What is the characteristic imaging feature of Primary Sclerosing Cholangitis (PSC)?
A ‘beaded appearance’ due to alternating strictures and dilations throughout the entire biliary tree.
What gastrointestinal condition is strongly associated with PSC?
Inflammatory Bowel Disease (IBD), with Ulcerative Colitis (UC) being more common than Crohn’s Disease (CD).
How do intrahepatic ducts typically appear on imaging in PSC?
Irregular and narrowed, reflecting fibroinflammation.
When do extrahepatic ducts typically become involved in PSC?
Later in the disease process, indicating progressive disease.
What is a significant long-term risk associated with PSC?
PSC is considered pre-malignant, carrying a high risk of cholangiocarcinoma (bile duct cancer), necessitating surveillance.
What are the primary diagnostic imaging modalities for PSC?
Magnetic Resonance Cholangiopancreatography (MRCP) or Endoscopic Retrograde Cholangiopancreatography (ERCP).
What mnemonic helps remember key features of PSC?
PSC = Beaded + IBD + Pre-malignant (cancer risk).
What is cholangitis?
An infection of the biliary tree.
What are the three classic symptoms of Charcot’s triad for cholangitis?
Fever, Right Upper Quadrant (RUQ) pain, and jaundice.
What is the most common cause of cholangitis?
Usually due to stone obstruction (in about 80% of cases), leading to bacterial infection.
What might be seen on imaging in a patient with cholangitis?
Dilated bile ducts, possibly a visible stone, and debris within the ducts.
What is the recommended management for cholangitis?
ERCP (to relieve obstruction) combined with antibiotics. It is considered urgent due to the risk of sepsis.
What additional symptoms, when present with Charcot’s triad, indicate Reynolds’ pentad (severe cholangitis/sepsis)?
Hypotension and altered mental status.
What is the emergency management for severe cholangitis (Reynolds’ pentad)?
Antibiotics, IV fluids, and ERCP.
When is ERCP the first choice for a suspected CBD stone?
ERCP is the first choice when a CBD stone is suspected, as it allows for both diagnosis and immediate stone removal.
When would MRCP be preferred over ERCP for diagnosis?
MRCP is preferred when the diagnosis is uncertain, as it provides non-invasive visualization without the risks associated with ERCP.
What is the recommended procedure for recurrent stones?
For recurrent stones, ERCP with sphincterotomy is recommended to prevent recurrence.
When should MRCP be used for follow-up after an ERCP?
MRCP is used for non-invasive follow-up after ERCP complications.
What is the indication for PTC (Percutaneous Transhepatic Cholangiography)?
PTC is indicated when ERCP fails, particularly if there are anatomical changes, and PTC access is needed.
What is the key principle for performing ERCP?
ERCP should only be performed if an intervention (stone removal, stent placement, sphincterotomy) is planned, not for diagnosis alone.
What is the main risk associated with performing ERCP solely for diagnosis?
Performing ERCP solely for diagnosis carries an unnecessary risk of pancreatitis, estimated at 1-5%.
What does the ‘WES Sign’ mnemonic stand for and what is its use?
The ‘WES Sign’ stands for Wall Echo Shadow and is pathognomonic for gallstones.
What are the components of the ‘MACE’ mnemonic and what condition does it relate to?
‘MACE’ stands for Murphy’s sign, Anterior wall thickening, Collection, and Echo stone. It is used in scoring for acute cholecystitis.
What are the ‘4 Fs’ associated with gallstone risk factors?
The ‘4 Fs’ are Fat, Female, Forty, and Fertile, all of which are risk factors for gallstones.
-
basics and usg abdo184
-
usg abdo 2123
-
usg abdo 3156
-
machines161
-
MRI150
-
mri and c270
-
usg145
-
contrast media78
-
GI131
-
Intestine156
-
gallbladder117
-
gallbladder 232
-
Kidneysss158
-
Uretheral trauma ovaries and pregnancy130
-
thoracic radio210
-
thoracic park 2108
-
neuroradio139
-
neuroradio 296
-
MSK145
-
nuclear radio155
-
nuclear radio 2119
