Chapter 4: The Bile Ducts
how many different types of choledochal cysts are there?
4
12. which of the following would be the most proximal portion of the biliary tree? a. intrahepatic radicles b. cystic duct c. common hepatic duct d. common bile duct
A
13. which of the following would be the most distal portion of the biliary tree? a. common bile duct b. common hepatic duct c. gallbladder d. intrahepatic radicles
A
6. the klatskin tumor is located: a. at the junction of the right and left hepatic ducts b. at the junction of the cystic and common bile duct c. at the junction of the common bile duct and common hepatic duct d. between the pancreatic head and duodenum
A
9. air within the biliary tree is referred to as: a. pneumobilia b. cholangitis c. choledocholithiasis d. cholesterolosis
A
8. a patient presents with jaundice, pain, fever, secondary to an impacted stone in the cystic duct. This is referred to as: a. caroli syndrome b. mirizzi syndrome c. choledochal cyst d. biliary atresia
B
what is an uncommon manifestation of choledocholithiasis that presents as jaundice, pain, fever, secondary to a lodged stone in the cystic duct? Compression of the common hepatic duct results.
Mirizzi syndrome
biliary stasis
a condition in which bile is stagnant and allowed to develop into the sludge or stones
biliary atresia
a congenital disease describes as the narrowing or obliterations of all or a portion of the biliary tree
ring-down artifact
a form of reverberation artifact seen posterior to air or gas bubbles
Klatskin tumor
a malignant biliary tumor located at the junction of the right and left hepatic ducts
cholangiography
a radiographic procedure in which contrast is injected into the bile ducts to assess for the presence of disease
bilirubin
a yellow pigment found in bile that is produced by the breakdown of old red blood cells by the liver
what are the sonographic findings of biliary atresia?
absent biliary ducts gallbladder may be absent features of cirrhosis and portal hypertension
what is the normal anteroposterior diameter of the common duct in adults at the level of the porta hepatis?
between 1 and 7 mm
______ is a vital digestive fluid that is produced by the liver
bile
describe the path of bile
bile first accumulates in the small intrahepatic biliary radicles that are located throughout the liver. From these bile flows into either the right or left hepatic duct. They ducts eventually unite to form the common hepatic duct. Bile then travels a short distance to the gallbladder where it is concentrated and stored
_____ is a congenital disease that is thought to be caused by a viral infection at birth. Defined as the narrowing or obliteration of all or a portion of the biliary tree
biliary atresia
what are the sonographic findings of cholangitis
biliary dilation biliary sludge choledocholithiasis bile duct wall thickening
whenever _____ occurs, gallstone formation is probable
biliary stasis
what is the yellowish pigment found in bile, can turn the skin and the whites of the eyes yellow if allowed to accumulate
bilirubin
what is bile made up of?
bilirubin bile acids cholesterol
How is Mirizzi syndrome most often diagnosed?
cholangiography endoscopic retrograde cholangiopancreatography
______ is inflammation of the biliary ducts
cholangitis
what is the most common choledochal cyst?
cystic dilation of the common bile duct
what is caroli disease often associated with?
cystic renal disease and may precede the development of cholangiocarcinoma, a hepatic abscess, cholangitis, or sepsis
1. a congenital disease in which there is a narrowing or obliteration of the bile ducts is referred to as: a. caroli disease b. mirizzi disease c. choledochal cyst d. biliary atresia
d
what are the sonographic findings of cholangiocarcinoma?
dilated intrahepatic ducts that abruptly terminate at the level of the tumor a solid mass may be noted within the liver or ducts
where in the duct is the most common location for an obstruction to occur
distal common bile duct
acute pancreatitis
inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
what are the clinical findings of cholangiocarcinoma?
jaundice pruitis unexplained weight loss abdominal pain elevated bilirubin elevated alkaline phosphatase
where are Klatskin tumors located?
junction of the right and left intrahepatic ducts and causes them to dilate
cholangiocarcinoma
primary bile duct cancer
what is the function of the biliary tree?
provide a conduit for bile to drain from the liver into the small intestine
biliary dilation will occur ______ to the level of obstruction
proximal
what is pneumobilia usually associated with?
recent biliary/ gastric surgery emphysematous or prolonged acute cholecystitis fistula formation
what is the maximum diameter of the common bile duct for patients older than 60 who have had a cholecystectomy
10mm
15. the gallbladder is connected to the biliary tree by the: a. cystic duct b. ampulla of vater c. sphincter of Oddi d. common bile duct
A
17. a 32 year old female presents to the sonography department with a history of fever, leukocytosis, and right upper quadrant pain. sonographically, you visualize dilated bile ducts that have thickened walls and contain sludge. what is the most likely diagnosis? a. choledocholithiasis b. cholangitis c. mirizzi syndrome d. biliary atresia
B
10. the spiral valves of Heister are located within the: a. common bile duct b. pancreatic duct c. common hepatic duct d. cystic duct
D
14. if an obstructive biliary calculus is located within the distal common duct, which of the following could ultimately dilate? a. common bile duct b. gallbladder c. common hepatic duct d. all of the above
D
7. inflammation of the bile ducts is referred to as: a. pneumobilia b. choledocholithiasis c. cholelithiasis d. cholangitis
D
what is the most common manifestation of cholangiocarcinoma?
Klatskin tumor
Mirizzi syndrome
a clinical condition when the patient presents with jaundice, pain and fever, secondary to a lodged stone in the cysticduct
Caroli disease
a congenital disorder characterized by segmental dilation of the intrahepatic ducts
what are the clinical findings of choledochal cysts?
abdominal mass jaundice pain fever
where does cholangiocarcinoma occur?
anywhere within the biliary tree
_______ is a congenital disorder characterized by segmental dilation of the intrahepatic ducts
caroli disease/syndrome
primary biliary carcinoma is referred to as ________
cholangiocarcinoma
what can choledochal cysts lead to?
cholangitis portal hypertension pancreatitis liver failure
_______ describes the presence of gallstones within the bile ducts
choledocholithiasis
what are the most common causes of common bile duct obstruction?
choledocholithiasis chronic pancreatitis acute pancreatitis pancreatic carcinoma
what ducts are considered to be extrahepatic?
common bile duct cystic duct part of the common hepatic duct
what will dilate with a distal common bile duct obstruction
common bile duct gallbladder common hepatic duct intrahepatic ducts
why does jaundice occur
consequence of bilirubin accumulation within the tissues of the body
the gallbladder is attached to the biliary tree by the ____.
cystic duct
what are the sonographic findings of pneumobilia
echogenic linear structures within the ducts that produce ring-down artifacts and may have dirty shadowing
what can excessive bilirubin in the body lead to
elevated serum bilirubin
endoscopic retrograde cholangiopancreatography
endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas
what is the "parallel tube sign" or "shotgun sign"
enlargement of the common duct to the size of the adjacent portal vein
what are the clinical findings of cholangitis?
fever leukocytosis jaundice right upper quadrant pain elevated alkaline phosphatase elevated bilirubin
when are choledochal cysts usually discovered?
first decade of life
spiral valves of Heister
folds located within the cystic duct that prevents it from collapsing and distending
what are the sonographic findings of a choledochal cyst
fusiform cystic mass in the area of the porta hepatis and biliary dilation
what is the most common cause of obstructive jaundice?
gallstones located within the bile duct (choledocholithiasis)
cholangitis
inflammation of the bile ducts
what results from a biliary tree obstruction?
jaundice
if biliary obstruction has occurred as a result of choledocholithiasis what will the patient present with?
jaundice elevated bilirubin alkaline phosphatase right upper quadrant pain
the common bile duct segment closest to the pancreatic head is considered to be the _____ portion
most distal
what is the most common cause of cholangitis?
obstructive disease
chyme
partially digested food
_____ is air within the biliary tree
pneumobilia
what is the prognosis for biliary atresia? what does it cause?
poor (fatal without surgical intervention) infants usually suffer from cirrhosis and portal hypertension
pruritus
sever itchiness of the skin
the cystic duct contains tiny structures called _______ that prevent the cystic duct from collapsing or distending
spiral valves of Heister
serum bilirubin
the amount of bilirubin found in the blood
cholecystectomy
the surgical removal of the gallbladder
when would you suspect cholangitis?
when the bile duct wall thicken greater than 5mm
3. the merging point of the pancreatic duct and common bile duct at the level of duodenum is referred to as the: a. sphincter of Oddi b. ampulla of Vater c. common bile duct d. cystic duct
B
4. a gallstone located within the biliary tree is referred to as: a. cholecystitis b. choledocholithiasis c. cholangitis d. cholangiocarcinoma
B
11. if a gallstone, causing obstruction, is located within the distal common hepatic duct, which of the following would become dilated? a. common bile duct only b. gallbladder only c. intrahepatic ducts d. all of the above
C
16. the most common level for biliary obstruction to occur is the: a. junction of the right and left hepatic ducts b. proximal common hepatic duct c. distal common bile duct d. cystic duct
C
2. primary biliary tree cancer is referred to as: a. gallbladder carcinoma b. biloma c. cholangiocarcinoma d. lymphangioma
C
5. 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. AIDS conjestion b. pruritus c. jaundice d. bilirubinemia
C
pneumobilia
air within the biliary tree
where will most stones be located?
ampulla of Vater
what other conditions may present with jaundice
hepatitis cirrhosis liver carcinoma pancreatic carcinoma hemolytic disorders
what are the sonographic findings of carolis disease?
segmental dilation of the intrahepatic ducts the patient may also have cystic renal disease
dirty shadowing
shadowing seen posterior to gas or air: possibly referred to as a ring-down artifact
porta hepatis
the area of the liver where the portal vein and hepatic artery enter and the hepatic ducts exit; also referred to as the liver hilum
portal hypertension
the elevation of blood pressure within the portal venous system
cholecystokinin
the hormone produced by the duodenum that causes the gallbladder to contract
hepatopancreatic ampulla
the level of the biliary tree where the common bile duct and the main pancreatic duct meet: may also be referred to as the ampulla of Vater
ampulla of Vater
the merging point of the pancreatic duct and common bile duct just before the sphincter of Oddi; also referred to as the hepatopancreatic ampulla
hepatopancreatic sphincter
the muscle that controls the emptying of bile and pancreatic juices into the duodenum: may be referred to as the sphincter of Oddi
sphincter of Oddi
the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic sphincter
choledocholithiasis
the presence of a gallstone or gallstones within the biliary tree
chronic pancreatitis
the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scaring, and the development of calcification within the gland
jaundice
the yellowish discoloration of the skin, mucous membranes, and sclerae; found in presence of liver disease and/or biliary obstruction
describe the path of bile out of the gallbladder
travels from the common bile duct toward the duodenum where it meets the main pancreatic duct at the ampulla of vater/hepatopancreatic ampulla. There pancreatic juices and bile mix together. The sphincter of Oddi also known as hepatopancreatic sphincter is the opening that allows bile and pancreatic juices to flow into the duodenum. The fluid is then mixed with chyme in the duodenum and appropriate chemical reactions ensure
