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)