Chapter 10- Gallbladder, Biliary Tree

Question 1

Are Choledochal Cysts congenital or acquired? How common are they?

Answer 1

Congenital. They are rare.

Question 2

Who is at risk for Choledochal Cysts?

Answer 2

It is 4x as common in women and is also noted in infants.

Question 3

What is Type 1 Choledochal Cysts?

Answer 3

It is most common along with type 4a. A fusiform dilaton of CBD

Question 4

What is a Type 2 Choledochal Cyst?

Answer 4

A true diverticuli of the bile ducts

Question 5

What is a Type 3 Choledochal Cyst?

Answer 5

Are located in the intraduodenal portion of the CBD

Question 6

What is a Type 4a Choledochal Cyst?

Answer 6

They are intrahepatic and extrahepatic biliary dilations

Question 7

What is a Type 4b Choledochal Cyst?

Answer 7

Type 4b is confined to the extrahepatic biliary tree

Question 8

What is a Type 5 Choledochal Cyst?

Answer 8

It is multiple intrahepatic cysts also called Caroli disease.

Question 9

What is a common cause of sludge?

Answer 9

bile stasis

Question 10

when a gallbladder measures greater than 5 cm, what is this called?

Answer 10

hydropic

Question 11

what is cholecystitis?

Answer 11

inflammation of the gallbladder.

Question 12

what is the most common cause of acute cholecystitis? who is at risk?

Answer 12

the most common cause of acute cholecystitis is gallstones (90% of cases). women are 3x more likely than men. 40-50 years old.

Question 13

What is Emphysematous cholecystitis? Is it common?

Answer 13

The presence of gas-forming bacteria in the gallbladder wall, lumen, and/or biliary ducts. It is a rare complication of acute cholecystitis.

Question 14

Who is at risk for emphysematous cholecystitis?

Answer 14

More commonly men with diabetes

Question 15

How does emphysematous cholecystitis appear sonographically?

Answer 15

Gas in the gallbladder partially or completely obscures the lumen. Gallstones may or may not be present.

Question 16

What is gangrenous cholecystitis caused by and what is it a complication of?

Answer 16

A painful complication of acute
cholecystitis that may lead to perforation of the GB wall. It occurs after infection which causes necrosis.

Question 17

How does gangrenous cholecystitis appear sonographically

Answer 17

Gallstones appear in 80-95% of patients. Packed bag or WES sign.

Question 18

The acute inflammation of the gallbladder in the absence of cholelithiasis is called?

Answer 18

Acalculous Cholecystitis

Question 19

What is the most likely cause of Acalculous Cholecystitis

Answer 19

decreased bloodflow through the cystic artery, compression of the cystic duct, or lymphadenopathy.

Question 20

Is gallbladder torsion common? Who is most commonly affected?

Answer 20

It is rare and found most commonly in older women

Question 21

What is the most common form of gallbladder inflammation?

Answer 21

Chronic Cholecystitis

Question 22

What does the Wall Echo Sign (WES) look like? What does it indicate?

Answer 22

It shows that the gallbladder is a “packed bag” of gas. A sharp posterior shadow is noted

Question 23

What is the most common disease of the gallbladder?

Answer 23

Cholelithiasis. It might be one large gallstone or multiple tiny stones.

Question 24

What are the five categories of Cholelithiasis patietns?

Answer 24

Fat, Female, Forty+, Fertile years, Fair skin

Question 25

With what symptoms does Cholelithiasis typically present?

Answer 25

RUQ pain with radiation to the shoulder after a high-fat meal

Question 26

What is porcelain gallbladder? Is it common?

Answer 26

It is a rare occurance defined as calcium incrustation of the gallbladder wall. It is usually associated with gallstones

Question 27

Who does porcelain gallbladder typically affect? 20% of these patients typically develop what disease?

Answer 27

older females. 25% develop cancer of the gallbladder wall.

Question 28

How does a porcelain gallbladder appear sonographically? What else appears similar?

Answer 28

Bright echogenic echo with posterior shadow. The WES sign is similar.

Question 29

What is a gallbladder adenoma?

Answer 29

A benign epithelial tumor- also called a polyp

Question 30

Hyperplastic Cholecystitis is represented by 3 degenerative changes of the gallbladder. What are they?

Answer 30

Hyperconcentration, Hyperexcitability, Hyperexcretion

Question 31

What are the two types of hyperplastic cholecystitis

Answer 31

Cholesterolosis, Adenomyomatosis

Question 32

What is Chloesterolosis?

Answer 32

"strawberry gallbladder" is a condition in which cholesterol is deposited within the lamina propria of the gallbladder.

Question 33

What is adenomyomatosis

Answer 33

A hyperplastic change in the gallbladder wall. Small cholesterol crystals lodged within the Rokitansky-Aschoff sinuses

Question 34

How does adenomyomatosis appear sonographically?

Answer 34

Multiple papillomas are demonstrated along the anterior wall of the gallbladder, causing a “ring down” of echoes to occur.

Question 35

What is gallbladder carcinoma? Is it common?

Answer 35

primary gallbladder carcinoma is rare and is nearly always a rapidly progressive disease with a mortality rate approaching 100%

Question 36

Primary carcinoma of the gallbladder is twice as common as cancer of the bile ducts. Who is at risk?

Answer 36

women over 60

Question 37

What is the most common indirect extension of matastais to the gallbladder

Answer 37

melanoma

Question 38

what is Caroli's disease? What disease is it associated with

Answer 38

A rare congenital abnormality found in young adults/kids. It is strongly associated with renal disease and hepatic fibrosis

Question 39

How might Caroli's disease appear sonographically?

Answer 39

"string of pearls" appearance of intrahepatic bile ducts

Question 40

At what diameter is the common hepatic duct considered dilated?

Answer 40

5-6 mm

Question 41

At what diameter is the common bile duct considered dilated?

Answer 41

6/7 mm is borderline and greater than 10mm.

Question 42

What are two reasons for someone having a larger than average (not enlarged) bile duct?

Answer 42

With age and cholecystectomy

Question 43

what is the most common cause of a biliary obstruction?

Answer 43

The presence of a tumor or thrombus in the ductal system

Question 44

What does "too many tubes" or the "double barrel shotgun" sign demonstrate?

Answer 44

A dilated CBD appearing similar in size to the portal vein throughout the liver.

Question 45

What are the three primary areas for biliary obstruction?

Answer 45

intrapancreatic, suprapancreatic, porta hepatic

Question 46

What causes Courvoisier's Gallbladder?

Answer 46

A mass in the head of the pancreas compresses the common bile duct and enlarges the gallbladder.

Question 47

what are the most common causes of suprapancreatic obstuction between the pancreas and porta hepatis?

Answer 47

Malignancy and adenopathy

Question 48

What is the most common cause of porta hepatic obstruction?

Answer 48

Neoplasms

Question 49

What is primary choledocholithiasis

Answer 49

The formation of calcium stones in the bile duct

Question 50

What is secondary choledocholithiasis

Answer 50

Stones in the gallbladder migrate to the common bile duct.

Question 51

What is Mirizzi syndrome? Is it congenital or acquired?

Answer 51

A large stone in the cystic duct causes compression of the common hepatic duct. It is due to a congenital malformation of the cystic duct.

Question 52

What is the cause of hemobilia?

Answer 52

Blood in the bile duct due to trauma

Question 53

what is pneumobilia and how does it appear sonographically?

Answer 53

air within the biliary tree appears as ring down that follows the portal triads

Question 54

What is cholangitis? What are symptoms?

Answer 54

Inflammation of the bile ducts. patients might have fever, jaundice, leukocytosis, and increase of AlkPhos and bilirubin

Question 55

What is ascariasis?

Answer 55

A parasitic worm which uses a fecal-oral route of transmission through the ampulla of vater.

Question 56

Intrahepatic Biliary Neoplasms are rare. What is the most common type and who is most commonly at risk?

Answer 56

They are usually limited to cystadenoma and cystadenocarcinoma Middle-aged women are most frequent.

Question 57

What is the second most common primary malignancy in the liver? Is it common?

Answer 57

Intrahepatic cholangiocarcinoma. it is rare, but numbers are rising with numbers of cirrhosis and hepatitis C.

Question 58

What is Hilar Cholangiocarcinoma (Klatskin's) and does it have a good prognosis?

Answer 58

A specific type of cancer that occurs most commonly at the bifurcation of the common hepatic ducts. Most patients die within 1 year of diagnosis.

Question 59

What are the most common metastatic sites that spread to the biliary system?

Answer 59

Breast, colon, and melanoma