Gallbladder Flashcards
1
Q
The right and left hepatic ducts join to form the
A
Common hepatic duct
2
Q
Where is the gallbladder located
A
at the inferior end of the main lobar fissure
3
Q
The neck tapers to form the _____ which joins with the _______ to form the _____
A
cystic duct, common hepatic duct, common bile duct
4
Q
The common bile duct and the main pancreatic duct (Duct of Wirsung) join to form the
A
Ampulla of Vater
5
Q
At the porta hepatis, the portal triad consists of what 3 things
A
1) main portal vein
2) common hepatic duct
3) proper hepatic duct
( refered to as the mickey mouse sign)
6
Q
What is a spiral fold which controls bile flow in the cystic duct
A
Valve of Heisters
7
Q
What is an abnormal sacculation (diverticulum) of the neck of the gallbladder
A
Hartmann’s pouch
8
Q
What is a fold in the fundus of the gallbladder
A
Phrygian cap
9
Q
A ______ is a fold between the body and infundibulum of the gallbladder
A
Junctional fold
10
Q
The ampulla of Vater empties through the duodenal papilla, controlled by the
A
Sphincter of Oddi
11
Q
What is the most common cause of gallbladder wall thickening?
A
cholecystitis
12
Q
Name 5 other causes of gallbladder wall thickening
A
1) hypoalbuminemia
2) ascites
3) hepatitis
4) congestive hear failure
5) pancreatitis
13
Q
What type of jaundice is due to hepatic disease such as viral hepatitis
A
Hepatic jaundice
14
Q
What type of jaundice is due to destructive red blood cell disease such as sickle cell anemia
A
Hemolytic jaundice
15
Q
What type of jaundice is due to obstructive pathology of the biliary tree such as choledocholihiasis
A
Surgical jaundice
16
Q
Sludge in the GB is associated with biliary stasis secondary to
A
1) prolonged fasting
2) hyperalimentation
3) hemolysis
4) cystic duct obstruction
5) cholecysitis
17
Q
What appears as nonshadowing, echogenic material which layers and shifts with patient postioning?
A
Sludge
18
Q
What is the organization of sludge called
A
Tumefactive sludge or sludge balls
19
Q
Name the 3 sonographic criteria of cholelithiasis
A
1) mobile
2) strongly echogenic
3) acoustic shadowing
20
Q
Name 3 things gallstones are composed of
A
1) cholesterol
2) calcium bilirubinate
3) calcium carbonate
21
Q
Name 5 things cystic duct obstruction may result in
A
1) acute cholecystitis
2) empyema
3) gallbladder perforation
4) pericholecystic abscess
5) bile peritonitis
22
Q
A gallbladder filled with stones may be seen as a strong shadow in the RUQ this is called the
A
Double arc or WES sign (Wall-echo- shadow)
23
Q
Acute cholecystitis is associated with
A
1) RUQ pain
2) fever
3) leukocytosis
24
Q
Features of acute cholecystitis include
A
1) gallstones
2) murphys sign
3) diffuse wall thickening
4) gallbladder dilatation
5) sludge
25
Complications of acute cholecystitis include
1) empyema
2) gangrenous cholecystitis
3) gallbladder perforation
4) pericholecystic abscess
26
Elevation of what suggests obstruction at the level of the ampulla of Vater
amylase
27
What type of artifact is seen due to the presence of gas within the wall/lumen of the gallbladder due to gas forming bacteria
comet tail (reverberation ) artifact
28
Emphysematous Cholecystitis occurs more commonly in
Diabetic men
29
What is tissue loss due to decreased blood supply
Gangrenous
30
Signs suggestive of gangrenous cholecystitis include
1) asymmetric wall thickening
2) wall striations
3) intraluminal membranes
4) pericholecystic fluid
31
Purulent material within the gallbladder due to bacteria-containing bile associated with acute cholecystitis is called
Empyema of the gallbladder
32
What is a complication of acute cholecystitis and a localized fluid collection in the gallblader fossa called
Gallbladder perforation
33
Complications of gallbladder perforation include
1) peritonitis
2) pericholecystic abscess
3) biliary fistula
34
Acalculous Cholecystitis is associated with exsisting conditions such as
1) prolonged total parenteral (intravenous) nutrition
2) abdominal surgery
3) trauma
4) severe burns
5) sepsis
6) AIDS
35
What is a sludge like material with a high concentration of calcium associated with chronic cholecystitis and gallbladder obstruction of the cystic duct that may be seen as a fluid filled layer that results in distal acoustic shadowing
Milk of calcium bile (Limy bile)
36
what is calcification of the gallbladder wall that is associated with chronic cholecystitis
Porcelain gallbladder
37
What is another name for hydrops of the gallbladder
Mucocele
38
Cholesterolosis is a condition referred to as
Strawberry gallbladder
39
gallbladder carcinoma presents as an
1) intraluminal mass
2) asymmetric wall thickening
3) a mass that fills the gallbladder lumen
40
Associated findings of gallbladder carcinoma include
1) liver metastases
2) lymphadenopathy
3) bile duct dilatation
4) cholelithaisis
41
The gallbladder typically has a bile capacity of
30 to 60 mL
42
What is the function of the gallbladder
Concentrate and store bile until needed and regulate biliary pressure
43
When food enters the small intestine, what is secreted by the proximal small intestine causing the gallbladder to contract the sphincter of Oddi to relax
Cholecystokinin (CCK)
44
What is the most common type of obstructive biliary disease in infants and young children
Biliary atresia
45
What is the most common type of choledochal cyst
Fusiform dilatation of the CBD
46
A patient presents with ampulla of Vater obstruction, distention of the GB, and painless jaundice. Which of the following is the presentation associated with?
a) hydropic gallbladder
b) choledochal cyst
c) courvoisiers sign
d) mirizzi syndrome
e) caroli's disease
c) courvoisiers sign
47
Which of the following will long-standing cystic duct obstruction give rise to?
a) porcelain gb
b) hydropic gb
c) sepated gb
d) gb septations
e) gb contraction
b) hydropic gb
48
a patient presents with a dilated interhepatic duct, dilated gb, and a dilated cbd. This is most characteristic of which one of the following levels of obstruction?
a) proximal CBD
b) distal CBD
c) distal CHD
d) cystic duct
e) neck of the gb
b) distal CBD
49
Which of he following describers adenomyomatosis of the gallbladder?
a) a congenital anomaly that presents itself in the 4th or 5th decade of life
b) an inflammation of the GB and biliary ducts
c) associated with chronic pancreatitis
d) proliferation of the mucosal layer, which extends into the muscle layer
e) a malignant process that invovles the GB wall and lumen
d) proliferation of the mucosal layer, which extends into the muscle layer
50
A GB sonographic examination is performed and a small GB with intrahepatic dilatation is seen. This may indicate that the level of obstruction is at the level of which of the following?
a) neck of the GB
b) CBD
c) cystic duct
d) CHD
e) none of the above
d) CHD
51
A patient presents with empyema of the GB. what should the sonographer expect to find?
a) pus within the GB
b) CBD obstruction
c) stones within the GB
d) abscess surrounding the GB
e) duplication of the GB
a) pus within the GB
52
What is the cause of small gallbladder?
a) prolonged fasting
b) insulin-dependent diabetes
c) chronic cholecystitis
d) hydrops
e) ascites
c) chronic cholecystitis
53
Which of the following most likely appears as nonshadowing, nonmobile, echogenic foci imaged within the GB lumen?
a) polyps
b) calculi
c) biliary gravel
d) sludge balls
e) thin bile
b) calculi
54
What is hydrops of the gallbladder?
a) a small contracted GB
b) a GB with a thickened wall
c) a thick walled GB filled with stones
d) congenital duplication of the GB
e) an enlarged GB
e) an enlarged GB
55
A 6 year old child presents with recurrent fever, RUQ pain, and jaundice. An abdominal sonogram is performed. The liver and GB appear normal, but a 2 cm cysts is seen communicating with the CBD. What does this cystic structure most likely represent?
a) a choledochal cyst
b) a pseduocyst
c) an aortic aneurysm
d) a mucocele
e) hydatid cyst
a) a choledochal cyst
56
What type of gallbladder is a large gallbladder caused by an obstruction at the distal portion of the common bile duct
Courvoisier gallbladder
57
What is calcification of the gallbladder wall called?
a) cholesterolosis
b) courvoisiers gallbladder
c) hydropic gallbladder
d) porcelain gallbladder
d) porcelain gallbladder
58
When performing a GB examination, why is the patient asked to be NPO for approx 6 hours before the exam
a) to eliminate any overlying bowel gas
b) to make the patient more cooperative
c) to bring out dehydrationm which will make the patient easier to scan
d) causes bile to collect in the GB
e) causes bile ducts to dilate
d) causes bile to collect in the GB
59
The causes of large gallbladder include all of the following except
a) adenomyomatosis
b) pancreatic carcinoma
c) diabetes mellitus
d) a fasting patient
e) common bile duct obstruction
a) adenomyomatosis
60
Which of the following is an echogenic linear line extending from the portal vein to the neck of the gallbladder
a) cystic duct
b) right hepatic duct
c) left portal vein
d) main lobar fissure
e) round ligament
d) main lobar fissure
61
Which of the following may a jaundiced male child with a hemolytic disorder be found to have
a) increase in direct bilirubin
b) increase in indirect bilirubin
c) increase in alpha-fetoprotein
d) increase in prothrombin time
e) normal liver function test results
b) increase in indirect bilirubin
62
Hydrops of the GB may be secondary to all of the following except which one?
a) sludge
b) mass in the head of the pancreas
c) obstruction of the distal common bile duct by a mass of the ampulla of vater
d) stones in Hartmanns pouch
e) surgery
a) sludge
63
Which of the following terms describes the malformation variant in the GB that involves an acutely angulated pouch of the fundus
a) Phrygian cap
b) duplication of the GB
c) harmann pouch
d) junctional fold
e) murphys cap
a) Phrygian cap
64
Where is the spiral values of Heister located?
a) ampulla of vater
b) junction of the cystic duct and common duct
c) junction of the right and left common hepatic duct
d) proximal portion of the cystic duct
e) fundus of the GB
d) proximal portion of the cystic duct
65
Which of the following describes how carcinoma of the GB would most likely appear
a) thin-walled GB
b) small GB with thickened walls
c) large GB with a halo surrounding it
d) diffusely thickened GB with gallstones
e) echogenic mass with no distinguishing features of a GB
d) diffusely thickened GB with gallstones
66
A 32 year old female presents to the sonography department 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
a) gangrenous cholecystitis
b) gallbladder perforation
c) acalculous cholecystitis
d) adenomyomatosis
d) adenomyomatosis
67
What is hyperplastic changes invovling the gallbladder wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula
Adenomyomatosis
68
In majority of patients, biliary obstruction is due to pathology in the
Distal CBD
69
Name the 7 causes of biliary obstruction
1) choledocholithiasis
2) pancreatic carcinoma
3) cholangiocarcinoma
4) cholangitis
5) Mirizzi syndrome
6) choledochal cyst
7) gallbladder carcinoma
70
_______ or ______ refer to the dilated hepatic duct adjacent to the portal vein
Parallel channel sign or shotgun sign
71
This is a hormone that is released into the blood by the ingestion of fatty foods, causing gallbladder contractions
Cholecystokinin
72
What is the formation or presence of calculi in the bile ducts
Choledocholithaisis
73
What is the most common cause of extrahepatic obstructive jaundice
Choledocholithiasis
74
What lab values increase with choledocholithasis
Conjugated serum bilirubin
Alkaline phosphatase
GGT
75
Name 3 complications of choledocholithiasis
1) biliary cirrhosis
2) cholangitis
3) Pancreatits
76
Name 4 diagnostic tests to detect choledocholithiasis
1) ERCP
2) PTC (percutaneous transhepatic cholangiography)
3) CT
4) Ultrasound
77
What is extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct
Mirizzi syndrome
78
Name 4 associated findings of Mirizzi syndrome
1) intrahepatic duct dilatation
2) cystic duct stone
3) curved segmental stenosis of CHD
4) Cholecystocholedochal fistula
79
What tumor is a cholangiocarcinoma located at the hepatic hilum resulting in intrahepatic but not extrahepatic biliary dilation
Klastskin tumor
80
Another name for bile duct carcinoma is
Cholangiocarcinoma
81
Name 6 predisposing conditions of cholangiocarcinoma
1) ulcerative colitis
2) sclerosing cholangitis
3) carolis disease
4) choledochal cyst
5) parasitic infestation
6) chemical toxins
82
What is an infection and inflammation of the biliary ducts resulting in wall thickening that comprises the lumen of the bile duct
Cholangitis
83
What 3 things are associated with cholangits
1) choledocholithiasis
2) biliary tract interventions
3) ulcerative colits
84
Cholangitis results in increased
1) serum conjugated bilirunin
2) serum alkaline phosphatase
3) tansaminases
4) serum amylase and lipase
5) leukocytosis
85
What is air in the biliary system called
Pneumobilia
86
What are congenital anomalies of the bile ducts consisting of cystic dilatation of the intra and extrahepatic bile ducts
Choledochal cyst
87
Name the 2 sonographic findings of choledochal cysts
1) 2 cystic structures in the RUQ
| 2) intrahepatic bile duct dilatation `
88
Choledochal cysts are prevalent in what country
Asia
89
Name 6 associated findings for choledochal cysts
1) pancreatitis
2) cholangits
3) hepatic abscesses
4) cirrhosis
5) portal hypertension
6) cholangiocarcinoma
90
What is a congential abnormality of the biliary tract characterized by mulifocal segmental dilatation of the intrahepatic bile ducts
Carolis disease
91
Name 6 things carolis disease is associated with
1) congential hepatic fibrosis
2) portal hypertension
3) medullary sponge kidney
4) infantile polycystic kidney disease
5) renal tubular ectasia
6) choledochal cyst
92
Name 4 complications of carolis disease
1) recurent cholangitis
2) biliary calculi and obstruction
3) hepatic abscess
4) cholangiocarcinoma
93
What is the most common cause of malignant neoplasm obstructing the biliary tree
Pancreatic Adenocarcinoma
94
Pancreatic adenocarcinoma at the head of the pancreas typically causes
Courvoisier gallbladder
95
increased unconjugated bilirubin results from
1) increased bilirubin production (hemolysis
| 2) decreased liver conjugation
96
ALP increases in diseases that impair bile formation, specifically
bile duct obstruction
97
Name 5 things ALP increases with
1) biliary obstruction
2) liver disease
3) bone growth and diseases
4) hyperparathyroidism
5) pregnancy
98
What is the most common pathology of the biliary tract
Choledocholithiasis
99
A patient presents for an abdomen ultrasound with RUQ pain, nausea, fever, and leukocytosis. An abnormal enlarged gallbladder demonstrates thickened walls at 1.2 cm. An anterior segment of the wall is echogenic and ring down artifact and dirty shadowing are present posterior to this area. Which of the following conditions is identified on this exam?
a) chronic cholecystitis
b) cholesterol polyps
c) adenomyomatosis
d) emphysematous cholecystitis
d) emphysematous cholecystitis
100
Primary GB carcinoma most commonly presents as
a) enlarged GB surrounded by fluid
b) focal wall mass without stones
c) diffusely thickened GB wall with stones
d) small GB with thickened walls
c) diffusely thickened GB wall with stones
101
The WES sign indicates a diagnosis of
a) portal thrombosis
b) GB stone
c) solid mass in GB
d) cyst in GB
b) GB stone
102
What are 2 other names for gallbladder sludge?
1) billiary sand
| 2) microlithaisis
103
Charcot triad is used to describe the classic clinical presentation of
a) pyloric stenosis
b) abdominal aortic aneurysm
c) Hashimoto thyroiditis
d) acute cholangitis
d) acute cholangitis
104
What is another name for Hartmanns pouch
Infundibulum
105
Which of the following is not a congenital anomaly/disorder?
a) sclerosing cholangitis
b) choledochal cyst
c) caroli disease
d) billiary atresia
a) sclerosing cholangitis
| - sclerosing cholangitis is an aquired inflammatory disorder of the billiary tree
106
Which of the following is leas likely to be associated with gallbladder sludge
a) elevated cholecystokinin levels
b) alcoholism
c) cystic duct obstruction
d) fasting
a) elevated cholecystokinin levels
107
Which of the following is caused by infection or ischemia of the gallbladder wall
a) hartmann pouch
b) adenomyomatosis
c) bouveret syndrome
d) membranous gangrenous gallbladder
d) membranous gangrenous gallbladder
108
A patient with choledochal cysts has an increased risk of developing
a) polycystic liver disease
b) biliary atresia
c) cholangiocarcinoma
d) portal HTN
c) cholangiocarcinoma
109
Which of the following gallbladder abnormalities have a very similar appearance on ultrasound evaluation and clinical history is necessary for differentiation
a) porcelain gallbladder and tumefactive sludge
b) acalculous cholecystitis and adenomyomatosis
c) hemobilia and sludge
d) chronic cholecystitis and Courvoisier gallbladder
c) hemobilia and sludge
110
What term describes a gallbladder that is filled with bile that is isoechoic to the liver and is difficult to identify on ultrasound
a) Mirizzi syndrome
b) charcot triad
c) hepatization
d) courvoisier gallbladder
c) hepatization
