GROSS ANATOMY Overview Pancreas: Accessory digestive gland lying behind stomach in anterior pararenal space (APS) of retroperitoneum Exocrine function: Pancreatic acinar cells secrete pancreatic juice → pancreatic duct → duodenum Endocrine: Pancreatic islet cells (of Langerhans) secrete insulin, glucagon, and other polypeptides → portal venous system Divisions Head: Thickest part; lies to right of superior mesenteric artery and vein (SMA, SMV) Attached to "C" loop of…

KEY FACTS Terminology Secondary sclerosing cholangitis usually resulting from opportunistic infection of biliary tract in AIDS patients with CD4 count < 100/mm³ You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Recurrent episodes of acute pyogenic cholangitis with intra- and extrahepatic biliary pigment stones Synonyms: Hepatolithiasis, oriental cholangiohepatitis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Inflammation of intra-/extrahepatic bile duct walls due to ductal obstruction and infection You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Malignancy arising from intrahepatic bile duct (IHBD) or extrahepatic bile duct epithelium You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Definition: Gas within biliary tree, including bile ducts or gallbladder Synonyms: Pneumobilia, aerobilia You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Cholangiolithiasis, hepatolithiasis, biliary calculi, common bile duct (CBD) stones You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Spectrum of extrahepatic and intrahepatic bile ducts malformations characterized by fusiform dilatation You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Biliary ductal dilatation, dilated ducts You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Imaging US for initial detection and characterization, CECT or MR for preoperative assessment and staging 3 main morphological types Large soft tissue mass infiltrating gallbladder (GB) fossa/replacing GB, ± invading liver ( most common ) Diffuse or focal GB wall thickening: Asymmetric, irregular, extensive thickening Polypoid intraluminal mass: > 1 cm, thickened base, irregular margins You’re Reading a Preview Become a Clinical Tree membership…

KEY FACTS Imaging Gallbladder (GB) wall thickening with intramural hyperechoic foci and comet-tail reverberation artifacts V-shaped comet-tail artifacts from debris in GB wall cystic spaces Twinkling artifacts from intramural debris on color Doppler examination Morphological patterns: Diffuse, segmental, annular, focal Annular form: Midbody segmental thickening results in constricting ring around midbody and hourglass shape Focal fundal adenomyoma Smooth fundal solitary intraluminal mass, internal cystic spaces, echogenic…

KEY FACTS Terminology Intramural calcification of gallbladder (GB) wall, uncommon manifestation of chronic cholecystitis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Rare inflammatory process causing focal or diffuse destruction of gallbladder (GB) wall with accumulation of lipid-laden macrophages, fibrous tissue, and acute and chronic inflammatory cells You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Chronic inflammation of gallbladder (GB) causing wall thickening and fibrosis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Acute necroinflammatory disease of gallbladder (GB) secondary to stasis and ischemia, not related to gallstones You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Terminology Acute inflammation of gallbladder (GB) secondary to calculus obstructing cystic duct You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

KEY FACTS Imaging Single or multiple small, round/ovoid masses attached to gallbladder (GB) wall with no posterior acoustic shadowing Usually sessile but may be pedunculated with well-defined stalk Usually 2-10 mm in size, most commonly in middle 1/3 of GB Cholesterol polyp: Small with comet-tail artifact Avascular or hypovascular on Doppler examination Larger lesions may have slight internal vascularity Consider neoplastic GB polyp if size >…

KEY FACTS Imaging Amorphous, mid-/high-level echoes within gallbladder or bile ducts Free floating or mass-like, mobile, settling in dependent position Floating punctate echoes may show ring-down artifact Occasionally round, low to intermediate echogenicity and mass-like: "Tumefactive" sludge No posterior acoustic shadowing (unlike stones) and no internal color flow (suggesting mass) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

KEY FACTS Imaging Highly reflective, mobile and gravity-dependent intraluminal structures with posterior clean shadowing Variable size; stones < 5 mm may not shadow Contracted gallbladder (GB) full of stones may not exhibit mobility and may be mistaken for duodenal bulb Wall-echo-shadow (WES) sign: 2 echogenic, curvilinear lines separated by sonolucent line Always evaluate for biliary dilatation and signs of cholecystitis, cholangitis, or pancreatitis You’re Reading a…

TERMINOLOGY Abbreviations Extrahepatic biliary structures Gallbladder (GB) Cystic duct (CD) Right hepatic (RH) and left hepatic (LH) ducts Common hepatic duct (CHD) Common bile duct (CBD) Definitions Proximal/distal biliary tree (follows direction of flow) Proximal refers to portion of biliary tree that is closer in proximity to liver and hepatocytes Distal refers to caudal end closer to ampulla and bowel Central/peripheral Central refers to biliary ducts…