gall bladder WB quest Flashcards
(127 cards)
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
acute or chronic inflammation of the BG
cholecystitis
26
duct of the gall bladder which joins with the hepatic duct to form the common bile duct
cystic duct
27
what is the upper limit of normal for measurement of the gall bladder wall
3mm
28
what makes up the portal triad
bile duct
portal vein
hepatic artery
29
what is the normal measurement for an intrahepatic bile duct
less than 2mm
30
what is a fold or kinking of the gall bladder fundus onto the body commonly called
phrygian
31
which anatomic landmark can help locate the gall bladder
main lobar fissure
32
what three labs can be used to evaluate the biliary system?
alkaline phosphate
bilirubin
lactic dehydrogenase
33
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
choledochal cyst
34
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
biliary atresia
35
most common maligancy to matastisize to the gb
melanoma
36
a comet-tail reverberation artifact is seen originating from the anterior gall bladder wall. what gall bladder pathology could be causing this
adenomyomatosis
37
a distal obstruction of the panc head will cause which part of the biliary tree to dilate first
gallbladder
38
what will cause a thin walled gallbladder
hydrops
39
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
courvoisier gallbladder
40
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?
gallbladder carcinoma
41
3 things that increase the risk of developing gallbladder malignancy
gall stones
chronic cholecystitis
porcelain gallbladder
42
what would cause intrahepatic dialation with a normal GB and CBD
klatskin tumor
43
the normal distended GB size
7-10cm
44
the normal distended GB in AP and trans measures
less than 3cm
45
purpose of gallbladder
store and concentrate bile
46
an infundibulum at the neck of the gallbladder where stones may collect is called
hartmens pouch
47
_______ bilirubin is typically elevated in cases of obstructive jaundice as can occur in choledocholithiasis
direct
48
____ bilirubin is typically elevated with liver diease and hemolytic anemia
indirect
49
do polyps move or cause acoustic shadowing?
no
50
95% of gallbladder carcinoma have
gallstones
51
what can be used to look for internal vascularity in a suspected gallbladder mass and to distinguish sludge from a malignant mass
color doppler
52
2 most common hyperplastic cholecystoses are
adenomyomatosis
| cholesterosis
53
a distended gallbladder caused by an obstruction of the gallbladder neck or cystic duct
hydropic gallbladder
54
RUQ pain, jaundice, fever, elevated bilirubin or alkaline phosphate are symptoms of
biliary obstruction
55
bile ducts should be measured from
inner wall to inner wall
56
CBD measuring larger than ____ is abnormal
8mm
57
primary maligancies of the bile ducts
cholangiocarcinoma
58
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
cholangitis
59
u/s shows scattered echogenic linear structures within the liver parenchyma that produce a ring-down artifact what could the diagnosis be
pneumobilia
60
for pt over 60 who have had a cholecystectomy a maximum diameter of ____ cm may be considered normal
1
61
the yellow pigmant found in bile that id produces by the breakdown of red blood cells by the liver is
bilirubin
62
common form of symptomatic GB disease, typically with stones
chronic cholecystitis
63
repeated attacks of chronic cholecystitis results in
thickening and fibrosis of GB wall
| may also cause contraction of the GB
64
what symptoms are associated with chronic cholecystitis
intalorance to fatty foods
nausea/vom
moderate RUQ pain/ or radiating pain
may be asymptomatic
65
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
chronic cholecystitis
66
chronic cholecystitis complications
porcelain GB
Bouveret syndrome
mirizzi syndrome
67
*pathlogy that can mimic WES
*calcified gb
associated with high incidence of GB carcinoma
porcelain GB
68
in what syndrome does biliary enteric fistula from between the gb and the duodenum
Bourveret syndrome
69
who is at a higher risk for bouveret syndrome
women over 60 w/ symptoms of bowel obstruction and GB disease
70
stone impacts in neck or cystic duct, obstruction of bile proximal to cystic duct
mirizzi syndrome
71
at what measurement is the GB wall considered thickened
greater than 3mm
72
symptomatic thickening of GB wall
pancreatitis
CHF
patient with hep
end stage liver disease
73
causes of focal GB wall thickening
GB cancers
gangrenous cholecystitis
adenomyomatosis
74
stagnant bile may leak out into the blood stream
ICP
| intrahepatic cholestasis of pregnancy
75
sonographic appearance of ICP
gallstones may be seen
| no ductal dialation
76
benign GB neoplasm
adenoma (polyp)
77
polyps are made out of
adenomatous
| cholesterol
78
sonographic appearance of benign neoplasm
fixed
non shadowing
echogenic mass protruding into the gb lumen
typically less than 2mm
79
polyps greater than 1 cm are suggestive of
malignancy
80
Benign GB neoplasm caused by
chronic inflammation
hyperplasia of GB wall
lipid deposits
81
pus or blood cam mimic what
sludge
82
intrahepatic ducts should measure
2mm or less
83
what crosses anterior to the undivided rt portal vein
CHD
84
seen in cross section between the portal vein posteriorly and the CHD anteriorly
Hepatic artery
85
proper size of the common bile duct
10mm
86
correlate bile duct size to age in decades
presbyductia
87
what lie posterior to the CBD
Cystic duct
88
proper size of cystic duct
less than 2mm
89
allows for improved contrast
harmonics
90
a CHD with a measurement of greater then 8mm suggests
obstruction
91
types of bile duct obstructions
intrinsic
(intrahepatic)
extrinsic
(extrahepatic)
92
obstruction of intrahepatic biliary caused by
primary sclerosing cholangitis
| space occupying mass in liver
93
obstruction at porta hepatis caused by
cholangiocarcinoma
primary sclerosing cholangitis
GB cancer
metastic tumors
94
biliary obstruction extrinsic cause
blunt abrupt end to duct may indicate malignancy
| tapered dilated duct typically benign cause
95
where is an obstruction if the intrahepatic ducts are dilated
ducts between porta hepatis and pancreas will be normal
obstruction at porta hepatis
96
dilated intrahepatic ducts measure at
greater than 2mm
97
sonographic appearence
parallel channel sign (shotgun sign)
irregular jagged walls
stallate confluence
dilated intrahepatic ducts
98
most common pathology of the biliary tract
choledocholithiasis
99
a condition where stones that form in the Gb and move to the CBD
choledocholithiasis
100
```
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
```
choledocholitiasis
101
primary maligancy of bile duct
cholangiocarcinoma
102
cholangiocarcinoma occurs where
throughout biliary tree
in the porta hepatis (klatskin)
ampullary carcinomas at distal CBD
103
grows slowly and may extend along the length of CHD and CBD
cholangiocarcinoma
104
risk factors of cholangiocarcinoma
sclerosing cholangitis
choledocal cyst
parasitic infection
105
symptoms of cholangiocarcinoma
```
abd pain
anorexia
fatigue
weight loss
hepatomegaly
ascites
```
106
sonographic appearance of cholangiocarcinoma
ductal wall irregularity
107
non union or ft and rt hepatic ducts is suggestive of what type of tumor
hilar cholangiocarcinoma
108
chronic inflammatory and fibrosing disorder of bile duct
primary sclerosing cholangitis (psc)
109
assoctiated with ulcerative colitis and crohns disease
PSC
110
can progress to cirrhosis, liver failure and colangiocarcinoma
PSC
| Primary sclerosing cholagitis
111
sonographic appearence
| thickened edematous duct walls that narrow the lumen dialating more proximal ducts
PSC
112
a medical emergency
acute cholangitis
113
sonographic appearance
| mobile bright echoes with dirty shadowing
pneumobilia
114
portal vein air can occur with
necrotic bowel
115
result from surgical trauma, or blunt abd trauma
strictures
116
may penitrate into the CBD creating a
fistula
117
```
sonographic appearance
intrahepatic duct dialation
normal cbd distal to the cystic duct
stone in the neck of the gb or cystic duct
contracted gb
```
mirizzi syndrome
118
collection of bile
biloma
119
adbominal fluid collection, can bee seen along falciform ligament or ligamantun venosum
biloma
120
can occur with lacoration or rupture of biliary tract
biloma
121
```
sonographic appearance
thickening gb wall
striations, gb dilation
pericholecystic fluid collection
sludge, biliary dilatation, duct wall thickening
```
AIDS cholecystopathy
122
occurs in pt with recurrent pyogenic cholangitis
inrahepatic biliary calculi
123
roundworms found in the biliary tree
ascaris lumbricoides
124
sonographic appearance
| worms seen in bile duct or gb
ascaris lumbricoides
125
liver fluke
chonorchis sinensis
126
sonographic appearance
minimal or absent dilaation of intrahepatic ducts
increased echogenicity of the involved duct wall
chonorchis sinensis
127
needle inserted into the biliary tree
percutaneous transhepatic cholangiography
