Gallbladder and Biliary System
For patients older than 60, of those who have had a cholecystectomy, a maximum diameter of _______ may be considered normal
1cm
The gallbladder wall should measure no more than
3mm
Thickness of the gallbladder wall in a normal fasting patient should not exceed
3mm
The diameter of a normal fasting adult gallbladder should not exceed
5cm
The diameter of the gallbladder should not exceed
5cm
The biliary duct wall should never measure more than
5mm
Which enzyme is produced primarily by the liver, bone and placenta?
Alkaline phosphate
Yellow pigment in bile formed by the breakdown of red blood cells.
Bilirubin
The innermost layer of the gallbladder wall is the
Mucosal layer
The most common variant of gallbladder shape is the
Phrygian cap
Which of the following conditions is most likely to occur with an episode of prolonged fasting? a. Cholelithiasis b. Biliary sludge c. Cholangitis d. Gallbladder carcinoma e. Polypoid mass
b. Biliary sludge
A 43-year old female patient presents to the ER complaining of RUQ pain and sudden onset of jaundice. Which of the following findings is identified in this sonogram? a. Cholangitis b. Choledocholithiasis c. Cholangiocarcinoma d. Cholecystitis e. Pancreas neoplasm
b. Choledocholithiasis
All of the following are possible complications of acute cholecystitis EXCEPT: a. Septicemia b. Cholelithiasis c. Liver abscess d. Empyema e. Perforation of the gallbladder
b. Cholelithiasis
Indications for a biliary sonogram include all of the following EXCEPT: a. Abdominal pain b. Postprandial pain c. Positive McBurney sign d. Elevation of liver function tests e. Intolerance to fatty foods
c. Postive McBurney sign (appendicitis)
Smal polypoid projections from the gallbladder wall
Adenomyomatosis
The merging point of the pancreatic duct and common bile duct at the level of the duodenum is referred to as
Ampulla of Vater
A congenial disease in which there is narrowing or obliteration of the bile ducts is referred to as
Biliary atresia
A Klatskin tumor is a form of
Cholangiocarcinoma
Which hormone stimulates gallbladder contraction and the secretion of pancreatic enzymes
Cholecystokinin
An abdominal sonogram is ordered on an infant in the ICU who is suffering from jaundice and fever. Sonographically, you visualize a cystic mass within the common bile duct that is causing a focal enlargement. This is most suggestive of
Choledochal cyst
Dilation of the common duct that may cause obstruction.
Choledochal cyst
Cholangiocarcinoma located at the junction of the right and left hepatic ducts is termed a(n)
Klatskin tumor
In the portal hepatis, the common hepatic duct is located
Lateral to the proper hepatic artery
Air within the biliary tree is referred to as
Pneumobilia
Sonographically, you visualize scattered echogenic linear structures within the liver parenchyma that produces ring-down artifact. What is the most likely diagnosis?
Pneumobilia
The cystic artery is branch of the
Right hepatic artery
Complications in biliary atresia include all of the following except: a. Death b. Cirrhosis c. Cholangitis d. Portal hypertension e. Hydropic gallbladder
e. Hydropic gallbladder
The biliary system has 3 main functions. Which of the following describes one of these functions? a. Produces bile b. Produces cholesterol c. Stores enzymes d. Stores fat e. Stores bile
e. Stores bile
Dilation of the intrahepatic ducts with normal extrahepatic ducts is characteristic of
A Klatskin tumor
WES sign denotes
A gallbladder with cholelithiasis
A small septation located between the neck and body of the gallbladder BEST describes:
A junctional fold
A patient presents with a sudden onset of abdominal pain and extreme tenderness over the gallbladder fossa. Localized gallbladder wall thickening is visualized on US. This most likely represents
Acute cholecystitis
A 32-year old female patient presents to the sonography department with vague abdominal pain. The sonographic investigation of the gallbladder reveals a focal area of gallbladder wall thickening that produces comet tail artifact. These findings are consistent with
Adenomyomatosis
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with
Adenomyomatosis
The Klatskin tumor is located
At the junction of the right and left hepatic ducts
Condition in which the bile ducts become narrowed
Biliary atresia
Complications with Choledocholithiasis would most likely include
Biliary obstruction
Nonshadowing, low-amplitude echoes located in the dependent portion of the gallbladder BEST describes
Biliary sludge
The yellow pigment found in bile that is produced by the breakdown of old red blood cells by the liver is
Bilirubin
Which liver function tests is produced from the breakdown of hemoglobin
Bilirubin
A 64-year old man presents to the department for a RUQ sonogram. He is complaining of abdominal pain, weight loss, and pruritus. Sonographically, you visualize an area of dilated ducts the abruptly end. What is the most likely diagnosis?
Cholangiocarcinoma
Primary biliary tree cancer is referred to as
Cholangiocarcinoma
A 32-year old female patient presents to the sonography department with a history of fever, leukocytosis, and RUQ pain. Sonographically, you visualize dilated bile ducts that have thickened walls and contain sludge. What is the most likely diagnosis?
Cholangitis
Infection of the bile duct, caused by bacteria ascending from its junction with the duodenum.
Cholangitis
Inflammation of the bile ducts is referred to as
Cholangitis
Inflammation of the gallbladder; may be acute or chronic.
Cholecystitis
What hormone causes the gallbladder to contract?
Cholecystokinin
Procedure creating an anastomosis of the common bile duct to the jejunum; to relieve symptoms of biliary obstruction and restore continuity to the biliary tract.
Choledochojejunostomy
A gallstone located within the biliary tree is referred to as
Choledocholithiasis
Stones in the bile duct
Choledocholithiasis
Intermittent obstruction of the cystic duct by gallstone results in
Chronic cholecystitis
A 71-year old patient presents to the emergency department with painless jaundice and an enlarges, palpable gallbladder. These findings are highly suspicious for:
Courvoisier gallbladder
The direct blood supply to the gallbladder is the
Cystic artery
The gallbladder is connected to the biliary tree by the
Cystic duct
The spiral valves of Heister are found within the
Cystic duct
The spiral valves of Heister are located in which structure?
Cystic duct
The spiral valves of Heister are located within the
Cystic duct
The most common level for biliary obstruction to occur is the
Distal common bile duct
The distal portion of the common bile duct terminates in which structure?
Duodenum
The sequela of acute cholecystitis that is found more often in diabetic patients is
Emphysematous cholecystitis
The sequela of acute cholelithiasis that is complicated by gas within the gallbladder wall is
Emphysematous cholecystitis
Which segment of the biliary tree tends to dilate first with obstruction
Extrahepatic
The middle layer of the gallbladder wall is the
Fibromuscular layer (subserosa)
As dilation of the intrahepatic biliary tree progresses, the portal system becomes
Flattened
Tumefactive sludge can resemble the sonographic appearance of
Gallbladder carcinoma
A nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represents a
Gallbladder polyp
What is/are cholelithiasis
Gallstones
Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes
Gangrenous cholecystitis
A small protrusion near the neck of the gallbladder describes
Hartmann pouch
Which technical factor would most likely aid in demonstrating shadowing posterior to small-caliber gallstones?
Increased transducer frequency
The yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as
Jaundice
Which structure is a useful landmark for identifying the gallbladder?
Main lobar fissure
All of the following are sources of diffuse gallbladder wall thickening except
Malignant ascites
A patient presents with jaundice, pain, and fever secondary to an impacted stone in the cystic duct. This is referred to as
Mirizzi syndrome
Focal tenderness of the gallbladder with probe pressure describes
Murphy's sign
Hartmann pouch involves which part of the gallbladder
Neck
The junctional fold is found at which level of the gallbladder
Neck (where neck and body meet)
A decrease in diameter of the common bile duct after ingestion of a fatty meal is associated with
Normal findings
In biliary obstruction, identifying multiple anechoic tubular structures in the left lobe of the liver is termed
Parallel channeling
The outermost layer of the gallbladder wall is the
Serosal layer
Which of the following patient positions may aid in visualization of the cystic duct?
Trendelenburg or right lateral decub
Which of the following is not associated with the development of pneumobilia? a. Cholangiocarcinoma b. Gastric surgery c. Acute cholecystitis d. Fistula formation
a. Cholangiocarcinoma
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
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
Which statement is not true of cholelithiasis? a. Men have an increased likelihood of developing cholelithiasis b. Patient who have been or are pregnant have an increased occurrence of cholelithiasis c. A rapid weight loss may increase the likelihood of developing cholelithiasis d. Patients who have hemolytic disorders have an increased occurrence of cholelithiasis
a. Men have an increased likelihood of developing cholelithiasis
Courvoisier's gallbladder is associated with which of the following: a. A pancreatic head mass b. A stone in the cystic duct c. Cholecystitis d. Chronic diverticulitis
a: A pancreatic head mass
All of the following are potential differential considerations in cases of pneumobilia EXCEPT: a. Stent b. Cavernous hemangioma c. Biliary calculus d. Arterial calcification e. Surgical clip
b. Cavernous hemangioma
A 73-year old patient complains of vague RUQ pain. A hyperechoic focus with marked posterior acoustic shadowing is demonstrated in the anterior wall of the gallbladder. This history is most consistent with which of the following pathologies? a. Emphysematous cholecystitis b. Porcelain gallbladder c. Cholelithiasis d. Mirizzi syndrome e. Adenomyomatosis
b. Porcelain gallbladder
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
Clinical findings of choledocholithiasis include all of the following except: a. Jaundice b. Elevated bilirubin c. Elevated blood urea nitrogen d. Elevated alkaline phosphate
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 the above
c. Intrahepatic ducts
All of the following are associated with cholesterolosis EXCEPT: a. Cholesterosis b. Cholesterol polyp c. Serum cholesterol levels d. Local disturbance in cholesterol metabolism e. accumulation of triglyceride and esterified sterols in the gallbladder wall
c. Serum cholesterol levels
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 the above
d. All the above
All of the following are clinical findings consistent with cholangiocarcinoma except: a. Pruritus b. Weight loss c. Elevated bilirubin d. Dilation of the intrahepatic ducts
d. Dilation of the intrahepatic ducts
All of the following are considered layers of the gallbladder wall EXCEPT: a. Epithelial b. Serosal c. Muscular d. Endothelial e. Subserosal
d. Endothelial
All of the following are sources of diffuse gallbladder wall thickening except: a. Benign ascites b. Hepatitis c. Congestive heart failure d. Gallbladder polyp
d. Gallbladder polyp
Predisposing factors linked to the development of cholelithiasis include all of the following except: a. Pregnancy b. Obesity c. Diabetes mellitus d. Hepatitis e. Female gender
d. Hepatitis
All of the following are forms of cholangitis except: a. Acute bacterial b. AIDS c. Oriental d. Parabolic
d. Parabolic
Intraductal pressure differences are affected by all of the following EXCEPT: a. Resorption of bile in the gallbladder b. Bile flow from the liver c. Activity of the sphincter of oddi d. Filling of the bile in the gallbladder e. Location of the bile duct
e. Location of the bile duct
