Term
| What is calcification of the gb wall called? |
|
Definition
|
|
Term
| Porcelain gb occurs in association with? |
|
Definition
| gallstones disease and may represent some form of chronic cholecystits |
|
|
Term
| What determines the sonographic appearance for porcelain gb? |
|
Definition
| the degree and pattern of calcification |
|
|
Term
| What is seen sonographically when the entire gb wall is thickly calcified? |
|
Definition
| a hyperechoic semilunar line with dense posterior acoustic shadowing is noted |
|
|
Term
| what is seen sonographacially when there is a mild calcification on the gb? |
|
Definition
| appears as an echogenic line with variable degrees of posterior acoustic shadowing |
|
|
Term
| how does the lumen of porcelain gb look? |
|
Definition
| the luminal contents may be visible. interrupted clumps of calcium appear as echogenic foci with posterior shadowing |
|
|
Term
| Why is the WES sign absent in a porcelain gb? |
|
Definition
| because the calcifications occur in the wall |
|
|
Term
| What is the benign condition affecting the gb wall? |
|
Definition
|
|
Term
|
Definition
| rokitansky-aschoff sinuses |
|
|
Term
| what is seen in adenomyomatosis? |
|
Definition
| diverticula within the gb wall accumulate stones or sludge within them |
|
|
Term
| adenomyomatosis can be ______ or _______ |
|
Definition
|
|
Term
| What is the common appearance of adenomyomatosis? |
|
Definition
tiny echogenic foci in the gb wall that creat comet-tail arifacts
echogenic foci with ringdown or with twinkling artifact on doppler exams |
|
|
Term
| The finding of absence of the echogenic foci or twinkling artifact or the presence of internal vascularity should promot further investigation to _____________ |
|
Definition
|
|
Term
| What are the different types of Polypoid masses? |
|
Definition
Cholesterol polyps
inflammatory polyps
adenoma
focal adenomyomatosis
gb adenocarcinoma
metastases (especially melanoma) |
|
|
Term
| Why is the differentiation of benign and malignant polys important? |
|
Definition
| because the former are very common and the later require early intervention to improve the outcome |
|
|
Term
| what is the most frequently used criteria for polyps being benign? |
|
Definition
| multiplicity and size of up to 10mm |
|
|
Term
| Malignancy has been documented in 37-88% of resected polyps that were ______ |
|
Definition
|
|
Term
| What are other malignancy risk factor? |
|
Definition
older than 60
single lesion
gallstone disease
rapid changes in size on follow up
sessile morphology (have no peduncle but attached directly by a broad base)
Doppler:velocity of >20 cm/sec and an RI of <0.65 |
|
|
Term
| Approximately 1/2 of all gb polyps are |
|
Definition
|
|
Term
| cholesterol polyps represent ___________ form of gb cholesterolosis, a common non-neoplastic condition |
|
Definition
|
|
Term
| How does cholesterolosis form? |
|
Definition
| results in the accumulation of lipids (triglycerides & cholesterol) in the gb wall |
|
|
Term
| What is the difference between polyps and stones? |
|
Definition
| polyps do no roll like stone and do not produce any posterior shadowing |
|
|
Term
| What is a diffused form of cholesterolosis called? |
|
Definition
|
|
Term
| What are the symptoms of cholesterosis and how do they look sonographically? |
|
Definition
cholesterosis is usually asymptomatic and if symptoms occur it's usually in the form of colicky abdominal pain
It appears similar to adenomyomatosis but do not have the comet tail reverberation artifact |
|
|
Term
| what are the 2 most common lesions that cause biliary obstruction? |
|
Definition
gallstones
carcinoma of panc head |
|
|
Term
| What lab values are typically elevated which are associated with biliary obsruction? |
|
Definition
| serum alk. phos and bilirubin |
|
|
Term
| Obstuction of the distal CBD results in progressive dilation of the ______________ |
|
Definition
| intra and extra hepatic biliary tree |
|
|
Term
| What are the other causes of biliary obstruction? |
|
Definition
choledocholithiasis
pancreatic carcinoma
cholangiocarcinoma
cholangitis
mirizzi syndrome
choledochol cyst
gallbladder carcinoma |
|
|
Term
| what is dilated intrahepatic ducts? |
|
Definition
| irregular and tortuous bile ducts |
|
|
Term
| dilated intrahepatic ducts is aka? |
|
Definition
parallel channel sign
shot gun sign |
|
|
Term
| How do you see dilated intrahepatic ducts sonographically? |
|
Definition
stellate confluence: bile ducts that branch into a star shaped configuration
acoustic enhancement: bile structues attenuate sound much less than blood which creates posterior acoustic enhancement |
|
|
Term
| what happens to the biliary tree when there is a distal cbd obstruction? |
|
Definition
| the entire system distends including the gb |
|
|
Term
| what happens to the biliary tree when there is a chd obstruction? |
|
Definition
| only the proximal ducts will distend. the gb will be contracted |
|
|
Term
| what happens to the biliary tree when there is a RT & LT hepatic duct obstruction? |
|
Definition
| intrahepatic ducts dilate |
|
|
Term
| what are the biliary tract abnormalities? |
|
Definition
choledochal cysts
caroli's disease
mirizzi syndrome
hemobilia
pneumobilia
acute (bacterial) cholangitis
recurrent pyogenic cholangitis
ascariasis
HIV cholangiopathy
Primary sclerosing cholangitis
cholangiocarcinoma
metastases |
|
|
Term
| These are congenital bile duct anomalies that consist of cystic dilation of intra or extra hepatic bile ducts - |
|
Definition
|
|
Term
| What is the most common classification of choledochal cyst? and what happens in this type? |
|
Definition
Type I - most common
Fusiform dilation of the cbd resulting in a long channel between distal cbd and the mpv |
|
|
Term
| What is the rare classification of choledochal cyst? |
|
Definition
type II - very rare
true diverticuli of the bile ducts |
|
|
Term
| What is type III clasification of choledochal cyst? |
|
Definition
choledochoceles
confined to the intraduodenal portion of the cbd |
|
|
Term
| Where is type IVa & IVb seen in choledochal cyst? |
|
Definition
IVa - multiple intra and extra hepatic biliary dilations
IVb - only extrahepatic |
|
|
Term
| How does choledochal cyst look like sonographically? |
|
Definition
a cystic structure indentified which may contain internal sludge, stones or even solid neoplasm
because of a proven risk of cholangiocarcinoma with all choledochal cysts, surgical resection is advocated
ERCP necessary to ensure that the dilation is not a result of a distal neoplasm, especially in the case of type I choledochal cysts |
|
|
Term
| What is type V of choledochal cyst also known as? |
|
Definition
|
|
Term
| What is a rare congenital anomaly of the biliary tract characterised by multifocal segmental dilation of the Intrahepatic bile ducts? |
|
Definition
| caroli's disease or type V |
|
|
Term
| What is the sonographic findings of caroli's disease? |
|
Definition
multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts
sludge and calculi may accumumate in these ectatic ducts that will result in posterior acoustic shadowing |
|
|
Term
| What are the clinical signs of Mirizze syndrome? |
|
Definition
clinical syndrome of jaundice with pain and fever resulting from
compression of the chd
because of a stone in the cystic duct
(the stone is often impacted in the distal cystic duct and the accompanying inflammation and edema result in the obstruction of the adjacent CHD |
|
|
Term
|
Definition
| blood clot in the biliary tree |
|
|
Term
| what is pneumobilia? what does it result from? |
|
Definition
air within the biliary tree
results from previous biliary intervention, like biliary enteric anastomoses or cbd stents |
|
|
Term
| How does pneumobilia appear sonographically? |
|
Definition
as intrahepatic linear echogenic regions that often produce distal acoustic shadowing
posterior dirty shadowing and reverberation artifacts are seen. Movement of the air bubbles, best seen just after changing the patient's position is diagnostic |
|
|
Term
| What is an essential component of bacterial cholangitis along with CBD stones? |
|
Definition
| antecedent (precursor) biliary obstruction |
|
|
Term
| What are the clinical presentation of acute (bacterial) cholangitis? |
|
Definition
leukocytosis
elevated alkaline phosphatase and bilirubin
charcot's triad - fever, RUQ pain, jaundice |
|
|
Term
| What is the bile most commonly infected by for acute cholangitis? |
|
Definition
| infected by gram-negative enteric bacteria, which are often retrieved in blood cultures |
|
|
Term
| How does acute (bacterial) cholangitis seen sonographically? |
|
Definition
choledocholihiasis and possible sludge
bile duct wall thickening
dilation of the biliary tree
hepatic abscesses |
|
|
Term
| HIV cholangiopathy is also known as - |
|
Definition
|
|
Term
| what is an inflammatory process affecting the biliary tree in the advanced stages of HIV infection |
|
Definition
| HIV cholangiopathy or AIDS cholangitis |
|
|
Term
| What does the patient present for HIV cholangiopathy? |
|
Definition
| severe RUQ or epigastric pain, markedly elevated alkaline phosphatase but normal bilirubin levels |
|
|
Term
| What are the findings for HIV cholangiopathy? |
|
Definition
bile duct wall thickening, intra & extra hepatic
focal structures and dilations
cbd dilation
diffuse gb wall thickening |
|
|
Term
| What is a chronic disease process that effects the entire biliary tree? |
|
Definition
| primary sclerosing cholangitis |
|
|
Term
| irregular, circumferential bile duct wall thickening of varying degrees, encroaching on and narrowing the lumen is seen in which disease? |
|
Definition
| primary sclerosing cholangitis |
|
|
Term
| focal strictures and dilations of the bile ducts are ensured in |
|
Definition
| primary sclerosing cholangitis |
|
|
Term
| ____________ develops in 7-30% of patients with primary sclerosing cholangitis |
|
Definition
|
|
Term
| primary sclerosing cholangitis is seen in |
|
Definition
| intra & extra hepatic stricture |
|
|
Term
| What are parasitic roundworm in the biliary tree called? |
|
Definition
|
|
Term
| how is ascariasis formed? |
|
Definition
| by use of fecal oral route and most common in children |
|
|
Term
| How does ascariasis enter the biliary tree? |
|
Definition
| ascariasis is active within the small bowel and may enter the biliary tree retrogradely through the ampulla of vater, causing biliary obstruction |
|
|
Term
| A parrallel echogenic line within the bile ducts, which also can be similar in appearance of a biliary stent is appeared for which disease? |
|
Definition
|
|
Term
| How does ascariasis look transversely? |
|
Definition
| rounded worm surrounded by the bile duct gives a target appearance |
|
|
Term
| What is associated with gallstones, chronic gallstones disease and resultant dysplasia? |
|
Definition
|
|
Term
| Mass arising in the gb fossa, obliterating the gb and invading the adjacent liver is a pattern of which disease? |
|
Definition
|
|
Term
| focal or diffuse, markedly abnormal and irregular wall thickening pattern is associated with which disease? |
|
Definition
|
|
Term
| intraluminal polypoid mass pattern is associated with which desease? |
|
Definition
|
|
Term
| what are the patterns of tumor spread? |
|
Definition
contiguous hepatic spread
lymphatic spread |
|
|
Term
| Why is contiguous hepatic invasion the most common pattern of spread in gb tumor? |
|
Definition
| because the gb wall is quite thin and little connective tissue separates it from the liver parenchyma |
|
|
Term
| how does the gb tumor mimic hilar cholangiocarcinomas? |
|
Definition
| gb tumors also extend along the cystic duct into the porta hepatis, where they mimic hilar cholangiocarcinomas |
|
|
Term
| __________ spread of the gb tumor may occur in the absence of invasion of the adjacent organs |
|
Definition
|
|
Term
| where is the first nodes affected in the lympatic spread of gb tumor? |
|
Definition
| Hilar region (hilar: depression or recess at exit or entrance of a duct into a gland or of nerves and vessels into an organ |
|
|
Term
| masses replacing the normal gb fossa when small, may be difficult to appreciate because they may blend into the liver is a sonographic appearance of which disease? |
|
Definition
|
|
Term
| the absence of a normal appearing gb with no history of cholecystectomy should raise suspicion of which disease? |
|
Definition
|
|
Term
| primary gb adenocarcinomas may appear as a ______________ |
|
Definition
|
|
Term
| hyperechoic, broad based polyps may be multiple is the appearance of ____________ |
|
Definition
|
|
Term
| _________ or _________ are 2 types of cholangiocarcinoma |
|
Definition
| intrahepatic or extrahepatic |
|
|
Term
| what happens to any portion of the biliary tree in a cholangiocarcinoma? |
|
Definition
| uncommon neoplasm may arise |
|
|
Term
| which is the least common but represents the 2nd most common primary malignancy of the liver? |
|
Definition
| intrahepatic cholangiocarcinoma |
|
|
Term
| Large hepatic mass, hypovascular, solid with heterogeneous echotexture is the most common finding of which disease? |
|
Definition
| intrahepatic cholangiocarcinoma |
|
|
Term
| what are the risk factors for intrahepatic cholangiocarcinoma? |
|
Definition
primary sclerosing cholangitis (most common)
chronic biliary stasis and inflammation |
|
|
Term
|
Definition
|
|
Term
| where does the patterns of tumor growth and staging begin? |
|
Definition
| in either the right or left bile ducts and extends both proximally into higher order branches and distally into the chd and contralateral bile ducts |
|
|
Term
| Where can the tumor of the gb also extend to? |
|
Definition
| outside of the ducts to involve adjacent portal vein and arteries |
|
|
Term
| nodal disease often begins in the ____________ |
|
Definition
|
|
Term
| mets is usually to the _________ |
|
Definition
|
|
Term
| what mimics different appearances of cholangiocarcinoma and affects both intra and extra hepatic ducts? |
|
Definition
|
|
Term
| what sites constitue the majority of primary metastases malignancy? |
|
Definition
|
|
Term
| what is the most common malignant neoplasm that obstructs the biliary tree? |
|
Definition
| pancreatic adenocarcinoma |
|
|
Term
| pancreatic adenocarcinoma at the head of the pancreas typically causes __________ |
|
Definition
|
|
Term
| an enlarged, often palpable gallbladder in a patient with carcinoma of the head of the pancreas which is associated with jaundice due to obstruction of the common bile duct is called? |
|
Definition
|
|
