Ch.6 Biliary System
what is the upper limit of normal for the measurement of the gallbladder wall?
3 mm
the normal distended gallbladder measures _______ cm in length and less than _____ cm in the AP and transverse dimensions.
7-10, 3
which of the following does NOT increase a patient's risk of developing gallbladder malignancy? A. septate gallbladder B. chronic cholecystitis C. porcelain gallbladder D. cholelithiasis
A
which of the following statements regarding gallbladder polyps is FALSE? A. polyps will move to the dependent portion of the gallbladder with change in patient position B. polyps are attached to the gallbladder wall by a stalk C. polyps typically do not shadow D. polyps are typically adenomatous or made of cholesterol
A
which of the following would cause intrahepatic dilation with a normal gallbladder and CBD? A. carcinoma in the pancreatic head B. gallstone in the gallbladder neck C. stone in the distal CBD D. Klatskin tumor
D
an impacted stone in the cystic duct/GB neck causing obstruction of the CHD with a normal CBD
Mirrizi syndrome
what is seen on ultrasound when the gallbladder is completely filled with stones?
WES sign
what is the most common cause of cholelithiasis?
abnormal bile composition
a 2 week old infant presents with a sudden onset of jaundice. the sonogram demonstrates intrahepatic ductal dilatation but does not demonstrate a gallbladder or CHD. which congenital biliary anomaly is the most likely cause?
biliary atresia
collections of bile in cystic masses (not a true cyst)
biloma
primary malignancy of the bile ducts is called _________.
cholangiocarcinoma
the primary cancer of the biliary ducts
cholangiocarcinoma
choledocholithiasis may lead to ______
cholangitis
inflammation of the bile ducts
cholangitis
what disease appears on ultrasound with dilated ducts with thickened edetamous walls that narrow the bile duct lumen
cholangitis
surgical removal of the gallbladder
cholecystectomy
acute or chronic inflammation of the gallbladder
cholecystitis
what disease appears on ultrasound as a gallbladder with thickened walls ( >3 mm), hydropic, and with hypoechoic walls (edematous)
cholecystitis
what is the hormone that causes the gallbladder to contract and the sphincter of Oddi to relax, allowing bile to flow from the gallbladder to the small intestine?
cholecystokinin
a 2 month old infant presents with persistend jaundice and a palpable RUQ mass. the sonogram demonstrates a normal gallbladder and a cystic mass in the porta hepatis that appears to be separate from the gallbladder. the CBD appears to be entering the cystic mass. what is the most likely diagnosis?
choledochal cyst
calculi located within the bile duct
choledocholithiasis
stones within the bile ducts, called ______, are the most common pathology of the biliary tree.
choledocholithiasis
formation or presence of stones within the gallbladder
cholelithiasis
what is the most common cause of acute (calculous) cholecystitis?
cholelithiasis
masses connected by a stalk to the GB wall
cholesterol polyps
strawberry GB; echogenic "ball"
cholesterolosis
porcelain GB can be caused by _______, a decrease in vascular supply to the GB, cystic duct obstruction, and a chronic low grade ______.
chronic cholecystitis, infection
_________ may be used to look for internal vascularity in a suspected gallbladder mass and to distinguish sludge from a malignant mass.
color doppler
duct which carries bile from the cystic and hepatic ducts to the duodenum
common bile duct
what vessels make up the portal triad?
common hepatic duct, common hepatic artery, main portal vein
the purpose of the gallbladder is to ______ and _____ bile
concentrate, store
in the presence of a hydropic GB in a patient with painless jaundice, assume malignancy NOT stones
courvoisier GB
a gallbladder that is enlarged, thin-walled, and not tender that is caused by a mass in the pancreatic head obstructing the common bile duct is called __________.
courvoisier gallbladder
an abdominal sonogram demonstrates a large hypoechoic mass in the head of the pancreas. the gallbladder is enlarged with a thin wall. murphy sign is negative. no gallstones are seen and the bile ducts are normal in caliber. what is the most likely diagnosis?
courvoisier gallbladder
duct of the gallbladder which joins with the hepatic duct to form the common bile duct
cystic duct
a hydropic GB (mucocele) is caused by the obstruction of the _______ or ______.
cystic duct, common bile duct
_______ is typically elevated in cases of obstructive jaundice as can occur with choledocholithiasis; _______ bilirubin is typically elevated with liver disease and hemolytic anemia.
direct, indirect
complications of acute cholecystitis:
empyema (pus in GB), GB perforation, emphysematous (gas forming bacteria in GB), gangrenous (necrosing GB)
cholangiocarcinoma is most commonly found in ________
extrahepatic ducts
what are the 5 F's and what disease are they for?
female, fair, fat, forty, fertile, cholelithiasis
bile ducts should be measured from the ______ wall to the _____ wall, with a CBD measurement greater than ____ mm considered abnormal.
inner, inner, 8
born without a cystic duct and common hepatic duct
interposition
fold within the neck or body of the gallbladder
junctional fold
what is the normal measurement for an intrahepatic bile duct?
less than 2 mm
which of the following is NOT a laboratory test that can be used to evaluate the biliary system? A. lipase B. alkaline phosphatase C. bilirubin D. lactic dehydrogenase
lipase
which anatomical landmark can help localize a gallbladder that is difficult to visualize?
main lobar fissure
GB cancer usually metastisizes from _______
melanoma
what is the most common malignancy to metastasize to the gallbladder?
melanoma
pain in the area of the gallbladder when pressure is applied by the ultrasound transducer
murphy sign
fold within the gallbladder fundus
phyrgian cap
air in the bile ducts; dirty shadowing and ring down effect
pneumobilia
air within the bile ducts
pneumobilia
a calcium encrusted GB wall that appears hyperechoic with posterior shadowing.
porcelain GB
type of choledocholithiasis where stones are formed in the ducts themselves
primary
2 kinds of choledocholithiasis:
primary, secondary
type of cholangitis that is caused by stagnant bile which contributes to infection
recurrent pyogenic
which of the following statements regarding gallstones is FALSE? A. the prevalence of gallstones is higher in females than males B. the majority of stones in the United States are made up of cholesterol C. the majority of gallstones cause symptoms D. abnormal gallbladder emptying and altered absorption are precursors to stone formation
C
what is a type of choledochal cyst that causes the dilation of the intrahepatic ducts?
Carolis disease
which of the following will cause a thin-walled gallbladder? A. chronic cholecystitis B. acute cholecystitis C. a fatty meal D. hydrops
D
porcelain GB can cause _______
GB carcinoma
primary cancer of the GB; cauliflower shaped
GB carcinoma
an infundibulum at the neck of the gallbladder where stones may collect is a variant called a ______.
Hartman pouch
the most common location for cholangiocarcinoma to occur is at the porta hepatis. this type of cholangiocarcinoma is called a ________.
Klatskin tumor
type of cholangiocarcinoma that occurs at the junction of the left and right hepatic ducts
Klatskin tumor
patients with biliary system obstruction typically present with symptoms of ______, ______, _______, and elevated ______ or _______.
RUQ pain, jaundice, fever, bilirubin, alkaline phosphate
what is the most common form of cholecystitis?
acute (calculous)
what are the 3 kinds of cholecystitis?
acute (calculous), acute acalculous, chronic
what is the most common cholangiocarcinoma?
adenocarcinoma
what is the most common primary carcinoma of the GB?
adenocarcinoma
benign GB mass, can become malignant; sticks to GB wall; DD= adenomyomatosis
adenoma
a comet-tail reverberation artifact is seen originating from the anterior gallbladder wall. what gallbladder pathology is most likely causing the artifact?
adenomyomatosis
comet tail from hyperechoic foci, cholesterol crystal deposits in the Rokitansky-Aschoff sinuses; benign
adenomyomatosis
the two most common hyperplastic cholecystoses are ________ and _______.
adenomyomatosis, cholesterosis
echogenic, spaghetti like structures in the colon; parasite from injesting contaminated water
ascariasis
pear-shaped sac responsible for storing bile until it is released through the cystic duct
gallbladder
with a distal obstruction such as a mass in the head of the pancreas, which part of the biliary tree is the first to dilate?
gallbladder
a 76 year old patient presents for an abdominal sonography examination with chronic abdominal pain. an irregular mass is seen projecting into the gallbladder lumen. color doppler detects flow within the mass. gallstones are also seen. what is the most likely diagnosis?
gallbladder carcinoma
sludge increases the patient's risk for _______.
gallstones
______ are seen in up to 95% of cases of gallbladder carcinoma. other risk factors include chronic _______ and ______ gallbladder, or calcification of the gallbladder wall.
gallstones, cholecystitis, porcelain
which of the following is NOT a symptom of gallbladder disease? A. nausea and vomiting B. epigastric or RUQ pain C. pain that radiates to the right shoulder D. hematuria
hematuria
blood in the biliary ducts; echogenic debri in bile ducts
hemobilia
an enlarged GB with no wall thickening or inflammation
hydropic GB (mucocele)
a ______ is a distended gallbladder caused by an obstruction of the gallbladder neck or cystic duct
hydropic gallbladder
type of cholangitis that is caused by the hardening of the bile ducts; has to do with Chron's disease
sclerosing
4 types of cholangitis:
sclerosing, recurrent pyogenic, AIDS cholangitis, acute bacterial
type of choledocholithaisis where the stones came from the GB
secondary
care must be taken not to misdiagnose a polyp as a gallstone. unlike gallstones, polyps should not produce an acoustic ______ and should not ______ when the patient changes position
shadow, move
low-level, nonshadowing echoes are seen layering along the dependent portion of the gallbladder. the echoes move along with a change in patient position. the most likely diagnosis is ______.
sludge
solid, semisolid, or thickened bile within the gallbladder or bile duct
sludge
2 types of sludge:
tumefactive (sludge ball), hepatization (completely full of sludge, same echogenicity of liver)