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Flashcards in gall bladder WB quest Deck (127)
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1
Q

a congenital disease in which there is a narrowing or obliteration of the bile ducts is referred to as

A

biliary atresia

2
Q

primary biliary tree cancer is referred to as

A

cholangiocarcinoma

3
Q

the merging of the pancreatic duct and common bile duct at the level of duodenum is reffered to as the

A

ampulla of vater

4
Q

a gall stone located in the biliary tree is called

A

choledocholithiasis

5
Q

the yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as

A

jaundice

6
Q

the klatskin tumor is located

A

at the junction of the rt and lt hepatic ducts

7
Q

inflammation of the bile ducts is referred to as

A

cholangitis

8
Q

a pt presents with jaundice, pain , fever, secondary to am impacted stone in the cystic duct this is referred to as

A

mirizzi syndrome

9
Q

air within the biliary tree is referred to as

A

pneumobilia

10
Q

the spiral valves of heister are located within the

A

cystic duct

11
Q

if a gall stone, causing obstruction, is located within the distal common hepatic duct what become dialated

A

intrahepatic ducts

12
Q

what is considered the most proximal portion of the biliary tree

A

intrahepatic radicles

13
Q

what would be the most distal portion of the biliary tree

A

common bile ducts

14
Q

what could dilate if there was an obstructive biliary calculus located within the distal common duct

A

common bile duct
gall bladder
common hepatic duct

15
Q

the gall bladder is connected to the biliary tree by the

A

cystic duct

16
Q

formation or presence of stones within the gall bladder

A

cholelithiasis

17
Q

hormone which stimulates gall bladder contractions

A

cck

cholecystokinin

18
Q

fold with the neck or body of the gallbladder

A

junctional fold

19
Q

pain in the area of the gall bladder when applying pressure with the u/s transducer

A

murphy’s sign

20
Q

inflammation of the bile ducts

A

cholangitis

21
Q

surgical removal of the gall bladder

A

cholecystectomy

22
Q

solid or semi solid or thickened bile within the gall bladder or bile duct

A

sludge

23
Q

pear shaped sac responsible for storing bile until it is released through the cystic duct

A

gall bladder

24
Q

duct which carries bile from the cystic and hepatic ducts to the duodenum

A

common bile duct

25
Q

acute or chronic inflammation of the BG

A

cholecystitis

26
Q

duct of the gall bladder which joins with the hepatic duct to form the common bile duct

A

cystic duct

27
Q

what is the upper limit of normal for measurement of the gall bladder wall

A

3mm

28
Q

what makes up the portal triad

A

bile duct
portal vein
hepatic artery

29
Q

what is the normal measurement for an intrahepatic bile duct

A

less than 2mm

30
Q

what is a fold or kinking of the gall bladder fundus onto the body commonly called

A

phrygian

31
Q

which anatomic landmark can help locate the gall bladder

A

main lobar fissure

32
Q

what three labs can be used to evaluate the biliary system?

A

alkaline phosphate
bilirubin
lactic dehydrogenase

33
Q

a 2wk old infant presents with persistent jaundice and a palpable RUQ mass. the u/s demonstrates a normal gb and a cystic mass in the porta hepatis that appears to separate from the gall bladder. the CBD appears to be entering the cystic mass. what is most likely the diagnosis

A

choledochal cyst

34
Q

2 week old presents with a sudden on set of jaundice. the u/s demonstrates intrahepatic ductal dilation but does not deminstrate a gall bladder or CHD. which congenital biliary anomaly is the most likely cause

A

biliary atresia

35
Q

most common maligancy to matastisize to the gb

A

melanoma

36
Q

a comet-tail reverberation artifact is seen originating from the anterior gall bladder wall. what gall bladder pathology could be causing this

A

adenomyomatosis

37
Q

a distal obstruction of the panc head will cause which part of the biliary tree to dilate first

A

gallbladder

38
Q

what will cause a thin walled gallbladder

A

hydrops

39
Q

an abdominal u/s shows lg hypoechoic mass in the head of the panc. The gallbladder is enlarged with a thin wall. murphy’s sign is negative. no gallstone are present and bile ducts are normal size. what is most likely the diagnosis

A

courvoisier gallbladder

40
Q

a 76 yr old pt presents for an abdominal u/s with chronic abd pain. an irregular mass is seen projecting into the gallbladder lumen. color doppler detects flow within the mass. gallstones are also seen. what is most likely the diagnosis?

A

gallbladder carcinoma

41
Q

3 things that increase the risk of developing gallbladder malignancy

A

gall stones
chronic cholecystitis
porcelain gallbladder

42
Q

what would cause intrahepatic dialation with a normal GB and CBD

A

klatskin tumor

43
Q

the normal distended GB size

A

7-10cm

44
Q

the normal distended GB in AP and trans measures

A

less than 3cm

45
Q

purpose of gallbladder

A

store and concentrate bile

46
Q

an infundibulum at the neck of the gallbladder where stones may collect is called

A

hartmens pouch

47
Q

_______ bilirubin is typically elevated in cases of obstructive jaundice as can occur in choledocholithiasis

A

direct

48
Q

____ bilirubin is typically elevated with liver diease and hemolytic anemia

A

indirect

49
Q

do polyps move or cause acoustic shadowing?

A

no

50
Q

95% of gallbladder carcinoma have

A

gallstones

51
Q

what can be used to look for internal vascularity in a suspected gallbladder mass and to distinguish sludge from a malignant mass

A

color doppler

52
Q

2 most common hyperplastic cholecystoses are

A

adenomyomatosis

cholesterosis

53
Q

a distended gallbladder caused by an obstruction of the gallbladder neck or cystic duct

A

hydropic gallbladder

54
Q

RUQ pain, jaundice, fever, elevated bilirubin or alkaline phosphate are symptoms of

A

biliary obstruction

55
Q

bile ducts should be measured from

A

inner wall to inner wall

56
Q

CBD measuring larger than ____ is abnormal

A

8mm

57
Q

primary maligancies of the bile ducts

A

cholangiocarcinoma

58
Q

23 yr ols female pt presents to the u/s dept with hx of a fever, leukocytosis, and RUQ pain. u/s shows dialated bile ducts that have thickened walls and contain sludge. what is the most likely diagnosis

A

cholangitis

59
Q

u/s shows scattered echogenic linear structures within the liver parenchyma that produce a ring-down artifact what could the diagnosis be

A

pneumobilia

60
Q

for pt over 60 who have had a cholecystectomy a maximum diameter of ____ cm may be considered normal

A

1

61
Q

the yellow pigmant found in bile that id produces by the breakdown of red blood cells by the liver is

A

bilirubin

62
Q

common form of symptomatic GB disease, typically with stones

A

chronic cholecystitis

63
Q

repeated attacks of chronic cholecystitis results in

A

thickening and fibrosis of GB wall

may also cause contraction of the GB

64
Q

what symptoms are associated with chronic cholecystitis

A

intalorance to fatty foods
nausea/vom
moderate RUQ pain/ or radiating pain
may be asymptomatic

65
Q

Sonographic apperarence

  • small contracted GB with stones and evenly thickened, fibrous echogenic walls
  • stone often lodged in neck
  • WES or double arc sign may be seen
A

chronic cholecystitis

66
Q

chronic cholecystitis complications

A

porcelain GB
Bouveret syndrome
mirizzi syndrome

67
Q

*pathlogy that can mimic WES
*calcified gb
associated with high incidence of GB carcinoma

A

porcelain GB

68
Q

in what syndrome does biliary enteric fistula from between the gb and the duodenum

A

Bourveret syndrome

69
Q

who is at a higher risk for bouveret syndrome

A

women over 60 w/ symptoms of bowel obstruction and GB disease

70
Q

stone impacts in neck or cystic duct, obstruction of bile proximal to cystic duct

A

mirizzi syndrome

71
Q

at what measurement is the GB wall considered thickened

A

greater than 3mm

72
Q

symptomatic thickening of GB wall

A

pancreatitis
CHF
patient with hep
end stage liver disease

73
Q

causes of focal GB wall thickening

A

GB cancers
gangrenous cholecystitis
adenomyomatosis

74
Q

stagnant bile may leak out into the blood stream

A

ICP

intrahepatic cholestasis of pregnancy

75
Q

sonographic appearance of ICP

A

gallstones may be seen

no ductal dialation

76
Q

benign GB neoplasm

A

adenoma (polyp)

77
Q

polyps are made out of

A

adenomatous

cholesterol

78
Q

sonographic appearance of benign neoplasm

A

fixed
non shadowing
echogenic mass protruding into the gb lumen
typically less than 2mm

79
Q

polyps greater than 1 cm are suggestive of

A

malignancy

80
Q

Benign GB neoplasm caused by

A

chronic inflammation
hyperplasia of GB wall
lipid deposits

81
Q

pus or blood cam mimic what

A

sludge

82
Q

intrahepatic ducts should measure

A

2mm or less

83
Q

what crosses anterior to the undivided rt portal vein

A

CHD

84
Q

seen in cross section between the portal vein posteriorly and the CHD anteriorly

A

Hepatic artery

85
Q

proper size of the common bile duct

A

10mm

86
Q

correlate bile duct size to age in decades

A

presbyductia

87
Q

what lie posterior to the CBD

A

Cystic duct

88
Q

proper size of cystic duct

A

less than 2mm

89
Q

allows for improved contrast

A

harmonics

90
Q

a CHD with a measurement of greater then 8mm suggests

A

obstruction

91
Q

types of bile duct obstructions

A

intrinsic
(intrahepatic)
extrinsic
(extrahepatic)

92
Q

obstruction of intrahepatic biliary caused by

A

primary sclerosing cholangitis

space occupying mass in liver

93
Q

obstruction at porta hepatis caused by

A

cholangiocarcinoma
primary sclerosing cholangitis
GB cancer
metastic tumors

94
Q

biliary obstruction extrinsic cause

A

blunt abrupt end to duct may indicate malignancy

tapered dilated duct typically benign cause

95
Q

where is an obstruction if the intrahepatic ducts are dilated
ducts between porta hepatis and pancreas will be normal

A

obstruction at porta hepatis

96
Q

dilated intrahepatic ducts measure at

A

greater than 2mm

97
Q

sonographic appearence
parallel channel sign (shotgun sign)
irregular jagged walls
stallate confluence

A

dilated intrahepatic ducts

98
Q

most common pathology of the biliary tract

A

choledocholithiasis

99
Q

a condition where stones that form in the Gb and move to the CBD

A

choledocholithiasis

100
Q
sonographic appearence
dilated or non dilated ducts
may create shadow
single or double
large or small
mobile or stationary
small stones mare difficult to see
A

choledocholitiasis

101
Q

primary maligancy of bile duct

A

cholangiocarcinoma

102
Q

cholangiocarcinoma occurs where

A

throughout biliary tree
in the porta hepatis (klatskin)
ampullary carcinomas at distal CBD

103
Q

grows slowly and may extend along the length of CHD and CBD

A

cholangiocarcinoma

104
Q

risk factors of cholangiocarcinoma

A

sclerosing cholangitis
choledocal cyst
parasitic infection

105
Q

symptoms of cholangiocarcinoma

A
abd pain
anorexia
fatigue
weight loss
hepatomegaly 
ascites
106
Q

sonographic appearance of cholangiocarcinoma

A

ductal wall irregularity

107
Q

non union or ft and rt hepatic ducts is suggestive of what type of tumor

A

hilar cholangiocarcinoma

108
Q

chronic inflammatory and fibrosing disorder of bile duct

A

primary sclerosing cholangitis (psc)

109
Q

assoctiated with ulcerative colitis and crohns disease

A

PSC

110
Q

can progress to cirrhosis, liver failure and colangiocarcinoma

A

PSC

Primary sclerosing cholagitis

111
Q

sonographic appearence

thickened edematous duct walls that narrow the lumen dialating more proximal ducts

A

PSC

112
Q

a medical emergency

A

acute cholangitis

113
Q

sonographic appearance

mobile bright echoes with dirty shadowing

A

pneumobilia

114
Q

portal vein air can occur with

A

necrotic bowel

115
Q

result from surgical trauma, or blunt abd trauma

A

strictures

116
Q

may penitrate into the CBD creating a

A

fistula

117
Q
sonographic appearance
intrahepatic duct dialation
normal cbd distal to the cystic duct
stone in the neck of the gb or cystic duct
contracted gb
A

mirizzi syndrome

118
Q

collection of bile

A

biloma

119
Q

adbominal fluid collection, can bee seen along falciform ligament or ligamantun venosum

A

biloma

120
Q

can occur with lacoration or rupture of biliary tract

A

biloma

121
Q
sonographic appearance 
thickening gb wall
striations, gb dilation
pericholecystic fluid collection
sludge, biliary dilatation, duct wall thickening
A

AIDS cholecystopathy

122
Q

occurs in pt with recurrent pyogenic cholangitis

A

inrahepatic biliary calculi

123
Q

roundworms found in the biliary tree

A

ascaris lumbricoides

124
Q

sonographic appearance

worms seen in bile duct or gb

A

ascaris lumbricoides

125
Q

liver fluke

A

chonorchis sinensis

126
Q

sonographic appearance
minimal or absent dilaation of intrahepatic ducts
increased echogenicity of the involved duct wall

A

chonorchis sinensis

127
Q

needle inserted into the biliary tree

A

percutaneous transhepatic cholangiography