Biliary and Gallbladder pathology Flashcards by Rexlin Sebastin

3 sonographic characteristics help the sonographer to distinguish between dilated hepatic ducts and portal veins. Which of the following statements is NOT true?

Ducts will be more irregular and tortuous than PV..

Ducts will branch into stellate confluence.

Bile ducts will have posterior acoustic enhancement

Portal veins will be more irregular and tortuous than ducts.

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A normal GB wall measures ______ in thickness.

3 cm or less
5 mm or less
5 cm or less
3 mm or less

3 mm or les

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This is usually a secondary event in critically ill hospitalized patients. You will see a thick-walled GB, but no stones present, small amount of sludge.

acalculous cholecystitis

gangrenous cholecystitis

Acute cholecystitis

Chronic cholecystitis

acalculous cholecystitis

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Acute cholecystitis without the presence of gallstones is called ______ .

Porcelain GB

Chronic Cholecystitis

Acute Cholecystitis

Gangrenous Cholecystitis

Acalculous Cholecystitis

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Your patient presents with history of recent RUQ pain, nausea/vomiting, and back pain. Upon examination, you find a distended GB with multiple gallstones. Diffuse GB wall thickening is noted. You are able to elicit a positive Murphy’s sign. This describes what disease?

Emphysematous cholecystitis

GB polyps

Chronic Cholecystitis

Acute cholecystitis

GB perforation

Acute cholecystitis

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All of the following are complications of acute cholecystitis except:

Empyema

Perforation

Gangrenous cholecystitis

Pericholecystic abscess

Atherosclerotic disease

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Benign hyperplastic changes occur with the GB wall causing an overgrowth of the mucosa. As the wall thickens, diverticula form (called RAS) in which stones and sludge accumulate. The stones and sludge in the diverticula cause a comet-tail artifact. This describes what disease?

Adenomyomatosis
Cholesterolosis
Porcelain GB

Adenomyomatosis

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This condition is suspected when jaundice (hyperbilirubinemia) persists beyond 14 days of age due to absence of CHD and CBD.

Empyema of GB

Pancreatic adenocarcinoma

Biliary atresia

Mirizzi syndrome

Caroli’s disease

Biliary atresia

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Calcification of the GB wall is called:

Cholesterolosis

Choledocholithiasis

WES Sign

Porcelain GB

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This congenital anomaly is characterized by malformation of the intrahepatic ducts. There are 2 types, the 2nd form is more common. It can appear as saccular or fusiform dilation of the intrahepatic biliary tree.

Mirizzi syndrome

Cholangitis

Primary sclerosing cholangitis

Caroli’s disease

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Which of the following are symptoms of cholangiocarcinoma? Mark all that apply.

Abdominal pain

Jaundice

Weight loss

Nausea/Vomiting/diarrhea

Abdominal pain
Jaundice
Weight loss

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This disease is a bacterial infection of the bile ducts. Bile becomes infected due to stasis caused by an obstruction in the biliary tree. Common causes are choledocholithiasis, ERCP, and obstructing tumors.

Mirizzi Syndrome

Primary sclerosing cholangitis

Acute cholangitis

Empyema

Acute cholangitis

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This is a congenital condition of the bile ducts where there is cystic dilatation of the intrahepatic or extrahepatic bile ducts. Sono appearance is that of two cystic structures in RUQ. It is more prevalent in Asia and occurs more often in women.

Caroli’s disease

Mirizzi syndrome

Choledocholithiasis

Choledochal cysts

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________ is the term used for stones in the bile ducts.

Choledocholithiasis

Cholangitis

Caroli’s disease

Primary sclerosing cholangitis

Choledocholithiasis

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Choledocholithiasis refers to _____ in the bile ducts.

stones

air

parasites

blood clots

stones

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Cholelithiasis refers to _____ in the GB.
air

sludge balls

stones

pus

bacteria

stones

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This pathology occurs when lipids are deposited into GB wall. These deposits will appear in polyp form, varying in size and can be as large as 1 cm. The lesions are attached to GB wall and are non-shadowing. This GB disease is

Cholesterolosis

Adenomyomatosis

Mets of the GB

Empyema of GB

Cholangitis

Cholesterolosis

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True or False: Cholesterolosis will have reverberation artifact.

True

False

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Which GB disease is characterized by recurring symptoms of biliary colic due to multiple previous bouts of acute cholecystitis? Its sonographic appearance will include thickened GB wall, fibrotic contracted GB, and sludge or stones.

Xanthogranuloamtious cholecystitis

Primary sclerosing cholangitis

Gangrenous cholecystitis
Chronic cholecystitis

Chronic cholecystitis

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With Common Hepatic Duct obstruction, what portions of the biliary system will be dilated? (Stop and think about where the obstruction is located.)

Entire system will distend, including GB.

Only CHD & intrahepatic ducts will dilate. GB will be contracted.

Only intrahepatic ducts will be dilated. GB will be contracted.

No dilatation of intra or extrahepatic ducts. GB contacted.

No dilatation of intra or extrahepatic ducts. GB distended.

Only CHD & intrahepatic ducts will dilate. GB will be contracted.

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_______ is term given when the GB remains extremely large even when the patient has eaten a high fat meal, like it’s unable to expel the bile. It can indicate an extrahepatic mass; therefore, the pancreas needs to be carefully evaluated.

Acute Cholecystitis

Caroli’s Disease

Courvoisier’s GB

Mirizzi Syndrome

Cholesterolosis

Courvoisier’s GB

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With distal CBD obstruction, which part of biliary system will be dilated? (Think about where the obstruction is at.)

Entire biliary system will be dilated, including GB.

Only CHD & intrahepatic ducts will be dilated. GB contracted.

Only intrahepatic ducts will be dilated. GB will be contracted.

No dilatation of intra of extrahepatic ducts. GB dilated.

No dilatation of intra or extrahepatic ducts. GB contracted.

Entire biliary system will be dilated, including GB.

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The sonographic findings include comet-tail artifacts posterior to gas or dirty shadowing. Occurs most commonly in diabetic males. What pathology is this?

Acute cholecystitis

Chronic cholecystitis

Emphysematous cholecystitis

Xanthogranulomatous cholecystirs

Emphysematous cholecystitis

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This pathology occurs when a pus like material is within the GB. This is due to bacteria-containing bile associated with acute cholecystitis. The symptoms are the same as acute cholecystitis, but patient also has a fever. Atypical bile echoes may be seen.

Emphysematous cholecystitis

Empyema of GB

Mirizzi syndrome

Gangrenous cholecystitis

Empyema of GB

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The 3 sonographic characteristics of gallstones are echogenic, mobile, and non-shadowing. True False

False

This is the most common reason for air in the liver and is associated with previous biliary intervention. Empyema Cholangitis Pneumobilia Emphysematous cholecystitis

Pneumobilia

___________ causes 50-60% of mets to the GB. Melanoma Breast cancer Liver cancer Colon cancer

Melanoma

This name is used to refer to the appearance of the dilated hepatic duct adjacent to the Portal Vein. Banana peel sign Parallel channel sign or shotgun sign Mickey Mouse sign Seagull sign

Parallel channel sign or shotgun sign

Chronic and progressive cholestasis due to destruction of small intrahepatic bile ducts lead to end stage liver disease. Sonographic appearance is that of increased liver echogenicity with findings associated with cirrhosis and PHT. Primary biliary cirrhosis Pancreatic adenocarcinoma Cholangiocarcinoma Primary sclerosing cholangitis

Primary biliary cirrhosis

The liver is a site where mets from GB carcinoma may be found. True False

True

Mirizzi syndrome is extrahepatic biliary obstruction that occurs when stone is impacted in the ______ duct and causes extrinsic mechanical compression of the _____. CHD, CBD Cystic, CHD Rt. Hepatic duct, Lt Hepatic duct CBD, Pancreatic duct

Cystic, CHD

This disease is a malignancy that is the most common malignant tumor/neoplasm to cause obstruction of the biliary system. Typically this will cause "Courvoisier GB". Klatskin tumor Cholangiocarcinoma Pancreatic adenocarcinoma Primary sclerosing cholangitis

Pancreatic adenocarcinoma

Rokitansky-Aschoff sinuses are diverticula that are associated with emphysematous cholecystitis. True False

False

A pasty material that forms in the gallbladder and is high in calcium content is called: Sludge Empyema Cholesterolosis Milk of calcium bile (limy bile)

Milk of calcium bile (limy bile)

A mass that fills the GB is one of the most common findings with this disease. GB carcinoma Caroli's disease Cholesterolosis Biliary Atresia Cholangitis

GB carcinoma

This is a rare form of chronic cholecystitis in which lipids collect in GB wall. The lipid nodules may appear as hypoechoic nodules or bands within the thickened wall. Incorrect answer: Adenomyomatous Xanthogranulomatious Cholecystitis Cholangitis Cholangiocarcinoma Xanthogranulomatious Cholecystitis Mirizzi Syndrome

Xanthogranulomatious Cholecystitis

Necrosis of the GB due to prolonged acute cholecystitis is called Acalculous cholecystitis Emphysematous cholecystitis Gangrenous cholecystitis Xanthogranulomatious cholecystitis Primary sclerosing cholangitis

Gangrenous cholecystitis

The pathology known as milk of calcium bile will exhibit what sonography artifact? Enhancement Shadowing Comet-Tail Reverberation Shadowing

Shadowing

GB polyps are echogenic and mobile within the GB. True False

False

Perforation of the GB is a complication of GB polyps Acute cholecystitis Acalculous cholecystitis Cholesterolosis Choledochal cysts

Acute cholecystitis

This pathology is highly associated with cancer of the GB. Adenomyomatosis Porcelain GB Acute cholecystitis Porcelain GB Emphysematous cholecystitis Milk of calcium bile

Porcelain GB

Sonographically, you would see thickening of bile duct walls, strictures in ducts, and findings associated with cirrhosis. This results in liver failure leading to liver transplant. ERCP is used for the dx. Pneumobilia Primary sclerosing cholangitis GB carcinoma Biliary atresia

Primary sclerosing cholangitis

Pancreatic adenocarcinoma is usually located in the ______ of the pancreas. head body tail

head

All of the following describe the sonographic appearance of sludge except: Low level echoes in GB Layers Acoustic shadowing Shifts with pt. position Non-shadowing

Acoustic shadowing

This cholangiocarcinoma occurs at the junction of the right and left hepatic ducts. Primary sclerosing cholangitis Caroli's disease Cholangitis Klatskin tumor

Klatskin tumor

Organization of sludge in the GB into balls is called: Pneumobilia Cholelithiasis Tumefactive sludge Polyps Limy bile

Tumefactive sludge

The sonographic appearance of this pathology would be a deflated GB and pericholecystic fluid collection. Complications that could arise are peritonitis and pericholecystic abscess. GB perforation Hydrops Mirizzi syndrome Adenomyomatosis Gangrenous cholecystitis

GB perforation

With an obstruction at junction of right and left hepatic ducts, which portions of biliary system will be dilated? (Think about where the obstruction is located.) Entire system will distend, including GB. Only CHD & intrahepatic ducts will dilate. GB will be contracted. Only intrahepatic ducts will be dilated. GB will be contracted. No intra or extrahepatic ducts dilated. GB distended. No intra or extrahepatic ducts dilated. GB contracted.

Only intrahepatic ducts will be dilated. GB will be contracted.

GB carcinoma has a mean survival rate of ____ months. 12 18 9 6 2

Strawberry GB is the diffuse form of which pathology? GB polyps GB carcinoma Adenomyomatosis Cholesterolosis Xanthogranulomatious cholecystitis

Cholesterolosis

Congenital abnormality of the ducts, associated with renal tubular ectasia and congenital hepatic fibrosis. Caroli's Disease Choledochal Cyst Obstructive Intrahepatic Duct Dilation Mirizzi Syndrome

Caroli's Disease

This is a mass in between the right and left hepatic ducts. The doctors fear it may be cancerous, what do you think it is? Adenomyomatosis Cholangitis Biliary Cirrhosis Klatskin's Tumor

Klatskin's Tumor

This patient has RUQ pain, N/V, and is running a high fever. Their WBC is extremely high. There is NO fluid around the outside of the GB, you just see a thick material within the gallbladder that does not really look like sludge. What complication of acute cholecystitis has occurred? Empyema GB Carcinoma Empyema GB perforation Sludge

Empyema

A 60-year-old patient presents with loss of appetite and intolerance to fatty foods. The sonographic findings include a heterogeneous liver, gallstones with an irregularly bordered soft tissue mass protruding into the lumen of the gallbladder. This is most characteristic of: porcelain gallbladder chronic cholecystitis gallbladder carcinoma cholesterolosis

gallbladder carcinoma

A common variant of the gallbladder fundus is a(n): Hartman's Pouch phyrgian cap junctional fold hourglass shape

phyrgian cap

A congenital anomaly that demonstrates multiple cystic structures within the liver that communicate the intrahepatic ducts with normal extrahepatic ducts is characteristic of: cystadenoma cholangiocarcinoma cholangitis Caroli's disease

Caroli's disease

A female patient from Japan presents with pain, intermittent jaundice, and a palpable mass. A sonogram is performed, and a large cystic mass is seen in the porta hepatis region with dilatation of the CHD and CBD. This is characteristic of: biliary atresia Caroli's Disease choledochal cyst Klatskin tumor

choledochal cyst

Diffuse gallbladder wall thickening with comet-tail artifacts that emanate from the wall is most characteristic of: adenomyomatosis cholesterolosis chronic cholecystitis mets to the gallbladder

adenomyomatosis

Mirizzi syndrome is characterized by a(n): stone impacted in the cystic duct stone in the distal portion of the CBD contracted gallbladder hydropic gallbladder

stone impacted in the cystic duct

Non-shadowing, low amplitude layer found in the dependent portion of the gallbladder best describes: gallstones polypoid mass adenomyomatosis sludge

sludge

the distal portion of the common bile duct exits into the: liver stomach duodenum gallbladder

duodenum

Two non-biliary reasons for diffuse wall thickening of the gallbladder are: ascites and acute hepatitis porcelain gallbladder and congestive heart disease adenomyomatosis and cholesterol polyp contracted gallbladder and hydropic gallbladder

ascites and acute hepatitis

What is the function of the gallbladder? produce enzymes produce bile store bile store fats

store bile

When gallstones are identified on sonography, the sonographer should also image the: kidney stomach pancreas great vessels

pancreas

Where are the spiral valves of Heister located? body of the gallbladder neck of the gallbladder cystic duct common bile duct

cystic duct

Which of the following best describes a positive sonographic Murphy's sign? pain with transducer pressure over the gallbladder appearance of too many tubes within the liver due to biliary obstruction pain radiating to the right scapula and shortness of breath when lying in a supine position ecchymosis of the flanks due to hemorrhage

pain with transducer pressure over the gallbladder

With a patient in the supine position, mobile intraluminal gallbladder components should normally be located in the: cystic duct neck of the gallbladder fundus of the gallbladder neck of the gallbladder anterior wall of the gallbladder

neck of the gallbladder

Biliary and Gallbladder pathology Flashcards

(67 cards)