Gallbladder and Biliary System

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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


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