Biliary System - Part 5

Question 1

Adenoma (polyp)

Answer 1

Benign epithelial tumour

Question 2

What are the clinical findings of an adenoma? (3)

Answer 2

1. Asymptomatic
2. Dull RUQ pain
3. Intolerance to fatty foods

Question 3

What is the US appearance of an adenoma? (4)

Answer 3

1. Echogenic intraluminal focus(i) 2. Immobile
2. Non-shadowing
3. Thickening of the GB wall

Question 4

What are 3 differential diagnosis of an adenoma?

Answer 4

1. Cholelithiasis
2. Fold in the GB
3. Carcinoma

Question 5

Adenomyomatosis

Answer 5

Hyperplasia of the epithelial and muscle layers of the GB wall

Question 6

What are the clinical findings of adenomyomatosis? (3)

Answer 6

1. Asymptomatic
2. Dull RUQ pain
3. Intolerance to fatty foods

Question 7

What is the US appearance of adenomyomatosis? (5)

Answer 7

1. Echogenic intraluminal focus
2. Diffuse comet-tail reverberation artifact
3. Twinkling artifact on colour
4. Doppler
5. Immobile

Question 8

What are 3 differential diagnosis of adenomyomatosis?

Answer 8

1. Cholelithiasis
2. Fold in the GB
3. Carcinoma

Question 9

What are the 2 types of cholesterolosis?

Answer 9

1. Cholesterosis

2. Cholesterol polyps

Question 10

What are the clinical findings of cholesterolosis? (2)

Answer 10

1. Asymptomatic

2. Abdominal pain

Question 11

What is the US appearance of cholesterolosis? (4)

Answer 11

1. Echogenic intraluminal foci
2. Non-shadowing
3. Normal GB in the majority of cases
4. Strawberry appearance with
   cholesterosis

Question 12

What are 3 differential diagnosis of cholesterolosis?

Answer 12

1. Cholelithiasis
2. Carcinoma
3. Fold in the GB

Question 13

Cholelithiasis

Answer 13

Gallstones

Question 14

What are the causes of cholelithiasis? (3)

Answer 14

1. Abnormal bile composition
2. Bile stasis
3. Infection

Question 15

What are the risk factors of cholelithiasis? (5)

Answer 15

1. Family history
2. Obesity
3. Pregnancy
4. Diabetes
5. Female prevalence

Question 16

What are the clinical findings of cholelithiasis? (8)

Answer 16

1. Asymptomatic
2. RUQ pain
3. Epigastric pain
4. Chest or shoulder pain
5. Elevated LFTs
6. Nausea/vomiting
7. Postprandial pain
8. Fatty food intolerance

Question 17

What is the US appearance of cholelithiasis? (4)

Answer 17

1. Hyper echoic intraluminal focus(i)
2. Posterior acoustic shadowing
3. Mobile
   - need to flip the patient to prove this
4. Wall-echo-shadow (WES)

Question 18

What are 5 differential diagnosis of cholelithiasis?

Answer 18

1. Intestinal air
2. Adenomyomatosis
3. Polyp
4. Fold in the GB
5. Surgical clip

Question 19

Are gallstones more common in male or females?

Answer 19

Females

- 4:1

Question 20

Porcelain GB

Answer 20

Is a calcification of the gallbladder

Question 21

What are the causes of a porcelain GB? (3)

Answer 21

1. Decrease in vascular supply to the GB
2. Cystic duct obstruction causing bile stasis
3. Chronic low-grade infection

Question 22

Is a porcelain GB more common in male or females?

Answer 22

Females

Question 23

What are the clinical findings of a porcelain GB? (2)

Answer 23

1. Asymptomatic

2. Vague RUQ pain

Question 24

What is the US appearance of a porcelain GB? (4)

Answer 24

1. Gallstones
   - 95%
2. Hyper echoic wall
3. Marked posterior acoustic shadowing 4. Diffuse or localized

Question 25

What are 3 differential diagnosis of a porcelain GB?

Answer 25

1. Contracted GB with stones - WES complex 2. Intestinal air 3. Adenomyomatosis

Question 26

Mirizzi syndrome

Answer 26

Common hepatic duct obstruction

Question 27

What are the causes of Mirizzi syndrome? (2)

Answer 27

1. Impacted stone in the cystic duct or GB neck | 2. Obstruction of the CHD

Question 28

What are the clinical findings of Mirizzi syndrome? (4)

Answer 28

1. RUQ pain 2. Jaundice 3. Elevated bilirubin and alkaline phosphatase 4. Increase AST and ALT levels

Question 29

What is the US appearance of Mirizzi syndrome? (3)

Answer 29

1. Immobile calculus in the cystic duct or neck of the GB 2. Dilatation of the intrahepatic and CHDs 3. Normal CBD

Question 30

What is a differential diagnosis of Mirizzi syndrome?

Answer 30

Choledocholithiasis | - CBD stones

Question 31

What are the causes of sludge? (5)

Answer 31

1. Prolonged fasting 2. Biliary stasis 3. Biliary obstruction 4. Cholecystitis 5. Sickle cell anemia

Question 32

What are the clinical findings of sludge? (3)

Answer 32

1. Asymptomatic 2. RUQ pain 3. Nausea/vomiting

Question 33

What is the US appearance of sludge? (5)

Answer 33

1. Non-shadowing low amplitude echoes layering in the dependent portion of the GB 2. Echoes move slowly with position change 3. May fill entire GB 4. May demonstrate fluid-fluid levels

Question 34

What are 4 differential diagnosis of sludge?

Answer 34

1. Technical factors 2. Intestinal air 3. Carcinoma 4. Hematobilia