Biliary System Flashcards by lindsay crouse

hepatization of the GB occurs when the GB:

perforates
becomes hydropic
fills with sludge
undergoes torsion

fills with sludge

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A 71 year old patient presents to the ER with painless jaundice and an enlarged, palpable GB. These findings are highly suspicious for:

acute cholecystitis
chronic cholecystitis
courvoisier GB
porcelain GB

courvoisier GB

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the innermost layer of the GB wall is:

fibromuscular layer
mucosal layer
serosal layer
muscularis layer

mucosal layer

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which of the following would NOT be a lab finding typically analyzed with suspected GB disease?

ALP
ALT
bilirubin
AFP

AFP

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the cystic artery is most often a direct branch of the:

main pancreatic artery
celiac artery
right hepatic artery
left hepatic artery

right hepatic artery

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the middle layer of the GB wall is the:

fibromuscular layer
mucosal layer
serosal layer
muscularis layer

fibromuscular layer

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which structure is a useful landmark for identifying the GB?

MLF
hepatoduodenal ligament
falciform ligament
Lig venosum

MLF

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which would be least likely to cause focal GB wall thickening?

GB polyp
adenomyomatosis
ascites
adhered gallstone

ascites

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what hormone causes the gallbladder to contract?

estrogen
cholecystokinin
bilirubin
biliverdin

cholecystokinin

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the GB wall should measure not more than:

5 mm
6 mm
4 mm
3 mm

3 mm

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which is associated with cholelithiasis and is characteristically found in Africans or people of African descent?

sickle cell disease
GB torsion
cholesterolosis
Arland-Berlin syndrome

sickle cell disease

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the direct blood supply to the GB is the:

cholecystic artery
common hepatic artery
MPV
cystic artery

cystic artery

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the outermost layer of the GB wall is the:

fibromuscular layer
mucosal layer
serosal layer
muscularis layer

serosal layer

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which part of the GB is involved in Hartman pouch?

neck
fundus
body
phrygian cap

neck

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the GB is connected to the biliary tree by the:

CHD
CBD
cystic duct
right hepatic duct

cystic duct

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at which level of the GB is the junctional fold found?

neck
fundus
body
phrygian cap

neck

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empyema of the GB denotes:

GB hydrops
GB filled with pus
GB completely filled with air
GB completely filled with polyps

GB filled with pus

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what is cholelithiasis?

inflammation of the GB
gallstones
hyperplasia of the GB wall
polyps within the biliary tree

gallstones

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The diffuse polyploid appearance of the gallbladder referred to as strawberry gallbladder is seen with:

cholesterolosis
adenomyomatosis
cholangitis
Kawasaki disease

cholesterolosis

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the most common variant of the GB shape is the:

phrygian cap
hartmann pouch
separated GB
junctional fold

phrygian cap

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the diameter of the GB should not exceed:

8 cm
5 cm
7 mm
3 cm

5 cm

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Acute cholecystitis that leads to necrosis and abscess development within the GB wall describes:

emphysematous cholecystitis
gangrenous cholecystitis
chronic cholecystitis
GB perforation

gangrenous cholecystitis

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all of the following are sources of diffuse GB wall thickening EXCEPT:

acute cholecystitis
AIDS
hepatitis
GB polyp

GB polyp

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which statement is NOT true of cholelithiasis?

men have an increased likelihood of developing

patients who have been or are pregnant have increased occurrence

a rapid weight loss may increase the likelihood of development

patients who have hemolytic disorders have an increased occurrence

men DO NOT have an increased likelihood of developing cholelithiasis

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WES sign denotes: the presence of a gallstone lodged in the cystic duct multiple biliary stones and biliary dilatation GB filled with cholelithiasis sonographic sign of porcelain GB

GB filled with cholelithiasis

which is the most likely clinical finding of adenomyomatosis? Murphy sign hepatitis congestive heart failure asymptomatic

asymptomatic

tumefactive sludge can resemble the sonographic appearance of: cholelithiasis GB carcinoma cholecystitis adenomyomatosis

GB carcinoma

the champagne sign is associated with: adenomyomatosis cholangiocarcinoma emphysematous cholecystitis acalculous cholecystitis

emphysematous cholecystitis

A 32 year old female patient presents with vague abdominal pain. The sonographic investigation of the GB reveals a focal area of GB wall thickening that produces comet tail artifact. These findings are consistent with: gangrenous cholecystitis GB perforation acalculous cholecystitis adenomyomatosis

adenomyomatosis

the sequela of acute cholecystitis that is complicated by gas within the GB wall is: emphysematous cholecystitis membranous cholecystitis chronic cholecystitis GB perforation

emphysematous cholecystitis

which would be the least likely finding of acalculous cholecystitis? GB wall thickening pericholecystic fluid choleithiasis positive Murphy sign

cholelithiasis

intermittent obstruction of the cystic duct by a gallstone results in: emphysematous cholecystitis gangrenous cholecystitis chronic cholecystitis acute cholecystitis

chronic cholecystitis

which is NOT a risk factor for the development of gallstones? phrygian cap pregnancy total patenter nutrition oral contraceptive use

phrygian cap

a non mobile, nonshadowing focus is seen within the GB lumen. this most likely represents a: gallstone GB carcinoma GB polyp sludge ball

GB polyp

focal tenderness over the GB with probe pressure describes: Murphy sign strawberry sign Courvoisier sign hydrops sign

Murphy sign

diabetic patients suffering from acute cholecystitis have an increased risk for developing: emphysematous cholecystitis gangrenous cholecystitis chronic cholecystitis GB torsion

emphysematous cholecystitis

cholesterol crystals within the Rotkitansky-Aschoff sinuses are found with: acute cholecystitis acalculous cholecystitis adenomyomatosis GB perforation

adenomyomatosis

the spiral valves of Heister are found within the: GB neck cystic duct GB fundus GB wall

cystic duct

which of the following is courvoisier GB associated? a pancreatic head mass a stone in the cystic duct cholecystitis chronic diverticulitis

a pancreatic head mass

calcification of the GB wall is termed: concrete GB Heister syndrome porcelain GB hyperplasticity cholecysosis

porcelain GB

You are having difficulty locating the gallbladder in a patient with RUQ pain. What anatomic landmark will help you identify the gallbladder fossa? Lig Venosum Lig Teres interlobar hepatic fissure falciform ligament coronary ligaments

interlobar hepatic fissure

in what anatomic variant is the fundus of the gallbladder folded over the body? cholesdochal cyst phrygian cap duplicated collecting system biliary atresia junction fold

phrygian cap

what is the normal diameter of the GB wall? < 3 mm < 0.5 mm < 35 mm > 3 mm > 3 cm

< 3 mm

what is a common cause of artifactual echoes within the GB? reverberation side lobes slice thickness artifact reverberation and side lobes only all of the above

all of the above

You have a patient scheduled for a GB sonogram. What prep is required? none patient should drink 4-6 8oz glasses of water prior to study patient should eat a fatty meal 30 min prior patient should be fasting 8-12 hours prior patient should be fasting at least 24 hours prior

patient should be fasting 8-12 hours prior

what is cholelithiasis? GB carcinoma gallstones GB polyps adenomyosis GB wall thickening

gallstones

which is NOT a cause of gallbladder wall thickening? inflammation hepatic dysfunction congestive heart failure malignant ascites GB wall varices

malignant ascites - usually associated with normal GB wall

the diagnostic accuracy of GB sonography is: >90% 50% 100% 75% cannot be determined

>90%

During GB sonography, you notice echogenic foci within the gallbladder but do not detect distal acoustic shadowing. What changes will improve the detect ability of stone shadowing? increase transducer frequency & increase transducer focusing decrease transducer frequency & increase gain increase output power & decrease transducer frequency increase dynamic range & increase gain increase transducer focusing & decrease transducer frequency

increase transducer frequency & increase transducer focusing

what does a porcelain GB mean? GB wall is asymmetrically thick GB is enlarged and tender GB wall calcification GB is enlarged and nontender GB contains multiple small polyps

GB wall calcification

which of the following best describes the location of the distal CBD? anterior and superior to the pancreatic tail medial and caudal to the pancreatic neck posterior and slightly lateral to the pancreatic head inferior and medial to the pancreatic neck posterior and medial to the pancreatic head

posterior and slightly lateral to the pancreatic head

What is the appearance of the GB in the postprandial state? dilation of thin walled GB contraction with diffuse wall thickening nonvisible due to complete contraction minimal contraction with sludge filled lumen

contraction with diffuse wall thickening

which lab test would best indicate the presence of bile duct obstruction? serum creatine serum amylase serum lipase serum direct bilirubin AFP

serum direct bilirubin

what is the most common cause of acute cholecystitis? hepatitis gallstone lodge in the GB fundus pancreatitis HCC calculus obstruction of GB neck or cystic duct

calculus obstruction of GB neck or cystic duct

tenderness over the GB with probe pressure is termed: murphy's sign morison's pouch douglas' sign tenderness of trietz courvoisier's GB

murphy's sign

You are performing an abdominal ultrasound study and detect a dilated, nontender GB. What should you look for? right kidney hydronephrosis mass in the head of pancreas mass in the posterior RLL AAA PV thrombosis

mass in the head of pancreas

which is a symptom associated with acute cholecystitis? nausea vomiting epigastric pain RUQ pain all of the above

all of the above

complications of acute cholecystitis that you should look for include all of the following EXCEPT: pancreatitis pancreatic carcinoma GB perforation gangrenous cholecystitis emphysematous cholecystitis

pancreatic carcinoma

You have been asked to rule out the presence of choledocholithiasis. What are you looking for? inflammation with thick GB wall stones in the CBD calcified GB wall contracted GB filled with stones GB carcinoma

stones within the CBD

identification of what anatomic structure would most help a sonographer locate a contracted GB? Lig Teres MLF RHV Lig venosum coronary ligament

MLF

The transverse diameter measurement of the GB in a fasting patient measure 5.3 cm. This measurement is: within normal limits consistent with hydropic GB consistent with abnormal contract GB diagnostic of chronic cholecystitis diagnostic of phrygian cap deformity

consistent with hydropic GB

You are scanning a patient in the ICU and notice low level echoes within the GB consistent with sludge. The GB wall is not thickened. Which statement below is true? patient most likely has acute acalculous cholecystitis these findings represent GB perforation the patient has sludge most likely due to bile stasis the patient has porcelain GB the patient has pancreatic abnormality

the patient has sludge most likely due to bile stasis

comet tail or V shaped reverberation artifact originating from the anterior wall of the GB most likely results from: adenomyomatosis GB carcinoma side lobes porcelain GB floating cholesterol stones

adenomyomatosis

A small echogenic focus is seen in the posterior aspect of the GB fundus. How can you determine if this represents a polyp or a stone? shadowing is not present with polyps but is present with stones unlike a stone, a polyp should move with varying patient positions a stone will produce ring down artifact and a polyp will produce a shadow a polyp is always located in a dependent position stones are always larger than polyps

shadowing is not present with polyps but is present with stones

what is the sonographic appearance of tumefactive sludge within the GB? an echogenic mass with prominent color doppler signals a mass with low level echoes with prominent color doppler signals a mass containing ringdown artifacts and no color doppler signals an avascular mass with low level echoes an adherent echogenic mass with weak color doppler signals

an avascular mass with low level echoes

You are scanning a 34 year old multiparous woman with symptoms of severe RUQ pain, nausea, and vomiting. The GB is thick walled with stones and adjacent complex fluid collection is seen. These findings most likely represent: adenomyomatosis complicated by stones GB carcinoma acute cholecystitis complicated by GB perforation acalculous cholecystitis emphysematous cholecystitis

acute cholecystitis complicated by GB perforation

You are scanning a 44 year old man with diabetes. He complains of severe epigastric pain radiating to the back, vomiting, chills, and fever. Ultrasound findings include a large GB with dependent hyperechoic foci associated with ringdown artifacts. These findings are most consistent with: adenomyomatosis complicated by stones GB carcinoma acute cholecystitis complicated by GB perforation acalculous cholecystitis emphysematous cholecystitis

emphysematous cholecystitis

hypervascularity associated with acute cholecystitis is best evaluated with doppler interrogation of what artery? common hepatic artery gastroduodenal artery pacreaticoduodenal artery cystic artery proper hepatic artery

cystic artery

which is NOT a sign of acalculous cholecystitis? GB wall thickening murphy's sign cholelithiasis pericholecystic fluid GB wall edema

cholelithiasis

You are scanning a GB and notice posterior acoustic shadowing and are unsure if the shadowing is due to bowel gas or gallstones. Which would be helpful in making this distinction? roll the patient into the LLD position have patient perform valsalva use lower frequency transducer increase the system overall gain increase the system dynamic range

roll the patient into the LLD position

You are imaging the GB in a transverse orientation and noticed a long shadow at both edges. What is the etiology of this shadow? normal shadowing from cystic duct small stones within the GB refraction artifact volume averaging artifact slick thickness artifact

refraction artifact refraction of the beam occurs at the edges of the GB because of the curved interface and difference between the agoutis velocities of the GB and surrounding tissue

An ultrasound image obtained from the GB shows an irregular mass within the lumen which demonstrates hypervascularity by color doppler imaging. Multiple stones are also seen within the GB lumen. These findings are most consistent with: GB carcinoma adenomyomatosis tumefactive sludge emphysematous cholecystitis GB perforation

GB carcinoma

Rokitansky-Aschoff sinuses are associated with: GB carcinoma adenomyomatosis tumefactive sludge emphysematous cholecystitis GB perforation

adenomyomatosis

the best way to identify the intrahepatic biliary system is to image: HVs all fissures and ligaments intrahepatic lymphatics intrahepatic PVs intrahepatic biliary system cannot be detected

intrahepatic PVs

what is pneumobilia? perforation of the bile ducts biliary duct dilation common bile duct stones air in the GB air in the bile ducts

air in the bile ducts

How can you differentiate dilated bile ducts from intrahepatic veins? A. dilated bile ducts demonstrate irregular, torturous walls B. intrahepatic PVs show increased through transmisssion C. bile ducts will not demonstrate flow with color doppler all of the above A and C only

A and C only

what forms the CBD? cystic duct and CHD right and left hepatic ducts CHD, right and left hepatic ducts cystic duct and right hepatic duct duct of Santorini and duct of Wirsung

cystic duct and CHD

During ultrasound evaluation of the GB system, you notice thickening of the bile duct walls. This finding may be related to: sclerosing cholangitis pancreatitis choledocholithiasis cholangiocarcinoma all of the above

all of the above

what are the arrows pointing to? junctional folds polyps adenomyomatosis Rotitansky-Aschoff sinuses tumefactive sludge

junctional folds

You have been asked to perform an ultrasound to evaluate for biliary obstruction in a patient with a history of weight loss and mid-epigastric pain. You find both intrahepatic and extrahepatic biliary dilation. The GB is hydropic. Which of the following conditions causing ductal dilation should you look for? A. choledocholithiasis B. pancreatic carcinoma C. chronic pancreatitis with stricture formation A and B only all of the above

all of the above

cystic dilation of the CBD is known as: Klatskin cyst choledochal cyst Mirizzi cyst cyst if Oddi peribiliary cyst

choledochal cyst

A 51 year old male is referred for abdominal ultrasound with abnormal LFTs and jaundice. Which lab work would aid in differentiation of an intrahepatic vs extrahepatic cause of jaundice? AFP ALP AST serum bilirubin serum creatine

serum bilirubin

You are scanning at the area of the porta hepatis in a patient with alcoholic liver cirrhosis. Two large tubular structures are identified. How can you identify which structure is the duct and which is the hepatic artery? HA is always located between the PV and bile duct bile duct can be compressed with probe pressure bile duct will dilate with valsalva doppler signals can be elicited from the artery but not the bile duct all of the above

doppler signals can be elicited from the artery but not the bile duct

A patient presents for abdominal ultrasound with a history of jaundice, weight loss, and nausea. You detect dilation of the CBD at the level of the porta hepatis but are unable to see the distal CBD due to overlying bowel gas. Which would be most helpful in improving visualization of the CBD? place the patient in trendelenberg position have the patient cough several times roll the patient into the right posterior oblique position roll the patient into a prone position roll the patient into a LLD position

roll the patient into the right posterior oblique position

the most common anatomic variant of the GB is: agenesis GB folds phrygian cap duplication

GB folds

what is the most accurate test for acute cholecystitis? ultrasound cholescintigraphy endoscopic retrograde cholangiography oral cholecystogram angiography

cholescintigraphy

You are scanning a patient with a porcelain GB. You must carefully evaluate the GB because these patients are at increased risk for: adenomyomatosis cholesterolosis choledocholithiasis GB carcinoma GB perforation

GB carcinoma

A patient is referred for GB ultrasound with a history of RUQ pain and nausea, you suspect the presence of a stone in the region of the GB neck but are not sure. Which would be helpful in confirming the presence of a stone? roll the patient into LLD position have patient perform valsalva place patient in trendelenberg position increase the dynamic range increase overall gain

roll the patient into LLD position

You have been asked to administer cholecystokinin to a patient. Which do you expect to occur if the study is normal? GB will contract CBD will dilate intrahepatic biliary system will dilate pancreatic duct will dilate HVs will dilate

GB will contract

You are attempting to locate the CHD at the porta hepatis. What is the most common anatomic relationship of the portal triad at this location? CBD is posterior to the HA and anterior to the PV CBD is anterior to the HA and posterior to the PV CBD is anterior to the HA and PV CBD is posterior to the HA and PV CBD bears no relationship to the HA and PV

CBD is anterior to the HA and PV

A patient is referred for ultrasound with jaundice, pain, nausea and vomiting and a history of cholecystectomy. Which is most likely? acute cholecystitis chronic cholecystitis adenomyomatosis emphysematous cholecystitis choledocholithiasis

choledocholithiasis

You have detected a stone impacted in the distal CBD in a patient with jaundice and abdominal pain. You will tailor your exam to evaluate what complication of this condition? AAA pancreatitis PV aneurysm PHTN choledochal cyst

pancreatitis

You are requested to perform an ultrasound evaluation of the GB and biliary tree on an elderly female with a small frame. Which transducer is most suited to this task? 2.5MHz phased array 5.0MHz curved linear array 3.5MHz linear array 10MHz curved linear array 13MHz linear array

5.0MHz curved linear array

You notice a patient has a yellow discoloration of the eyes and skin. This condition is called: hypoalbuminemia biliary stasis erythema priority's jaundice

jaundice

You are asked to perform an ultrasound study on a patient with suspected cholangiocarcinoma. What associated findings should you look for? dilation of the biliary tree cholesterolosis PHTN HA pseudoaneurysm adenomyomatosis

dilation of the biliary tree

what is the etiology of the low level echoes seen in the near field of this GB? biliary sludge tumefactive sludge floating cholesterol stones reverberation artifact gas due to emphysematous cholecystitis

reverberation artifact

what is the etiology of the layered echoes seen in the posterior aspect of this GB? biliary sludge tumefactive sludge floating cholesterol stones reverberation artifact gas due to emphysematous cholecystitis

biliary sludge

You are scanning a patient with sickle cell anemia and note the presence of gallstones and GB wall thickening. What else should you do to determine if acute cholecystitis is present? A. press with the probe over the GB to determine if it is painful B. look carefully to see if a gallstone is lodged in the GB neck C. check for the presence of pericholecystic fluid A and B only all of the above

all of the above

You are scanning a patient with symptoms of cholelithiasis. Although you clearly identify a GB, you detect a bright band of echoes with post shadowing in the RUQ. How can you determine if this represents a contracted GB filled with stones? A. connection of the shadowing echoes to the interlobar fissure confirms identification of the GB B. wall-echo-shadow (WES) sign confirms identification of the GB C. "dirty" shadowing from bowel gas can be differentiated from "clean" shadowing from stones by the presence of ringdown artifact in the bow shadow. A and C only All of the above

all of the above

a tumor that may be located in an intrahepatic or extrahepatic bile duct is known as: cholangiocarcinoma angiosarcoma angiomyolipoma cholesterolosis adenomyomatosis

cholangiocarcinoma

Ultrasound images you obtained on an 81 year old man with acute RUQ pain shows gallstones and bright echoes in the GB wall with ringdown artifacts. Which is most likely? emphysematous cholecystitis GB carcinoma cholangiocarcinoma acalculous cholecystitis uncomplicated cholelithiasis

emphysematous cholecystitis