Biliary System - Part 3

Question 1

What is the cause of biliary dilatation?

Answer 1

Biliary obstruction

Question 2

What are the clinical findings of biliary dilatation? (4)

Answer 2

1. Asymptomatic
2. RUQ pain
3. Jaundice
4. Elevated direct bilirubin and alkaline phosphatase

Question 3

What is the US appearance of biliary dilatation? (3)

Answer 3

1. Dilated intrahepatic and/or extrahepatic bile ducts
2. Parallel channeling
3. Portal vein may appear flattened
   with progressive dilatation

Question 4

What are 2 differential diagnosis for biliary dilatation?

Answer 4

1. Normal biliary tree

2. Portal hypertension

Question 5

What causes biliary atresia? (2)

Answer 5

1. Congenital anomaly

2. Viral infection

Question 6

What are 4 complications of biliary atresia?

Answer 6

1. Death
2. Cirrhosis
3. Cholangitis
4. Portal hypertension

Question 7

What is the clinical finding of biliary atresia?

Answer 7

Persistent jaundice

Question 8

What is the US appearance of biliary atresia? (4)

Answer 8

1. Absent hepatic biliary radicles
2. Small or absent GB
3. Absent CHD
4. Hepatomegaly

Question 9

What are 2 differential diagnosis for biliary atresia?

Answer 9

1. Normal biliary tree

2. Hepatitis

Question 10

What are the causes of hemobilia? (3)

Answer 10

1. Liver biopsy
2. Trauma
3. Vascular malformation

Question 11

Hemobilia

Answer 11

Blood in the biliary tree

Question 12

What are the clinical findings for hemobilia? (2)

Answer 12

1. Abdominal pain
2. Hematemesis
   - vomiting blood

Question 13

What is the US appearance for hemobilia? (2)

Answer 13

1. Low-level echoes within the bile ducts

2. Gravity dependent

Question 14

What are 2 differential diagnosis for hemobilia

Answer 14

1. Technical error

2. Cholangitis

Question 15

Pneumobilia

Answer 15

Presence of gas in the biliary system

Question 16

What can cause pneumobilia? (4)

Answer 16

1. Surgical procedure
2. Trauma
3. Infection
4. Incompetent
   sphincter of Oddi

Question 17

What are the clinical findings of pneumobilia? (2)

Answer 17

1. Asymptomatic

2. RUQ pain

Question 18

What is the US appearance of pneumobilia? (3)

Answer 18

1. Hyper echoic focus(i) in the intrahepatic bile ducts

2. Comet-tail reverberation artifact 3. Often centrally located

Question 19

What are 3 differential diagnosis for pneumobilia?

Answer 19

1. Foreign body
2. Biliary calculus
3. Arterial calcification

Question 20

What are the clinical findings of Caroli disease? (4)

Answer 20

1. Abdominal pain
2. Abdominal cramping
3. Fever
4. Intermittent jaundice

Question 21

What is the US appearance of Caroli disease? (2)

Answer 21

1. Segmental, saccular, or beaded appearance of the intrahepatic bile ducts
2. Multiple cystic structures in the liver that communicate with the biliary tree

Question 22

What are 2 differential diagnosis for Caroli disease? (2)

Answer 22

1. Polycystic liver disease

2. Biliary obstruction

Question 23

What is clonorchiasis caused by?

Answer 23

Ingestion of raw freshwater fish

Question 24

Clonorchiasis

Answer 24

Infectious disease

Question 25

What are the clinical findings for clonorchiasis? (3)

Answer 25

1. RUQ pain 2. Fever 3. Leukocytosis

Question 26

What is the US appearance for clonorchiasis? (3)

Answer 26

1. Dilatation of the intrahepatic bile ducts 2. Diffuse thickening of the bile duct walls 3. Echogenic focus within the bile duct

Question 27

What are 2 differential diagnosis for clonorchiasis?

Answer 27

1. Cholangitis | 2. Cholangiocarcinoma

Question 28

Klatskin tumour

Answer 28

Is a cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts

Question 29

What are the clinical findings of Klatskin tumour? (6)

Answer 29

1. Jaundice 2. Acute onset of abdominal pain 3. Biliary colic 4. Weight loss 5. Elevated bilirubin and alkaline phosphatase levels 6. Mild increase in AST and ALT levels

Question 30

What is the US appearance of Klatskin tumour? (3)

Answer 30

1. Small echogenic mass near the hepatic hilum 2. Dilatation of the intrahepatic bile ducts 3. Normal extrahepatic bile ducts

Question 31

What are 4 differential diagnosis for Klatskin tumour?

Answer 31

1. Artifact 2. . Portal vein thrombosis 3. Hepatic tumour 4. Lymphadenopathy