The Bile Ducts: Review Questions

The merging point of the pancreatic duct and common bile duct at the level of the duodenum is referred to as: A. Sphincter of Oddi B. Ampulla of Vater C. Common bile duct D. Cystic duct

B. Ampulla of Vater

The yellow pigment found in bile that is produced by the breakdown of old red blood cells by the liver is: A. Alkaline phosphatase B. Bilirubin C. Cholesterol D. Chyme

B. Bilirubin

The biliary duct wall should never measure more than: A. 2 mm B. 9 mm C. 4 mm D. 5 mm

D. 5 mm

A 64-year-old presents to the sonography department for a right upper quadrant sonogram. He is complaining of abdominal pain, weight loss, and pruitis. Sonographically, you visualize an area of dilated ducts that abruptly end. What is the most likely diagnosis? A. Biliary atresia B. Choledocholithiasis C. Caroli syndrome D. Cholangiocarcinoma

D. Cholangiocarcinoma

Inflammation of the bile ducts is referred to as: A. Pneumobilia B. Choledocholithiasis C. Cholelithiasis D. Cholangitis

D. Cholangitis

The spiral valves of Heister are located within the: A. Common bile duct B. Pancreatic duct C. Common bile duct D. Cystic duct

D. Cystic duct

Which of the following is not associated with the development of pneumobilia? A. Cholangiopneumonia B. Gastric surgery C. Acute cholecystitis D. Fistula formation

A. Cholangiopneumonia

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. Cystic duct

Which segment of the biliary tree tends to dilate first with obstruction? A. Intrahepatic B. Extrahepatic

B. Extrahepatic

A patient presents with jaundice, pain, and fever, secondary to an impacted stone in the cystic duct. This is referred to as: A. Caroli syndrome B. Mirizzi syndrome C. Choledochal cysts D. Biliary atresia

B. Mirizzi syndrome

A Klatskin tumor is a form of: A. Lymphocytic carcinoma B. Cholangiocarcinoma C. Pancreatic carcinoma D. Gallbladder carcinoma

B. Cholangiocarcinoma

Primary biliary tree cancer is referred to as: A. Gallbladder carcinoma B. Biloma C. Cholangiocarcinoma D. Lymphangioma

C. Cholangiocarcinoma

An abdominal sonogram is ordered on an infant in the intensive care unit who is suffering from jaundice and fever. Sonographically. you visualize a cystic mass within the common bile duct that is causing focal enlargement. This is most suggestive of: A. Cholangiocarcinoma B. Mirizzi syndrome C. Choledochal cyst D. Biliary atresia

C. Choledochal cyst

Which of the following is not a plausible cause of common bile duct obstruction in adults? A. Choledocholithiasis B. Chronic pancreatitis C. Choledochal cyst D. Pancreatic carcinoma

C. Choledochal cyst

The most common level for the 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. Distal common bile duct

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. Common bile duct

A 32-year old female patient 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. Cholangitis

A gallstone located within the biliary tree is referred to as: A. Cholecystitis B. Choledocholithiasis C. Cholangitis D. Cholangiocarcinoma

B. Choledocholithiasis

Clinical findings of choledocholithiasis include all of the following except: A. Jaundice B. Elevated bilirubin C. Elevated blood urea nitrogen D. Elevated alkaline phosphatase

C. Elevated blood urea nitrogen

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. Intrahepatic ducts

The yellowish staining of the white of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as: A. AIDS cholangitis B. Pruitis C. Jaundice D. Bilirubinemia

C. Jaundice

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. All of the above

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. Biliary atresia

All of the following are clinical findings consistent with cholangiocarcinoma except: A. Pruitis B. Weight loss C. Elevated bilirubin D. Dilation of the intrahepatic ducts

D. Dilation of the intrahepatic ducts

All of the following are forms of cholangitis except: A. Acute bacterial B. AIDS C. Oriental D. Parabolic

D. Parabolic

For patients older than 60, or for those who have had a cholecystectomy, a maximum diameter of _________ may be considered normal. A. 1 cm B. 12 mm C. 14 mm D 1.5 cm

A. 1 cm

The Klatskin tumor is located: A. At the junction at 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. At the junction at the right and left hepatic ducts

Which of the following is considered the most proximal portion of the biliary tree? A. Intrahepatic radicles B. Cystic duct C. Common hepatic duct D. Common bile duct

A. Intrahepatic radicles

Sonographically, you visualize scattered echogenic linear structures within the liver parenchyma that produce ring-down artifact. What is the most likely diagnosis? A. Pneumobila B. Choledocholithiasis C. Sludge balls D. Cholesterolosis

A. Pneumobila

Air within the biliary tree is referred to as: A. Pneumobilia B. Mirizzi syndrome C. Choledochal cysts D. Biliary atresia

A. Pneumobilia