancreas, pt will present w/ jaundice and may not have pain

cbd and gb will dialiate within __ hours of obstruction. progressive dilation of intra and extrahepatic biliary tree follows.

24 hours

parallel channel or shotgun sign indicates ?

they are parallel channels adjacent to the ____

biliary obstruction

portal veins

causes of biliary obstruction include

choledocholithiasis (stone in cbd)

mirizzi’s syndrome

choledocholithiasis

stone in cbd

a congenital anomaly of biliary tract characterized by multifocal segmental dilation of intrahepatic bile ducts.

-is usually genetic

-can cause hepatic fibrosis

-portal hypertension-

-associated with autosomal recessive polycystic kidney disease

caroli disease/ caroli’s syndrome

a type of cholangiocarcinoma (bile duct carcinoma) located at hepatic hilium resulting in intra but not extrahepatic ductal dilaiton

klatskins tumor

sclerosing cholangitis is a chronic liver disease characterized by what

inflammation and scarring of the bile ducts. many people later need liver transplants

classic findings of biliary obstruction

RUQ pain, fever, and jaundice

bile duct wall thickening

IRREGULAR WALLS & DEBRIS

most common cause of malignant neoplasm obstructing biliary tree

pancreatic adenocarcinoma

what does pancreatic adenocarcinoma cause?

what is that?

courvoiser gb

enlarged, palpable, non-tender gb due to a mechanical obstruction of the gb