Ch. 10 GB U/S

_______ of patients with porcelain gallbladder may develop gallbladder carcinoma.

25%

The normal thickness of the gallbladder wall is _______ or less.

3 mm

The normal diameter of the common hepatic duct is approximately ________ millimeters (mm).

4 mm

In a 50-year-old adult, the normal common bile duct should not measure more than _____ mm.

6 mm The normal common bile duct has a diameter of up to 6 mm.

The abscence of Murphy's sign is an important finding in gangrenous cholecystitis, which may occur in up to ________% of patients.

70%

Air within the biliary tree, secondary to common bile duct stents, is called: a. pneumobilia. b. hemobilia. c. pneumothorax. d. cholangitis.

ANS: A Pneumobilia is air within the biliary tree, secondary to biliary intervention, biliary-enteric anastamoses, or common bile duct stents.

All of the following sonographic appearances are found in cases of gallbladder carcinoma except: a. pericholecystic fluid. b. wall thickening. c. cholelithiasis. d. intraluminal wall mass.

ANS: A Sonographic findings in cases of gallbladder carcinoma generally demonstrate a thickening of the gallbladder wall with a globe-shaped heterogeneous mass projecting into the lumen of the gallbladder. Between 80% and 90% of patients have associated gallstones.

Classic symptoms of gallbladder disease include all of the following except: a. hematuria. b. right upper quadrant pain. c. right shoulder pain. d. nausea and vomiting.

ANS: A The most common symptom of gallbladder disease is right upper quadrant pain, usually after ingesting a fatty meal. Other symptoms include nausea and vomiting, right shoulder blade pain, and epigastric pain.

The valves of Heister are tiny valves found within the: a. cystic duct. b. common bile duct. c. pancreatic duct. d. common hepatic duct.

ANS: A The valves of Heister are tiny valves located within the cystic duct of the gallbladder.

The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the: a. common hepatic duct. b. cystic duct. c. common bile duct. d. common pancreatic duct.

ANS: A The right and left hepatic ducts unite to form the common hepatic duct, which then passes caudally and medially.

The sonographic appearance of cholelithiasis is best described as: a. nonshadowing, mobile, hyperechoic focus. b. mobile, hyperechoic focus demonstrating posterior shadowing. c. immobile, echogenic focus demonstrating a comet-tail artifact. d. mobile, hypoechoic focus demonstrating posterior shadowing.

ANS: B A gallstone generally appears as mobile hyperechoic intraluminal focus (i) demonstrating posterior acoustic shadowing. Gallstones are typically mobile.

A positive Murphy sign is a clinical finding associated with: a. cholelithiasis. b. cholecystitis. c. porcelain gallbladder. d. adenomyomatosis.

ANS: B A presenting sign of cholecystitis is acute right-upper quadrant pain upon palpation of the gallbladder (positive Murphy sign).

Thickening of the gallbladder wall may be caused by all of the following except: a. hepatitis. b. pancreatitis. c. adenomyomatosis. d. cholecystitis.

ANS: B A thickening of the gallbladder wall may be caused by cholecystitis, acquired immunodeficiency syndrome, cholangiopathy, sclerosing cholangitis, ascites, right-sided heart failure, renal failure, severe hypoalbuminemia states, and nonfasting state.

Patients positive for AIDS are at risk for developing: a. hepatitis. b. cholangitis. c. pancreatitis. d. nephritis.

ANS: B AIDS patients are at risk for developing cholangitis.

The most common cause of biliary ductal obstruction is the presence of a ductal: a. cyst. b. tumor. c. stone. d. stricture.

ANS: B The most common cause of biliary ductal obstruction is the presence of a ductal tumor or thrombus in the ductal system.

Which one of the following describes the most common sonographic appearance of gallbladder carcinoma? a. "Comet tail" shadowing posterior to a hypoechoic focus b. Irregular echogenic mass projecting from the gallbladder wall c. Shadowing posterior to mobile echogenic mass d. Comet tail shadowing posterior to a hyperechoic focus

ANS: B The sonographic appearance of gallbladder carcinoma is described as a heterogeneous, solid, immobile mass projecting into the gallbladder from a thickened gallbladder wall.

A thick calcified gallbladder wall describes which one of the following conditions? a. Wall-echo-shadow (WES) sign b. Gangrenous gallbladder c. Porcelain gallbladder d. Emphysematous gallbladder

ANS: C A porcelain gallbladder is associated with gallstones and demonstrates a thick, hyperechoic (calcified) gallbladder wall with posterior acoustic shadowing. WES sign demonstrates a gallbladder wall and then a hyperechoic focus with posterior shadowing.

The physiologic effect of a fatty meal includes all of the following except: a. stimulation of cholecystokinin (CCK). b. contraction of the gallbladder. c. decreased bile flow to the liver. d. relaxation of the sphincter of Oddi.

ANS: C After a fatty meal, CCK stimulation causes the contraction of the gallbladder; the sphincter of Oddi relaxes with the outpouring of bile into the duodenum, increasing bile flow from the liver.

A condition causing RUQ pain in which small polypoid masses arise from the gallbladder wall demonstrating "comet tail" artifact is: a. choledocholithiasis. b. cholesterosis. c. adenomyomatosis. d. pruritus.

ANS: C An immobile echogenic focus (i) protruding from the gallbladder wall demonstrating a "comet tail" artifact describes adenomyomatosis.

In cases of choledocholithiasis, stones tend to lodge in the: a. pancreatic duct. b. common bile duct. c. ampulla of Vater. d. common hepatic duct.

ANS: C In cases of choledocholithiasis, stones tend to lodge in the ampulla of Vater and may project into the duodenum.

Which one of the following is a function of the gallbladder? a. Storage for extra cholesterol b. Storage for enzymes c. Reservoir for bile d. Reservoir for biliary salts

ANS: C The gallbladder serves as a reservoir for bile, which is drained from the hepatic ducts in the liver.

Gas-forming bacteria in the gallbladder appear on ultrasound as a: a. dilated round shape. b. nonshadowing echogenic mass. c. localized dilation. d. bright echo with a ring down or comet-tail artifact.

ANS: D Emphysematous cholecystitis is gas-forming bacteria in the gallbladder, which appear on ultrasound as a bright echo in the area of the gallbladder with a ring down or comet-tail artifact.

The most common tumor sites that can spread carcinoma to the biliary tree include all of the following except: a. colon. b. breast. c. melanoma. d. kidney.

ANS: D Metastatic carcinoma in the gallbladder occurs secondary to melanoma, colon, or breast carcinoma.

Which one of the following best describes nonshadowing, low-amplitude echoes in a dependent gallbladder? a. Cholelithiasis b. Porcelain gallbladder c. Cholecystitis d. Sludge

ANS: D Sludge is described as low-level internal echoes that are gravity dependent.

The "Mickey Mouse" sign is used to describe the portal triad. The right ear represents the ________, the left ear represents the ________, and the head represents the ________ .

CBD, HA, PV

Inflammation of the gallbladder is known as?

Cholecystitis is the inflammation of the gallbladder that may have several forms—acute or chronic, acalculous, emphysematous, or gangrenous.

A fusiform dilation of the common bile duct is known as what?

Choledochal cysts are classified as one of the following: (1) localized cystic dilation of the common bile duct; (2) diverticulum from the common bile duct; (3) dilation of the entire common bile duct and common hepatic duct; and (4) invagination of the common bile duct into the duodenum.

A gallbladder with a small outpuch at the neck is called a?

Hartmann Pouch

Onset of pain while scanning over the gallbladder is termed?

Murphy's sign

Klatskin tumors cause: a. dilatation of intrahepatic ducts b. porcelain gallbladder c. dilatation of extrahepatic ducts d. gallstones

a. dilatation of intrahepatic ducts

A patient presents with a dilated intrahepatic duct, dilated gallbladder, and a dilated common bile duct. Identify the level of obstruction this is most likely characteristic of: a. distal common bile duct b. proximal common duct c. neck of the gallbladder d. cystic duct

a. distal common bile duct

The common bile duct is joined by the main pancreatic duct. Together they open through the _____________________ into the duodenal wall.

ampulla of Vater

A fold at the fundal portion of the gallbladder is usually called a. Hartman's pouch b. Phrygian cap c. junctional fold d. valves of Heister

b. Phrygian cap

A 3 year-old child with a clinical history of intermittent pain, jaundice, and a palpable mass presents for an abdominal sonogram. A cystic dilation of the common bile duct is seen in the liver. This is most characteristic of a. biliary atresia b. choledochal cyst c. hepatitis d. hypertrophy pyloric stenosis e. normal liver finding

b. choledochal cyst

The common bile duct is formed by the: a. cystic duct joining the right hepatic duct b. common duct joining the cystic duct c. common duct joining the pancreatic duct d. right and left hepatic ducts joining the cystic duct e. common duct joining the neck of the gallbladder

b. common duct joining the cystic duct

A gallbladder sonographic examination is performed and a small gallbladder with intrahepatic dilatation is seen. This finding may indicate that the level of obstruction is at the level of the: a. cystic duct b. common hepatic duct ! c. common bile duct d. neck of the gallbladder

b. common hepatic duct

Carcinoma of the gallbladder would most likely appear as a(n): a. thin-walled gallbladder b. diffusely thickened gallbladder wall with gallstones c. large gallbladder with a halo surrounding itd. small gallbladder with thickened walls

b. diffusely thickened gallbladder wall with gallstones

Adenomyomatosis of the gallbladder is a. an inflammation of the gallbladder and biliary ducts b. proliferation of the mucosal layer which extends into the muscle layer c. a congenital anomaly that presents itself in the fourth or fifth decade of life. d. a malignant process that involves the gallbladder wall and lumen

b. proliferation of the mucosal layer which extends into the muscle layer

When performing a gallbladder examination, the patient is asked to be NPO for approximately 6-8 hours before the examination because this will: a. eliminate any overlying bowel gas b. make the patient more cooperative c. cause bile to collect in the gallbladder d. dehydrate the patient which will make the patient easier to scan

c. cause bile to collect in the gallbladder

Long-standing cystic duct obstruction will give rise to a: a. gallblader contraction b. septated gallbladder c. hydropic gallbladder d. porcelain gallbladder

c. hydropic gallbladder

The gastrointestinal peptide hormone, which stimulates gallbladder contraction is known as?

cholecystokinin (CCK)

The hepatic duct is joined by the ______________ to form the ________________.

cystic duct; common bile duct

Nonshadowing, nonmobile, echogenic foci imaged within the gallbladder lumen are most likely: a. sludge balls b. thin bile c. calculi d. polyps

d. polyps

A 42-year-old female presents postcholecystectomy with RUQ pain, elevated bilirubin, and bilirubin in her urine. This is the best characteristic of: a. pancreatic pseudocyst b. hepatitis c. alkaline phosphatase will be normal d. stone, tumor, or stricture causing obstruction of the bile duct

d. stone, tumor, or stricture causing obstruction of the bile duct

All of the following are characteristic for dilated intrahepatic bile ducts except a. irregular borders to dilated bile ducts b. the parallel channel sign c. echoenhancement behind dilated ducts d. do not fill with color e. decreasing size as they course toward the porta hepatis

e. decreasing size as they course toward the porta hepatis

Whats a Phrygian cap?

folding of the gallblabber fundus.

The bright linear echo within the liver connecting the neck of the gallbladder and the right or main portal vein is called the?

main lobar fissure

The cystic duct connects the _________ of the gallbladder with the common hepatic duct to form the ___________.

neck of the GB, CBD

The distal duct lies ___________ with the anterior wall of the inferior vena cava (IVC).

parallel

Calcification of the gallbladder wall is called what?

porcelain GB

The spiral valves of Heister are located in the what?

proximal portion of the cystic duct

A patient presents with empyema of the gallbladder, the sonographer should expect to find?

pus within the gallbladder

The common bile duct is joined by the pancreatic duct as they enter the ________ of the duodenum

second portion