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Abdominal Radiology > Liver, Biliary tree and gallbladder > Flashcards

Liver, Biliary tree and gallbladder Flashcards

1
Q

current method of choice for most hepatic imaging

A

dynamic bolus contrast-enhanced MDCT

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2
Q

imaging used to characterize cavernous hemangiomas and focal nodular hyperplasia

A

radionuclide imaging

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3
Q

2/3 of hepatic blood supply comes from

A

portal vein

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4
Q

maximum enhancement of the liver parenchyma occurs at

A

60 to 120 seconds following hepatic arterial enhancement

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5
Q

2 major classes of gadolinium used in hepatic imaging

A

extracellular agents such as gadopentetate dimeglumine (magnevist) and liver specific contrast agent such as gadoxetate disodium (eovist)

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6
Q

imaging that is very useful for definitive diagnosis of cavernous hemangioma

A

radionuclide blood pool imaging

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7
Q

3 longitudinal plane landmarks of surgical liver segments

A

middle hepatic vein, IVC, gallbladder fossa

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8
Q

divides the right liver lobe in anterior and posterior segments

A

right hepatic vein

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9
Q

anterior segments of right liver lobe

A

segment 5 and 8

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10
Q

posterior segments of right liver lobe

A

segment 6 and 7

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11
Q

divides the left liver lobe into medial and lateral segments

A

left hepatic vein

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12
Q

divides the left liver lobe into superior and inferior segments

A

left portal vein

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13
Q

divides the right liver lobe into superior and inferior segments

A

right portal vein

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14
Q

segment 1 of liver is the _____ which extends between the fissuer of the ligamentum venosum and IVC

A

caudate lobe

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15
Q

hepatic venous drainage from caudate lobe is directly into the

A

IVC via small veins

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16
Q

difference of THADs or THIDs (transient hepatic attenuation differences) from true parenchymal abnormality

A

no associated mass effect, vessels traverse them without distortion, underlying liver parenchyma is preserved

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17
Q

“third inflow” of portal venous flow are from systemic veins in the

A

pericholecystic, parabiliary, epigastric-paraumbilical venous systems

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18
Q

hepatic arterial flow may be increased by

A

hypervascular tumors, arterioportal shunting, inflammation of adjacent orgas, aberrants hepatic arterial supply

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19
Q

normal liver length

A

15.5 cm

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20
Q

liver length is measured in

A

midclavicular line

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21
Q

normal variant of hepatic shape found most in women. refers to an elongated inferior tip of right liver lobe

A

Reidel lobe

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22
Q

most common abnormality demonstrated by hepatic imaging

A

fatty liver

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23
Q

includes a continuum of liver disease that extends from simple fatty liver through nonalcoholic steatohepatitis to cirrhosis

A

nonalcoholic fatty liver disease

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24
Q

at risk for NASH include

A

those with type 2 DM, metabolic syndrome

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25
Q

reliable US findings of fatty liver include

A

liver echogenicity greater than that of the renal cortex, loss of visualization of normal echogenic portal triads in the periphery of the liver, poor sound penetration with loss of definition of the diaphragm

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26
Q

on unenhanced CT, fatty liver is diagnosed when the liver is ___ HU less than the spleen attenuation or when the liver is less than ____ HU

A

10 HU less than the spleen or less than 40 HU

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27
Q

MR sequence most sensitive to diganosis of fatty liver

A

GRE

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28
Q

potential pitfall in MR diagnosis of fatty liver in patients with cirrhosis

A

Iron deposition, which also cause a loss of signal in our-of-phase MR imaging

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29
Q

characteristic feature of fatty liver deposition on all modalities include

A

lack of mass effect, angulated geometric boundaries between involved and uninvolved parenchyma

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30
Q

fatty changes can develop within ___ weeks of hepatocyte insult and may resolve within ____ days of removing the insult

A

3 weeks, 6 days

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31
Q

focal fatty infiltration is most common in what parts of the liver

A

adjacent to falciform ligament, GB fossa, porta hepatis

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32
Q

fat-spared area is most commonly in what segment

A

segment 4

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33
Q

used to quantify liver fat

A

MR spectroscopy

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34
Q

type of fatty liver distribution that is only associated with renal failure on peritoneal dialysis and only when insulin is added to the dialysate

A

subcapsular fatty liver

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35
Q

characterized pathologically by portal and perilobular inflammation and fibrosis

A

chronic hepatitis

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36
Q

causes of chronic hepatitis

A

chronic viral infection and hepatitis B and C

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37
Q

characterized pathologically by diffuse parenchymal destruction, fibrosis with alteration of hepatic architecture and innumerable regenerative nodules that replace normal liver parenchyma

A

cirrhosis

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38
Q

causes of cirrhosis

A

hepatic toxins (alcohol, drugs, aflatoxin from a grain fungus), infections, biliary obstruction and heredity (Wilson disease)

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39
Q

In asia and africa, most cases of cirrhosis are due to

A

chronic active hepatitis

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40
Q

morphologic alterations seen in cirrhosis

A

hepatomegaly, atrophy or hypertrophy of hepatic segments, coarsening of hepatic parenchymal texture, nodularity of the parenchyma, hypertrophy of caudate lobe and left lobe with shrinkage of right lobe, regenerating nodules, enlargement of hilar periportal space (>10 mm) reflecting parenchymal atrophy

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41
Q

extrahepatic signs of cirrhosis

A

presence of portosystemic collaterals as evidence of portal hypertension, splenomegaly and ascites

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42
Q

effective treatment for portal hypertension and long-term control of esophageal variceal bleeding

A

transjugular intrahepatic portosystemic shunts (TIPS)

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43
Q

well established effective treatment for end-stage liver disease

A

liver transplantation

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44
Q

mimics of cirrhosis include

A

diffuse hepatic nodularity or portal hypertension including pseuocirrhosis of treated breast cancer metastases, miliary metastases, sarcoidosis, schistosomiasis, Budd-Chiari syndrome, nodular regenerative hyperplasia, idiopathic portal hypertension, portal vein obstruction, biliary obstruction

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45
Q

constant feature of cirrhosis

A

nodules

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46
Q

causes of nodules in a cirrhotic liver

A

regenerative nodules, dysplastic nodules, HCC, confluent fibrosis, focal fat infiltration, focal fat sparing, metastases

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47
Q

micronodular pattern of cirrhosis include small RN with sizes of

A

< 3mm

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48
Q

macronodular pattern of cirrhosis include RN size of

A

> 3mm

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49
Q

regenerative nodules are supplied by

A

portal vein

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50
Q

describe cirrhotic nodules that are high in iron content and appear as low signal nodules on both T1 and T2

A

siderotic nodules

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51
Q

siderotic nodules may be considered benign when they are

A

< 20 mm in diameter, homogeneous on all image sequences, isoenhance compared to background cirrhotic nodules in all phases

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52
Q

most often involved part of the liver in confluent fibrosis

A

central portion of right hepatic lobe

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53
Q

appearance of acute liver fibrosis on MRI

A

bright on T2 due to high fluid content

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54
Q

chronic cirrhosis appears what on MRI

A

low in fluid content and appears dark on T2

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55
Q

pathologic increase in portal venous pressure that results in the formation of portosystemic collateral vessels that divert blood flow away from the liver into the systemic circulation

A

portal hypertension

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56
Q

causes of portal hypertension

A

progressive vascular fibrosis associated with chronic liver disease, portal vein thrombosis or compression and parasitic infections

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57
Q

complications of portal hypertension

A

hemorrhage from varices and hepatic encephalopathy

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58
Q

Signs of portal hypertension include

A

visualization of portosystemic collaterals, increased portal vein diameter, increased SMV and splenic vein diameters, portal vein thrombosis, calcifications in the portal and mesenteric veins, edem in the mesentery, omentum and retroperitoneum, splenomegaly, ascites, reversal of flow in any portion of the portal venous system

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59
Q

normal diameter of portal vein

A

<13mm

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60
Q

normal diameter of SMV and splenic vein

A

< 10mm

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61
Q

portosystemic collaterals

A

coronary, gastroesophageal, splenorenal, paraumbilical, hemorrhoidal and retroperitoneal

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62
Q

causes of portal vein thrombosis

A

as complication of cirrhosis, portal vein invasion or compression by tumor, hypercoagulable states or inflammation (pancreatitis)

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63
Q

refer to a group of disorders characterized by obstruction to hepatic venous outflow involving one or more hepatic veins

A

Budd-Chiari syndrome

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64
Q

causes of Budd-Chiari syndrome include

A

coagulation disorder, membranous webs, obstructing hepatic veins or IVC and malignant tumor invasion of the hepatic veins

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65
Q

in Budd-Chiari syndrome, caudate lobe is spared because

A

it has a separate venous drainage which the IVC

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66
Q

characteristic appearance of Budd-Chiari syndrome

A

early phase CT images show the markeldy heterogeneous liver with prominent central and weak peripheral enhancement

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67
Q

common complication of congestive heart failure and constrictive pericarditis wherein the hepatic venous drainage is impaired and the liver becomes engorged and swollen

A

passive hepatic congestion

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68
Q

radiographic findings of passive hepatic congestion

A

distention of hepatic veins and IVC, reflux of IV contrast into the hepatic veins and IVC, increased pulsatility of portal vein, and inhomogeneous contrast enhancement of the liver

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69
Q

this condition may primary resulting from a hereditary disorder that increases dietary iron absorption, or secondary due to excessive iron intake usually from multiple blood transfusions or chronic diseases including cirrhosis, myelodysplastic syndrome and certain anemias

A

hemochromatosis

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70
Q

reticuloendothelial pattern of iron deposition is seen in

A

secondary hemochromatosis with iron overload cause by blood transfusions

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71
Q

renal pattern of iron deposition appears

A

loss of renal cortical signal on T1 and T2, reversing the normal corticomedullary differentiation pattern

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72
Q

excess iron increases hepatic parenhcymal attenuation of ___ on noncontrast images

A

above 72 HU

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73
Q

an omnious imaging sign associated with bowel ischemia in adults and necrotizing enterocolitis in infants

A

gas in portal venous system

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74
Q

portal venous gas presents as

A

air-density tubular structures extending to the periphery of liver

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75
Q

pneumobilia presents as

A

central and does not extend into the peripheral 2 cm of the liver

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76
Q

LI-RADS category: definitely benign ; hemangioma, cyst, cystic biliary hamartoma, focal fat deposition or sparing, perfusion alteration, vascular anomalies, definite confluent fibrosis, hypertrophic pseudomass

A

LR-1

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77
Q

LI-RADS category: findings are less certain than for LR-1, persistent perfusion alteration, probable confluent fibrosis, pseudomass, cirrhosis-associated nodule, focal scars

A

LR-2

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78
Q

LI-RADS category: intermediate probability for HCC

A

LR-3

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79
Q

LI-RADS category: probably HCC

A

LR-4

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80
Q

LI-RADS category: Definitely HCC

A

LR-5

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81
Q

LI-RADS category: definitely tumor invading vein

A

LR-TIV

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82
Q

LI-RADS category: Treated posttreatment observation

A

LR-5 treated posttreatment observation

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83
Q

LI-RADS category: other malignancy which include cholangiocarcinoma, lymphoma, metastases

A

OM

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84
Q

Management of LR 1 and 2

A

Continued routine surveillance, as appropriate

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85
Q

management of LR-3

A

variable follow-up (depends on clinical consideration)

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86
Q

management of LR-4

A

Additional imaging, biopsy, treatment or close follow-up

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87
Q

management of LR-5 and LR-TIV

A

Treat without biopsy. Radiologic TNM staging

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88
Q

management of LR-5 treated posttreatment observation

A

close follow-up to asses treatment response. Retreat if needed

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89
Q

management of other malignancies

A

biopsy, additional imaging, treatment or close follow-up

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90
Q

In normal liver parenchyma, most common hypervascular lesions are

A

hemangiomas, FNH, hepatic adenoma and hypervascular metastases

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91
Q

In fibrotic liver and cirrhosis, the most hypervascular lesions are

A

HCC and dysplastic nodules

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92
Q

hepatic metastases most commonly originate from

A

GI, breast or lung

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93
Q

most characteristic of hepatic metastases

A

band-like peripheral enhancement creating a “target-lesion” on postcontrast CT and MR

94
Q

true or false: metastases are extremely rare in cirrhotioc liver

A

true

95
Q

most common hypovascular metastases

A

colorectal, lung, prostate, gastric and uroepithelial carcinomas

96
Q

hypervascular metastases are

A

associated with primary neuroendocrine tumors (pancreatic islet cell tumors, carcinoid tumor, pheochromocytoma), RCC, thyroid carcinoma, melanoma, some sarcomas and choriocarcinoma

97
Q

most common liver neoplasm that is common in women

A

cavernous hemangioma

98
Q

tumor that consists of large, thin-walled, blood-filled vascular spaces separated by fibrous septa

A

cavernous hemangioma

99
Q

giant hemangiomas meaures

A

> 5 cm

100
Q

gian hemangiomas occassionally cause symptoms by

A

mass effect, hemorrhage or AV shunting

101
Q

true or false: no doppler signal is obtained from most cavernous hemangiomas because the flow is too low

A

true

102
Q

characteristic pattern of enhancement of hemangioma

A

discontinuous nodular enhancement from the periphery of the lesion that gradually becomes isodense or hyperdense compared to the liver parenchyma

103
Q

contrast enhancement of hemangioma persists for up to how many minutes

A

20 to 30 minutes

104
Q

most common primary malignancy of liver

A

HCC

105
Q

risk factors for HCC

A

cirrhosis, chronic hepatitis, variety of carcinogens (sex hormones, aflatoxin and thorotrast)

106
Q

tumor marker for HCC

A

serum AFP

107
Q

3 major growth patterns that affect imaging appearance of HCC

A

solitary massive, multinodular, diffuse infiltrative

108
Q

essential characteristic for diagnosis of HCC

A

arterial phase enhancement reflects neoangiogenesis with supply from hepatic artery

109
Q

benign solid mass consisting of abnormally arranged hepatocytes, bile ducts, and Kupffer cells

A

Focal nodular hyperplasia

110
Q

these lesions are solitary, less than 5 cm in diameter, hypervascular, with central fibrous scar containing thick-walled blood vessels. lack a capsule

A

FNH

111
Q

treatment for FNH

A

do not require tx

112
Q

finding that is highly indicative of FNH

A

show normal or increased radionuclide activity on technetium-99m sulfur colloid liver-spleen scans because of the presence of Kupffer cells

113
Q

rare, benign tumors that carry a risk of life threatening hemorrhage and potential for malignant degeneration

A

hepatic adenomas

114
Q

found most commonly in woman on long-term oral contraceptives

A

hepatic adenomas

115
Q

this tumor consists of sheets and cords of benign hepatocytes without a distinct acinar architecture

A

hepatic adenomas

116
Q

appearance of hepatic adenomas on technetium sulfur colloid radionuclide scans

A

appear as cold defects due to the presence of some nonfunctional Kupffer cells

117
Q

treatment for hepatic adenomas

A

surgical removal

118
Q

characteristic feature of hepatic adenoma that makes it prone to hemorrhage

A

poor connective tissue support

119
Q

most of this tumors are solitary, smooth and encapsulated. they do not have central scars. tumor size is commonly 8-15 cm but may be up to 30 cm in size. areas of necrosis, hemorrhage and fibrosis are common

A

hepatic adenomas

120
Q

this tumors is usually heterogeneous in appearance depending on presence of fat, necrosis, hemorrhage or rarely calcification

A

hepatic adenomas

121
Q

presence of multiple adenomas (>10) in an otherwise normal liver in patients, usually young women without risk factors for hepatic adenomas

A

Liver adenomatosis

122
Q

a hepatocellular malignancy with clinical and pathologic features that are distinct from HCC. tumors present as large liver mass in an adoloscent or young adult (mean age 23) with none of the risk factors for HCC, and without elevation of AFP. cords of tumor are surrounded by prominent fibrous bands that emanate from a central fibrotic scar. characteristic appearance is a large, lobulated hepatic mass with central scar and calcifications

A

fibrolamellar carcinoma

123
Q

lymphoma involving the liver usually appears

A

it is diffusely infiltrative and undetectable by imaging methods

124
Q

an autosomal dominant disorder of fibrovascular dysplasia resulting in multiple telangiectasias and AVM

A

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

125
Q

thin walled dilated vascular channels that appear on the skin and mucous membranes as well as throughout the body in multiple organs

A

telangiectasias

126
Q

patients present with epistaxis and intestinal bleeding, about 30% of patients have diffuse telangiectasias and multiple AV fistuals in the liver. these can result in pain, jaundice, portal hypertension and high-output cardiac failure

A

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

127
Q

nodular transformation of the liver parenchyma without fibrosis occurs in this condition and is called pseudocirrhosis

A

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

128
Q

rare disorder associated with chronic wasting from cancer or tuberculosis, or associated with use of oral contraceptives or anabolic steroids. cystic dilatation of the hepatic sinusoids and multiple small (1 to 3 mm) blood-filled spaces characterize the lesions

A

Peliosis hepatis

129
Q

small benign neoplasms consisting of dilated cystic branching bile ducts embedded within fibrous tissue. they appear as multiple, tiny (<1 cm) cystic lesions throughout the liver, best recognized in MR

A

bile duct hamartomas

130
Q

rare cystic neoplasm of biliary epithelium. they are premalignant and on continuum of disease with cystadenocarcinomas. tumors typically contain mucin and appear as large (up to 35 cm) multiloculated cystic mass

A

biliary cystadenoma/cystadenocarcinoma

131
Q

presence of thick, coarse, calcifications in biliary cystadenoma suggests

A

malignancy

132
Q

pyogenic liver abscess is usually caused by

A

E.coli, S. aureus, streptococcus or anaerobic bacteria

133
Q

liver abscess that may present as a solitary cavity or a tight group of individual loculated abscesses

A

pyogenic

134
Q

liver abscess that presents as solitary with thick nodular walls

A

amebic abscess

135
Q

hydatid cyst is caused by

A

Echinococcus granulosus or E. multilocularis tapeworm

136
Q

most common organ affected by hydatid cyst

A

liver

137
Q

tx for amebic abscess

A

metronidazole or tinidazole

138
Q

tx for hydatid cyst

A

mebendazole or surgical excision

139
Q

preferred screening method for biliary obstruction

A

US

140
Q

mainly used to guide therapy when the biliary tree cannot be accessed endoscopically

A

percutaneous transhepatic cholangiography

141
Q

has the greates sensitivity for early biliary tree obstruction

A

scintigraphy

142
Q

CT cholangiography is performed using what contrast agent

A

iopanoic acid

143
Q

hepatobiliary agents for MRCP are utilized for

A

contrast-enhanced cholangiogram, bile leak, suspected gallbladder obstruction, and hepaticojejunostomy evaluations

144
Q

more anteriorly located bile ducts

A

left

145
Q

right and left hepatic ducts combine to form

A

common hepatic duct

146
Q

cystic duct coarses posteriorly and inferiorly from the GB to join the ___ and form the ___

A

joint the common hepatic duct to form the common bile duct

147
Q

CBD and pancreatic duct share a common orifice in how many percent of individuals

A

60%

148
Q

considered as extrahepatic bile ducts

A

CHD and CBD

149
Q

normal intrahepatic bile ducts has diameter of

A

< or = to 3mm

150
Q

normal extrahepatic bile duct measures

A

< 7 mm

151
Q

increased CBD diameter has also been attributed with

A

aging and previous cholecystectomy

152
Q

right hepatic duct drains what segments

A

5 and 8

153
Q

right posterior duct drains what segments

A

6 and 7

154
Q

left hepatic duct drains what segments

A

2,3 and 4

155
Q

caudate lobe drainage

A

either right or left hepatic duct

156
Q

variations of biliary tree

A

drainage of right posterior duct into left hepatic duct (13 to 19%), triple confluence with the right posterior, right anterior and left hepatic ducts uniting at a single position (11%), and anomalies of the cystic duct including low insertion on the CBD, long parallel coarse with CHD and insertion on the medial rather than lateral side of CBD

157
Q

presence of biliary obstruction has what laboratory findings

A

elevated alkaline phosphatase and direct hyperbilirubinemia

158
Q

true or false: not all patients with clinical evidence of biliary obstruction have biliary dilatation

A

true

159
Q

gallbladder hydrops has a diameter of

A

> 5 cm

160
Q

“double duct” sign refers to

A

dilatation of both common bile duct and pancreatic duct in the head of the pancreas

161
Q

dilataton of both the CBD and pancreatic duct are usually due to

A

tumor at the ampulla

162
Q

abrupt termination of a dilated common duct is characteristic of

A

malignant process

163
Q

warranted therapy prior to biliary interventional procedures in obstructed patient

A

IV antibiotics

164
Q

MRCP may miss stones smaller than ___ because they are lost within high signal fluid

A

3 mm

165
Q

75% of biliary tract obstruction are

A

benign

166
Q

primary sclerosing cholangitis is associated with ____ 50 to 70% of cases

A

ulcerative colitis

167
Q

key diagnostic finding in primary sclerosing cholangitis

A

alternating dilation and stenosis produce a characteristic beaded pattern of intrahepatic ducts

168
Q

complications of primary sclerosing cholangitis

A

biliary cirrhosis and cholangiocarcinoma

169
Q

characterized by thickening of walls of the bile ducts and GB due to inflammation and edema. caused by CMV and cryptosporidium

A

HIV-associated cholangitis

170
Q

occurs in the setting of biliary obstruction and is life-threatening with mortality as high as 65%

A

acute bacterial cholangitis

171
Q

charcot triad of acute bacterial cholangitis

A

fever, pain, jaundice

172
Q

previously been called oriental cholangiohepatitis because it is endemic in SE asia

A

recurrent pyogenic cholangitis

173
Q

recurrent pyogenic cholangitis is associated with parasitic infection, namely

A

clonorchis sinensis, ascaris lumbricoided

174
Q

findings in recurrent pyogenic cholangitis

A

intraductal stones, severe extrahepatic biliary dilation, focal strictures, pneumobilia, and straightening and rigidity of intrahepatic ducts

175
Q

uncommon congenital anomaly of the biliary tree characterized by saccular ectasia of the IHBD without biliary obstruction

A

Caroli disease

176
Q

enhancing fibrovascular bundles are seen centrally within many of the dilated bile ducts producing the characteristic central dot sign

A

caroli disease

177
Q

caroli disease is associated with

A

medullary sponge kidney and autosomal recessive polycystic kidney disease

178
Q

choledochal cysts are more common in what gender

A

females

179
Q

most common type of choledochal cysts

A

type 1

180
Q

type of choledochal cyst that is confined to the EHBD and appear as fusiform or saccular dilatation

A

type 1

181
Q

type of choledochal cyst that are diverticula of CBD attached by a narrow stalk

A

type 2

182
Q

type of choledochal cyst that are termed choledochoceles and are focal dilatations of the intaduodenal portion of the CBD, closely resembling ureteroceles

A

type 3

183
Q

type of choledochal cysts that are defined as multiple focal dilatations of the IHBD and EHBD usually with a focal large cystic dilatation of the CBD

A

type 4

184
Q

caroli disease from todani classification is

A

type 5

185
Q

most common primary tumors associated with intraluminal biliary metastases

A

colorectal cancers

186
Q

findings that favor biliary metastases from cholangiocarcinoma

A

contiguous parenchymal mass and expansion of the duct at the site of intraluminal mass in a patient with known colorectal cancer

187
Q

second most common malignant primary hepatic tumor

A

cholangiocarcinoma

188
Q

cholangiocarcinomas are usually

A

adenocarcinomas

189
Q

growth patterns of cholangiocarcinoma include

A

mass-forming, periductal infiltrating and intraductal polypoid

190
Q

findings which favor cholangiocarcinoma over HCC include

A

arterial phase target enhancement, portal venous and delayed phase central enhancement, retraction of the liver surface, biliary obstruction disproportionate to the size of the mass and elevated CA 19-9 and CEA

191
Q

hilar cholangiocarcinoma that occurs near the junction of right and left bile ducts is also called

A

Klatskin tumor

192
Q

most common form of cholangiocarcinomas

A

extrahepatic

193
Q

predisposing conditions for extrahepatic cholangiocarcinoma include

A

choledochal cyst, ulcerative colitis, Caroli disease, clonorchis sinensis infection and PSC

194
Q

produce a large amount of mucin that markedly dilates the biliary tree and impaurs the flow of bile. the tumors are intraductal, polypoid and characterized by innumerable tiny frond-like papillary projections

A

intraductal papillary mucinous tumor

195
Q

pneumobilia is most commonly encountered in

A

patient with a surgically created biliary-enteric anastomosis, or who has had sphincteroto,u to facilitate stone passage

196
Q

most commonly due to erosison of a gallstone through the gallbladder and into the duodeunum

A

cholecystoduodenal fistula

197
Q

choledochoduodenal fistula is caused by

A

penetrating peptic ulcer erording into the common bile duct

198
Q

neck of GB is invariably positioned in

A

porta hepatis and major interlobar fissure

199
Q

descriptive folding of the GB fundus which is a common normal variant

A

phrygian cap

200
Q

small fold in the cystic duct

A

spiral valves of Heister

201
Q

gallbladder less than how many cm is considered contracted

A

less than 2 cm

202
Q

normal gallbladder wall does not exceed

A

3mm

203
Q

gallbladder wall thickness is measured where

A

from GB lumen to liver parenchyma

204
Q

85% of gallstones are

A

cholesterol

205
Q

15% of gallstones are

A

bilirubin/pigment stones related to hemolytic anemia

206
Q

gallstones are best detected on what modality

A

US

207
Q

result from biliary stasis

A

sludge balls or tumefactive biliary sludge

208
Q

common benign polypoid masses that result from accumulation of triglycerides and cholesterol in macrophages in GB wall

A

cholesterol polyps

209
Q

polyps ___ mm and smaller are routinely dismissed as benign cholesterol polyps

A

5 mm

210
Q

all polypoid GB cancers found on large series of cholecystectomy specimens are larger than

A

10 mm

211
Q

recommended follow-up interval for GB polyps with size of 5-10 mm

A

6 to 12 months interval

212
Q

true or false: adenomatous polyps are potentially premalignant

A

true

213
Q

gallbladder polyps larger than __mm should be considered for surgical removal because of risk of cancer

A

10 mm

214
Q

may be focal and presents as a polypoid mass fixed to the gallbladder wall

A

adenomyomatosis

215
Q

acute inflammation of the GB is caused by _____ obstructing the cystic duct in 90% of cases

A

gallstones

216
Q

confident US diganosis of acute cholecystitis requires the presence of these 3 findings

A

cholelithiases, edema of GB wall, positive sonographic murphy sign

217
Q

acalculous cholecystitis may be due to

A

wall ischemia or direct bacterial infection

218
Q

patients at risk for acalculous cholecystitis include

A

those with lack of oral intake, posttrauma, postburn. postsurgery, or on TPN

219
Q

term used to describe the presence of thick particulate matter in highly concentrated bile

A

sludge

220
Q

indicated presence of necrosis of GB wall

A

gangrenous cholecystitis

221
Q

findings include mucosal irregularity, thickening of GB wall with multiple lucent layers, indicating mucosal ulceration and reactive edema

A

gangrenous cholecystitis

222
Q

life threatening complication of gangrenous cholecystitis

A

perforation

223
Q

results from infection of the GB with gas-forming organisms, usually E.coli or clostridium perfringens

A

emphysematous cholecystitis

224
Q

refers to condition of biliary obstruction resulting from a gallstone in the cystic duct eroding into the adjacent CBD

A

Mirizzi syndrome

225
Q

described the presence of dystrophic calcification in the wall of an obstructed and chronically inflamed GB

A

porcelain GB

226
Q

uncommon variant of chronic cholecystitis characterized by nodule depositis of lipid-laden macrophages in DB wall and proliferative fibrosis

A

xanthogranulomatous cholecystitis

227
Q

condition that is difficult to differentiated from GB carcinoma which include marked wall thickening (2 cm), fat density nodules in the wall and narrowing of lumen

A

xanhogranulomatous cholecystits

228
Q

finding that favors xanthogranulomatous cholecystitis from GB carcinoma

A

preservaton of linear enhancement of the mucosa on postcontrast MR

229
Q

benign condition of GB characterized by wall thickening caused by hyperplasia of the mucosa and smooth muscle

A

adenomyomatosis

230
Q

appears on MRCP as “pearl necklace” appearance of GB wall caused by bright fluid within the sinuses. CT shows wall thickening with tiny cystic spaces

A

adenomyomatosis

231
Q

thickening of GB wall is associated with

A

acute or chronic cholecystitis, hepatitis, portal venous hypertension. AIDS, hypoalbuminemia, GB carcinoma

232
Q

GB carcinoma is a tumor of what age group

A

elderly women

Abdominal Radiology (14 decks)

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