Chapter 4 The Bile Duct

Question 1

The yellowish pigment found in bile that is produced by the breakdown of old RBC by the liver is

Answer 1

Bilirubin

Question 2

Which segment of the biliary tree tends to dilate first with obstruction

Answer 2

Extrahepatic

Question 3

Clinical findings of choledocholithiasis (3):

Answer 3

1. Jaundice
2. Elevated ALP, ALT, GGT and bilirubin with obstruction
3. RUQ pain

Question 4

The biliary duct wall should never measure more than

Answer 4

2mm

Question 5

A klatskin tumor is a form of:

Answer 5

Cholangiocarcinoma

Question 6

Clinical findings of Cholangiocarcinoma (6):

Answer 6

1. Jaundice
2. Pruritus
3. Weight loss
4. Pain
5. Elevated bilirubin
6. Elevated ALP

Question 7

The most common level for biliary obstruction to occur is

Answer 7

Distal CBD

Question 8

The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:

Answer 8

Sphincter of oddi

Question 9

______ could accidentally introduce bacteria into the biliary tree and thus cause cholangitis

Answer 9

Endoscopic retrograde

Question 10

_____ would be the most distal portion of the biliary tree

Answer 10

CBD

Question 11

Pneumobilia will produce ______ artifact

Answer 11

Ring-down

Question 12

______is considered the most proximal portion of the biliary tree

Answer 12

Inteahepatic radicles

Question 13

If a gallstone, causing obstruction is located within the distal common hepatic duct, which of the ducts will dilate

Answer 13

Intrahepatic ducts

Question 14

The spiral valves of Heister are located within the

Answer 14

Cystic duct

Question 15

The presence of an echogenic dot in the nondependent part of the dilate duct representing small fibrovascular bundles is seen with

Answer 15

Caroli disease

Question 16

Air within the biliary tree is referred to as

Answer 16

Pneumobilia

Question 17

Inflammation of the bile ducts is referred to as

Answer 17

Cholangitis

Question 18

The klatskin tumor is located

Answer 18

At the junction of the right and left hepatic ducts

Question 19

_____is associated with the sonographic triangular cord sign

Answer 19

Biliary atresia

Question 20

A gallstone located within the biliary tree is referred to as

Answer 20

Choledocholithiasis

Question 21

The merging point of the pancreatic duct and CBD at the level of duodenum is referred to as the

Answer 21

Ampulla of vater

Question 22

_______is associated with Charcot triad

Answer 22

Cholangitis

Question 23

Primary biliary tree cancer is referred to as

Answer 23

Cholangiocarcinoma

Question 24

Ascariasis is caused by:

Answer 24

A parasitic roundworm

Question 25

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

Answer 25

Biliary atresia

Question 26

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

Answer 26

Jaundice

Question 27

The common bile duct, the cystic duct, and part of the common hepatic duct are considered:

Answer 27

Extrahepatic in location

Question 28

The most common level for an obstruction to occur is the:

Answer 28

Distal common bile duct

Question 29

______is coexisting dilation off the common bile duct and pancreatic duct

Answer 29

Double duct sign

Question 30

______ describes the enlargements of the common duct to the size of the adjacent portal vein within the portal hepatis

Answer 30

Shotgun sign or parallel tube sign

Question 31

The intrahepatic ducts are considered dilated if they exceed

Answer 31

2mm

Question 32

Biliary dilation will occur proximal to the

Answer 32

Level of obstruction

Question 33

What is the common cause of obstructive jaundice

Answer 33

Gallstones in the common bile duct

Question 34

Stones typically form in the gallbladder and pass into the

Answer 34

Biliary tree

Question 35

______describes the presence of **gallstones** within the **bile ducts**

Answer 35

Choledocholithiasis

Question 36

Clinical findings of choledocholithiasis (3):

Answer 36

1. jaundice 2. elevated ALP,ALT, GGT, and bilirubin 3. pain

Question 37

Inflammation of the biliary ducts is termed

Answer 37

Cholangitis

Question 38

Types of cholangitis

Answer 38

•acute bacteria •AIDS •recurrent pyogenic cholangitis •sclerosing

Question 39

_____is an infection of the small intestine that is caused by ascaris lumbricoides, a parasitic roundworm

Answer 39

Ascariasis

Question 40

Important points of oriental cholangitis (2):

Answer 40

1. Endemic to Asia 2. Seen in America because of immigration

Question 41

Biliary atresia is described as the

Answer 41

Narrowing or obliteration of all or a portion of the biliary tree

Question 42

Primary biliary tree cancer is referred to as

Answer 42

Cholangiocarcinoma

Question 43

_______are the most common manifestation of Cholangiocarcinoma

Answer 43

Klatskin tumor

Question 44

Klatskin tumor are located at the

Answer 44

_Junction_ of the **right and left hepatic ducts**

Question 45

The function of the biliary tree is to provide a

Answer 45

Conduit for bile to drain from the liver into the small intestine

Question 46

Bile, a viral digestive fluid is produced by the

Answer 46

Liver

Question 47

A common bile duct diameter that exceeds ______ is typically considered abnormal

Answer 47

6mm

Question 48

The gallbladder is attached to the biliary tree by the

Answer 48

Cystic duct

Question 49

Bile forest accumulates in the

Answer 49

Small intrahepatic biliary radicles in the Liver

Question 50

_____ **prevents** the **cystic duct** from **collapsing or distending**

Answer 50

Spiral valves of heister

Question 51

_______ is the opening that allows bile and pancreatic juices to flow into the duodenum

Answer 51

Sphincter of oddi (hepatopancreatic sphincter)

Question 52

______is the presence of echogenic dots in the nondependent part of the dilated duct representing small fibrovascular bundles

Answer 52

Central dot sign

Question 53

______is a congenital disorder characterized by **segmental dilation of the intrahepatic ducts**

Answer 53

Caroli disease

Question 54

When are choledochal cyst usually discovered

Answer 54

Infancy or in the first decade of life

Question 55

Choledochal cysts Can lead to (3):

Answer 55

1. Portal hypertension 2. Pancreatitis 3. Liver failure

Question 56

Clinical findings of biliary atresia (2):

Answer 56

1. neonatal jaundice 2. elevated AST, ALT, and bilirubin

Question 57

Sonographic findings of a choledochal cyst

Answer 57

1. Cystic mas the area of the porta hepatis (separate from the gallbladder) 2. Biliary dilation

Question 58

_______is an avascular, echogenic, **triangular** or tubular structure anterior to the portal vein, representing the replacement of the extrahepatic duct with fibrous tissue in the porta hepatis

Answer 58

Triangular cord sign

Question 59

_____is a congenital disease that is thought to be caused by a viral infection at birth

Answer 59

Biliary atresia

Question 60

Clinical findings of ascariasis

Answer 60

1. asymptomatic 2. Symptoms of inflammation of the biliary tree, gallbladder or pancreas

Question 61

Clinical findings of cholangitis

Answer 61

•Charcot triad: fever, RUQ pain, jaundice •leukocytosis •elevated ALP, ALT, GGT, and bilirubin

Question 62

Sonographic findings of cholangitis

Answer 62

•biliary dilation •biliary sludge or pus •choledocholithiasis •bile duct wall thickening

Question 63

Sonographic findings of pneumobilia

Answer 63

1. Echogenic linear structures within the ducts that produce ring down artifacts and dirty shadowing

Question 64

Sonographic findings of choledocholithiasis

Answer 64

1. Echogenic foci within the bile duct that may or may not shadow 2. May have biliary dilation

Question 65

Sonographic findings of caroli disease

Answer 65

•segment dilation of the intrahepatic ducts •May also have cystic renal disease •central dot sign

Question 66

Clinical findings of caroli disease (4):

Answer 66

1. Pain 2. Fever 3. Jaundice 4. Signs of portal hypertension

Question 67

Clinical findings of a choledochal cyst

Answer 67

•jaundice •pain •fever •abdominal mass

Question 68

Clinical findings of pneumobilia (2):

Answer 68

1. Recent biliary or gastric surgery, emphysematosis or acute cholecystitis, or fistula formation 2. Symptoms of acute cholecystitis

Question 69

Important points of acute bacterial cholangitis

Answer 69

•caused by bacterial accumulation secondary to obstruction • introduced during ERCP for choledocholithiasis • pus

Question 70

Important points of AIDS cholangitis

Answer 70

1. Associated with advanced HIV and AIDS 2. Results from inflection with cryptosporidium or cystomegalovirus

Question 71

Important points of sclerosing cholangitis (4):

Answer 71

1. Fibrotic thickening of the bile ducts 2. Most often affects young men 3. Associated with inflammatory bowel disease or ulcerative colitis 4. Increase risk of cholangiocarcinoma

Question 72

Sonographic findings of ascariasis (2):

Answer 72

1. Worm within the biliary ducts as an echogenic linear structure 2. Movement of the worm

Question 73

Sonographic findings of cholangiocarcinoma (2):

Answer 73

1. Dilated intrahepatic ducts that abruptly terminate at the level of the tumor 2. A solid mass May be noted within the liver or ducts

Question 74

Sonographic findings of biliary atresia (3):

Answer 74

1. Absent biliary ducts 2. Triangular cord sign 3. Sonographic signs of cirrhosis and portal hypertension

Question 75

Clinical findings of cholangiocarcinoma

Answer 75

1. jaundice 2. weight loss 3. pain 4. elevated bilirubin 5. elevated ALP