Biliary System - Part 7

Question 1

Chronic cholecystitis

Answer 1

Recurrent inflammation secondary to infection, obstruction, or metabolic disorders

Question 2

What are the clinical features for chronic cholecystitis? (7)

Answer 2

1. Asymptomatic
2. Vague RUQ pain
3. Heartburn
4. Fatty food intolerance
5. Intermittent nausea/vomiting
6. Mild increase in AST and ALT levels
7. Possible increase in alkaline phosphatase and bilirubin

Question 3

What is the US appearance for chronic cholecystitis? (5)

Answer 3

1. Small or contracted GB
2. Thick, hyper echoic walls
3. Cholelithiasis
   - 90% of cases
4. Posterior acoustic shadowing
5. Sludge

Question 4

What are 4 differential diagnosis for chronic cholecystitis?

Answer 4

1. Non-fasting patient
2. Cholelithiasis
3. PorcelainGB
4. Carcinoma

Question 5

What causes hydrops? (6)

Answer 5

1. Obstruction of the cystic duct
2. Prolonged biliary stasis
3. Surgery
4. Hepatitis
5. Gastroenteritis
6. Diabetes

Question 6

What are the clinical findings of hydrops? (4)

Answer 6

1. Asymptomatic
2. RUQ or epigastric pain
3. Nausea/vomiting
4. Palpable mass

Question 7

What is the US appearance of hydrops? (3)

Answer 7

1. Enlargement
2. GB diameter
   exceeding 4cm
3. Thin, hyper echoic walls

Question 8

What are 3 differential diagnosis for hydrops?

Answer 8

1. Normal GB
2. Hepatic cyst
3. Phrygian cap

Question 9

What causes GB varices? (3)

Answer 9

1. Portal hypertension
2. Portal vein thrombosis
3. Cholecystitis

Question 10

What is the US appearance for GB varices? (2)

Answer 10

1. Multiple tortuous tubular structures in the GB periphery

2. Vascular flow

Question 11

What are 2 differential diagnosis for GB varices?

Answer 11

1. Intestinal fluid

2. Normal vessels

Question 12

Cholangiocarcinoma located at the junction of the right and left hepatic ducts is termed a

Answer 12

Klatskin tumour

Question 13

A 73-year-old patient complains of vague RUQ pain. A hyper echoic focus with marked posterior acoustic shadowing is demonstrated in the anterior wall of the GB. This history is most consistent with which of the following pathologies?

Answer 13

Porcelain GB

Question 14

Non-shadowing, low-amplitude echoes located in the dependent portion of the gallbladder best describes

Answer 14

Biliary sludge

Question 15

A patient presents with a sudden onset of abdominal pain and extreme tenderness over the GB fossa. Localized GB wall thickening is visualized on US. This most likely represents

Answer 15

Acute cholecystitis

Question 16

The distal portion of the CBD terminates with which structure?

Answer 16

The duodenum

Question 17

In the portal hepatis, where is the CHD located?

Answer 17

Lateral to the proper hepatic artery

Question 18

Dilatation of the intrahepatic ducts with normal extrahepatic ducts is characteristic of

Answer 18

Klatskin tumour