Biliary System - Part 4

Question 1

Biloma

Answer 1

Collection of bile within the abdominal cavity

Question 2

What are the causes of a biloma? (3)

Answer 2

1. Surgery
2. Trauma
3. GB disease

Question 3

What are the clinical findings of a biloma?

Answer 3

RUQ pain

Question 4

What is the US appearance of a biloma? (3)

Answer 4

1. Anechoic fluid collection near the porta hepatis
2. Fluid may demonstrate mobility with changes in patient position
3. Check pelvis and paracolic gutters for free fluid

Question 5

What are 3 differential diagnosis for a biloma?

Answer 5

1. Seroma
2. Fluid in the stomach or intestines
3. Ascites

Question 6

Cholangitis

Answer 6

Inflammation of the bile duct

Question 7

What causes cholangitis? (6)

Answer 7

1. Congenital or acquired stricture
2. Infection
3. Parasitic infestation
4. Biliary stasis
5. Ulcerative colitis 6. Autoimmune deficiency syndrome (AIDS)

Question 8

What are the clinical findings for cholangitis? (6)

Answer 8

1. Abdominal pain
2. Fever
3. Leukocytosis
4. Jaundice
5. Mild elevation in
   AST and ALT levels 6. Marked elevation in bilirubin and alkaline phosphatase levels

Question 9

What is the US appearance for cholangitis? (5)

Answer 9

1. Biliary dilatation
2. Thickening of the bile duct walls
3. Pneumobilia
4. GB hydrops
5. Brightly echogenic portal
   triad

Question 10

What are 2 differential diagnosis for cholangitis?

Answer 10

1. Biliary obstruction

2. Caroli disease

Question 11

Cholangiocarcinoma

Answer 11

Cancer of the bile ducts

Question 12

What are the risk factors for cholangiocarcinoma? (6)

Answer 12

1. Ulcerative colitis 2. Cholangitis
2. Choledochal cyst
3. Chronic biliary stasis
4. Caroli disease
5. Male prevalence

Question 13

What are the clinical findings for cholangiocarcinoma? (7)

Answer 13

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

Question 14

What is the US appearance for cholangiocarcinoma? (6)

Answer 14

1. Echogenic mass within a bile duct
2. Dilatation of the intrahepatic and extrahepatic bile ducts
3. GB hydrops
4. Hepatomegaly
5. Gallstones
   - 30% of cases
6. Ascites

Question 15

What are 5 differential diagnosis for cholangiocarcinoma?

Answer 15

1. Artifact
2. Portal vein thrombosis
3. Lymphadenopathy 4. Choledocholithiasis 5. Pancreatic mass

Question 16

Choledocholithiasis

Answer 16

Stones in the CBD

Question 17

What are complications for choledocholithiasis? (3)

Answer 17

1. Biliary obstruction
2. Cholangitis
3. Pancreatitis

Question 18

What are the clinical findings for choledocholithiasis? (3)

Answer 18

1. RUQ colicky pain
2. Elevated bilirubin and
   alkaline phosphatase
3. Mild increase in AST and ALT levels

Question 19

What is the US appearance for choledocholithiasis? (4)

Answer 19

1. Echogenic focus(i) within the common duct
2. Posterior acoustic shadowing
   - 60-80% of cases
3. Biliary dilatation 4. Hydropic GB

Question 20

What are 5 differential diagnosis for choledocholithiasis?

Answer 20

1. Surgical clip
2. Tortuous bile duct
3. Cystic duct remnant
4. Intestinal air
5. Intraductal tumour

Question 21

What causes choledochal cyst? (2)

Answer 21

1. Congenital weakness of the ductile wall

2. Reflux of pancreatic juices into the bile duct

Question 22

What are the clinical findings for choledochal cyst? (4)

Answer 22

1. Asymptomatic
2. Jaundice
3. RUQ mass
4. RUQ pain

Question 23

What is the US appearance for choledochal cyst? (3)

Answer 23

1. Nonvascular cystic mass medial to the GB and lateral to the head of the pancreas
2. Dilated CHD, CBD or cystic duct entering the cystic mass
3. Dilated intrahepatic bile ducts

Question 24

What are 4 differential diagnosis for choledochal cyst?

Answer 24

1. Hepatic cyst
2. Pancreas cyst
3. Normal junction
   of the common hepatic and cystic ducts
4. GB duplication

Question 25

Ascariasis

Answer 25

Infection in the intestines with ascarids

Question 26

What causes ascariasis?

Answer 26

Ingestion of contaminated water or food

Question 27

What are the clinical findings of ascariasis? (4)

Answer 27

1. Asymptomatic 2. RUQ pain 3. Fever 4. Leukocytosis

Question 28

What is the US appearance of ascariasis? (3)

Answer 28

1. Spaghetti-like echogenic structure within a bile duct 2. Non-shadowing 3. Posterior acoustic enhancement

Question 29

What are 4 differential diagnosis for ascariasis?

Answer 29

1. Stent 2. Cholangitis 3. Cholangiocarcinoma 4. Choledocholithiasis

Question 30

Where is ascariasis more common? (3)

Answer 30

1. Africa 2. Asia 3. South America