The gallbladder and biliary system

Question 1

the right and left hepatic ducts emerge from the right lobe of the liver in the _____ and unite to form the common hepatic duct; runs parallel with the portal vein

Answer 1

porta hepatis

Question 2

the common hepatic duct is approximately _____ in diameter and descends within the edge of the lesser omentum; it is joined by the cystic duct to form the common bile duct

Answer 2

4 mm

Question 3

the normal common bile duct has a diameter of up to _____

Answer 3

6 mm

Question 4

the CBD joins the main pancreatic duct, and together they open through a small ampulla (called the _____) into the duodenal wall

Answer 4

ampulla of vater

Question 5

the end parts of both ducts and the ampulla are surrounded by circular muscle fibers known as the _____

Answer 5

sphincter of Oddi

Question 6

the cystic duct is about _____ long and connects the neck of the gallbladder with the CHD to form the CBD

Answer 6

4 cm

Question 7

the neck of the GB is _____ toward the porta hepatis

Answer 7

posteromedially

Question 8

generally the normal GB measures about _____ in diameter and _____ in length; the walls are less than _____ thick

Answer 8

2.5 to 4 cm; 7 to 10 cm; 3mm; dilation of the GB is known as hydrops

Question 9

the GB may fold back on itself at the neck, forming _____

Answer 9

Hartmann’s pouch; other anomalies include partial septation; complete septation (double GB); and folding of the fundus (phrygian cap)

Question 10

______ in the neck of the GB helps to prevent kinking of the duct

Answer 10

heister’s valve

Question 11

the arterial supply of the GB is from the _____, which is a branch of the right hepatic artery

Answer 11

cystic artery

Question 12

_____ of the extrahepatic ducts (usually less than 1 cm) occur after cholecystectomy

Answer 12

dilation

Question 13

_____ is the principal medium for excretion of bilirubin and cholesterol

Answer 13

bile; bile salts from the intestines stimulate the liver to make more bile, they activate intestinal and pancreatic enzymes

Question 14

______ sign indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarge GB

Answer 14

Courvoisior’s

Question 15

_____ and _____ may indicate stones in the CBD

Answer 15

nausea and vomiting

Question 16

______ may develop when a tiny stone blocks the bile duct between the gallbladder and the intestines, producing pressure on the liver and forcing bile into the blood

Answer 16

jaundice

Question 17

_____ or thickened bile frequently occurs from bile stasis

Answer 17

sludge; low-level echos layering in dependent parts of GB; prominent GB size; changes with position

Question 18

biliary cause of _____ include cholecystitis, adenomyomatosis, cancer, acquired immunodeficiency syndrome, cholangiopathy, and sclerosing cholangitis

Answer 18

wall thickening; non biliary include diffuse liver disease, pancreatitis, portal hypertension, and heart failure, ascites

Question 19

_____ is an inflammation of the GB that may have one of several forms; acute, chronic, acalculous, emphsysematous, or gangrenous

Answer 19

cholecystitis

Question 20

the most common cause of _____ cholecystitis is gallstones; stones maybe impacted in hartmann’s pouch or cystic duct

Answer 20

acute; increased serum amylase, abnormal LFT’s; dilation of the rounding of GB; + murphy sign; thick GB wall with irregular wall; stones; pericholecystic fluid (same signs with acalculous)

Question 21

with _____ cholecysitis, there is gas-forming bacteria in GB with abnormal LFT’s; 50% of times in diabetics

Answer 21

emphysematous; bright echoes in area of GB with ring down or comet tail artifact may appear as WES

Question 22

with _____ cholecysitis, medium to coarse echogenic densities that fill the GB lumen in absence of duct obstruction; no shadow; not gravity dependent; and does not layer

Answer 22

gangrenous; causes the GB to undergo necrosis because of prolong infection; the walls may become inflamed with hemorrhage

Question 23

_____ is the most common disease of the GB; check bilirubin levels; dilated GB wall

Answer 23

Cholelithiasis; gravity dependent calcification in GB; the tiny stones are more dangerous because they can enter the bile ducts and obstruct the outflow of bile

Question 24

with cholelithiasis the patient normally falls under the five F’s, what are they?

Answer 24

fat, female, fertile, forty, and fair

Question 25

_____ of the GB is a rare condition that is found more in elderly females and is associated with a mobile GB with a long suspensory mesentery

Answer 25

torsion; causes acute cholecystitis

Question 26

a _____ GB is a rare occurrence that is defined as calcium incrustation of the GB wall; wall is thickly calcified with shadowing

Answer 26

porcelain; female predominance; found in patients over 60; small percent may develop carcinoma of the GB

Question 27

_____ cholecystosis is represented by a variety of degenerative and proliferative changes of the GB characterized by hyperconcentration, hyperexcitability, and hyperexcretion

Answer 27

hyperplastic; cholesterolosis and adenomyomatosis are 2 types of this condition; malignancy is suspected when the polyp is singular and measures greater than 10mm

Question 28

_____ is a condition in which cholesterol is deposited within the lamina propria of the GB; echogenic structure in extrahepatic duct; dilated biliary tree

Answer 28

cholesterolosis; increase in direct bilirubin; abnormal liver enzymes; leukocytosis; increased alkaline phosphatase; referred to as the strawberry GB

Question 29

______ of the GB are small, well-defined soft tissue projections from the GB wall

Answer 29

polyps; cholesterol polyps are the most common pseudotumor of the GB; they are small, smooth ovoid wall projections; no shadow; comet tail

Question 30

_____ are benign neoplasms of the GB with a premalignant potential; usually is a solitary lesion

Answer 30

adenoma; occurs as flat elevations located in the body of the GB, almost always near the fundus; does not change with position; no shadow produced

Question 31

with _____ papillomas may occur single or in groups and may be scattered over a large part of the mucosal surface of the GB; does not move position changes; comet-tail artifact

Answer 31

adenomyomatosis

Question 32

primary carcinoma of the GB is associated with _____ most cases; the mass is heterogenious, solid or semi-solid, there is dilated biliary ducts causing a shotgun sign (PV and dilated duct)

Answer 32

cholelithiasis; most frequently in women 60 years or older; adjacent liver is often invaded by direct continuity extending through tissue spaces, the ducts of Luschka, and the lymph channels,

Question 33

_____ cysts are an unusual diverse group of diseases that may manifest as congenital, focal, or diffuse cystic dilatation of the biliary tree; may result form pancreatic juice refluxing

Answer 33

choledochal; jaundice; localized dilated cystic CBD; diverticulum in CBD; invagination of CBD into duodenum; dilated CBD and CHD

Question 34

_____ is a rare congenital abnormality that is most likely inherited in an autosomal recessive fashion; 2 types simple classic form, and more common form that is associated with periportal hepatic fibrosis

Answer 34

Caroli's disease; strongly associated with cystic disease of the kidney; multiple cystic structures in the area of the ductal system; sludge or calculi may reside in the dilated ducts

Question 35

sonography cannot image the biliary ducts routinely until their size dilates to greater than _____

Answer 35

4mm; ducts greater than 6mm is considered borderline and more than 10 mm is dilated

Question 36

_____ dilation occurs before intrahepatic, because ducts expand centrifugally from the point of obstruction

Answer 36

extrahepatic

Question 37

what are the 3 primary areas for obstruction to occur in extrahepatic ducts?

Answer 37

intrapancreatic, suprapancreatic, and porta hepatic

Question 38

what are the 3 important conditions that cause the majority of biliary obstruction at the level of the distal duct

Answer 38

pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation

Question 39

_____ obstruction originates between the pancreas and porta hepatis

Answer 39

suprapancreatic

Question 40

a ______ tumor is a specific type of cholangiocarcinoma that can occur at the bifurcation of the CHD, with involvement of both the central left and right duct

Answer 40

klatkin's tumor; isolated intrahepatic duct dilation indicates cholangiocarcinoma

Question 41

_____ syndrome is an uncommon cause for extrahepatic biliary obstruction resulting from an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the CHD

Answer 41

Mirizzi

Question 42

choledocholithiasis is common duct stones; they are usually associated with _____

Answer 42

calculous cholecystitis; they tend to become impacted into the ampulla of Vater

Question 43

biliary trauma secondary to percutanous biliary procedures or liver biopsies account for the majority of _____ cases

Answer 43

hemobila; blood in the biliary tree

Question 44

_____ is air within the biliary tree

Answer 44

pneumobilia; bright echogenic linear structure that follow the portal triads; posterior dirty shadowing and reverberation artifact is seen

Question 45

_____ is an inflammation of the bile duct

Answer 45

cholangitis; elevated lab values of serum alkaline phosphatase and bilirubin; decompression of CBD is necessary; may be hypoechoic or echogenic with stones

Question 46

______ is a parasitic roundworm that uses a fecal-oral route of transmission; may be 20-30 cm long and 6 cm diameter; travels from the small bowel

Answer 46

ascariasis; gives a target appearance;

Question 47

_____ biliary tumors are rare and are primarily limited to cystadenoma and cystadenocarcinoma

Answer 47

intrahepatic; cystic mass with multiple septa and papillary excrescences

Question 48

_____ cholangiocarcinoma is found in the distal CBD

Answer 48

papillary

Question 49

_____ is the second most common primary malignancy of the liver

Answer 49

intrahepatic cholangiocarcinoma; large hepatic mass; hypovascular

Question 50

_____ cholangiocarcinoma usually begins in the right or left bile duct and then extends into the proximal duct and distally into the common hepatic duct and contralateral bile duct; can lead to atrophy of involved lobes

Answer 50

hilar; should also evaluate the hepatic artery for adenopathy and metastases; elevated cholestatic liver parameters

Question 51

_____ cholangiocarcinoma may extend into the adjacent lymph nodes; tumor mass may be sclerosing or polypoid

Answer 51

distal; sclerosing tumor is nodular with focal irregular ductal constriction and wall thickening; hypoechoic and hypovascular; poorly defined margins

Question 52

what is the most common sites that can spread to the biliary system?

Answer 52

breast, colon, or melanoma