ARDMS/Edelman Main Biliary Tract Anatomy & Pathology

The right and left hepatic ducts join to form
the common hepatic duct (CHD)

The gallbladder is located at the ________ end of the main lobar fissure
inferior

The gb neck tapers to form
the cystic duct

The cystic duct joins with the _________ to form the ______
common hepatic duct (CHD); CBD

What two ducts join to form the ampulla of Vater?
CBD and the main pancreatic duct (Duct of Wirsung)

What fold controls bile flow in the cystic duct?
Valve of Heister

Abnormal diverticulum of the neck of the gallbladder
Hartmann’s pouch

Fold between the body and neck of the gallbladder
Junctional fold

The CBD passes __________ to the ________ part of the duodenum.
posterior; first

The ampulla of Vater empties through the duodenal papilla, controlled by the __________
sphincter of Oddi

M/c cause of wall thickening?
cholecystitis

Made up of calcium bilirubinate granules and cholesterol crystals
sludge

Non-shadowing, mobile, echogenic material in a non-contracted gallbladder
sludge

WES sign can also be referred to as
double arc

Wall inflammation of the gallbladder due to cystic duct obstruction by a gallstone
acute cholecystitis

Associated with cholelithiasis (90-95% of patients) and acalculosous
acute cholecystitis

Increased amylase in acute cholecystitis suggests obstruction at the level of the ________
ampulla of Vater

Acute cholecystitis due to gb wall ischemia and infection
emphysematous

Gb wall thickening that occurs commonly in diabetic men; high occurrence of gangrene
emphysematous

Gas is found in this type of gb wall thickening, causing a comet-tail sign
emphysematous

Purulent material in the gb due to bacteria-containing bile asso/w acute wall thickening
empyema

Presents with the same symptoms of acute cholecystitis. but with fever
empyema

Localized collection of fluid around the GB; caused by acute cholecystitis
perforation

Acute cholecystitis without the presence of gallstones. Typically a secondary event in hospitalized patients. Asso/w surgery, trauma, burns, sepsis, AIDS
acalculous cholecystitis

Sludge-like material with a high concentration of calcium
milk of calcium bile (limy bile)

Sludge that results in distal acoustic shadowing. Asso/w chronic cholecystitis and obstruction of the cystic duct.
milk of calcium bile (limy bile)

Calcification of the gb wall asso/w chronic cholecystitis
porcelain gb

Known as mucocele of the gallbladder
hydrops

Overdistended gb filled with mucoid or clear, watery substances. Asymptomatic and palpable
hydrops

Hydrops is suggested with a transverse diameter
>5cm

Polyps greater than _______ are likely to be cancerous
10mm

Lipids are deposited in the gb wall that appear as polyps. Lacks reverberation artifact.
cholesterolosis (strawberry gallbladder)

Symptoms mimic cholecystitis. Associated findings include a porcelain gallbladder
gb carcinoma

Hyperechoic changes in the gb wall causing overgrowth of the mucosa. Creates diverticula. Asso/w comet tail artifact
adenomyomatosis

In most situations, biliary obstruction is due to pathology in the _________
distal CBD

__________ and _______ are the two most common lesions of biliary obstruction.
gallstones; carcinoma of the head of the pancreas

Biliary obstruction presents with increased _____, _______, and ____.
ALP, direct bilirubin, GGT

“Parallel channel sign” or “Shotgun sign”
dilated intrahepatic ducts

Cholecystokinin causes the gb to ________
contract

M/C location for an obstructive stone?
distal CBD

Obstruction where only the common hepatic duct and the intrahepatic duct will dilate.
common hepatic obstruction

Obstruction where only the intrahepatic ducts dilate. Asso/w Klatskin’s tumors
obstruction at the junction of the rt and lt hep ducts

Calculi in the bile ducts
choledocolithiasis

Complications of choledocholithiasis include ______. ________, ______, and increased ______
cirrhosis, cholangitis, pancreatitis, ALP

Impacted stone in the cystic duct causing exstrinsic compression of the common hepatic duct
mirizzi syndrome

Primary sclerosing cholangitis is the most common predisposing condition of
cholangiocarcinoma

Cholangiocarcinoma typically originates within the ____________
extrahepatic biliary ducts (CBD or CHD)

Bacterial infection superimposed on an obstruction of the biliary tree
cholangitis

Suspected when jaundice persists beyond 14 days of age
biliary atresia

Air in the biliary tract
pneumobilia

Cyst of the intra or extrahepatic bile ducts that are most common in asia
choledochal cysts

Type V choledochal cyst characterized by multifocal segmental dilitation of the intrahepatic bile ducts
caroli’s disease

M/C cause of malignant neoplasm obstructing the biliary tree
pancreatic adenocarcinoma

Adenocarcinoma of the head of the pancreas typically causes
courvoisier gallbladder

Conjugated bilirubin + unconjugated bilirubin =
total bilirubin

______ increases in diseases that impair bile formation, specifically bile duct obstruction
ALP

Bile thickening occurs within the ducts of ______
Luschka

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