Chapter 4: The Bile Ducts (Penny)

d. biliary atresia

1. A congenital disease in which there is narrowing or obliteration of the bile ducts is referred to as: a. caroli disease b. mirizzi disease c. choledochal cysts d. biliary atresia

d. cystic duct

10. the spiral valves of Heister are located within the: a. CBD b. pancreatic duct c. Common hepatic duct d. cystic duct

c. intrahepatic ducts

11. If a gallstone, causing obstruction, is located within the distal common hepatic duct, which of the following would become dilated? a. CBD only b. GB only c. intrahepatic ducts d. all of the above

a. intrahepatic radicles

12. 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. CBD

a. CBD

13. Which of the following would be the most distal portion of the biliary tree? a. CBD b. common hepatic duct c. GB d. intrahepatic radicles

d. all of the above

14. If an obstructive biliary calculous is located within the distal common duct, which of the following could ultimately dilate? a. CBD b. GB c. common hepatic duct d. all of the above

a. cystic duct

15. The GB is connected to the biliary tree by the: a. cystic duct b. ampulla of vater c. sphincter of Oddi d. CBD

c. distal common bile duct

16. The most common level for 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

b. cholangitis

17. A 32 yr old female patient present 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? a. choledocholithiasis b. cholangitis c. mirrizi syndrome d. biliary atresia

a. pneumobilia

18. Sonographically, you visualize scattered echogenic linear structures within the liver parenchyma that produce ring-down artifact. What is the most likely diagnosis? a. pneumobilia b. choledocholithiasis c. sludge balls d. cholesterolosi

d. Cholangiocarcinoma

19. A 64 year old man presents to the sonography department for a RUQ sonogram. He is complaining of abdominal pain, weight loss, and pruritus. 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

c. cholangiocarcinoma

2. Primary biliary tree cancer is referred to as: a. GB carcinoma b. biloma c. cholangiocarcinoma d. lymphangioma

c. choledochal cyst

20. 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 CBD that is causing a focal enlargement. This is most suggestive of: a. cholangiocarcinoma b. mirizzi syndrome c. choledochal cyst d. biliary atresia

d. dilatation of the intrahepatic ducts

21. All of the following are clinical findings consistent with cholangiocarcinoma except: a. pruritis b. weight loss c. elevated bilirubin d. dilatation of the intrahepatic ducts

a. cholangiopneumonia

22. Which of the following is not associated with the development of pneumobilia? a. cholangiopneumonia b. gastric surgery c. acute cholecystitis d. fistula formation

b. cholangiocarcinoma

23. A klatskin tumor is a form of: a. lymphocytic carcinoma b. cholangiocarcinoma c. pancreatic carcinoma d. gallbladder carcinoma

d. 5mm

24. The biliary duct wall should never measure more than: a. 2mm b. 9mm c. 4mm d. 5mm

c. elevated BUN

25. Clinical findings of choledocholithiasis include all of the following except: a. jaundice b. elevated bilirubin c. elevated BUN d. elevated alkaline phosphatase

b. extrahepatic

26. Which segment of the biliary tree tends to dilate first with obstruction? a. intrahepatic b. extrahepatic

c. choledochal cysts

27. Which of the following is not a plausible cause of CBD obstruction in adults? a. choledocholithiasis b. chronic pancreatitis c. choledochal cysts d. pancreatic carcinoma

d. parabolic

28. All of the following are forms of cholangitis EXCEPT: a. acute bacterial b. AIDS c. oriental d. parabolic

b. bilirubin

29. 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. ampulla of vater

3. the merging point of the pancreatic duct and CBD at the level of the duodenum is referred to as: a. sphincter of Oddi b. ampulla of vater c. CBD d. cystic duct

a. 1 cm

30. For patients older than age 60, or those who have had a cholecystectomy, a maximum diameters of ______ may be considered normal: a. 1 cm b. 12 mm c. 14 mm d. 1.5 cm

b. choledocholithiasis

4. A gallstone located within the biliary tree is referred to as: a. cholecystitis b. choledocholithiasis c. cholangitis d. cholangiocarcinoma

c. jaundice

5. The yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstructed is referred to as: a. AIDS cholangitis b. pruritis c. jaundice d. bilirubinemia

a. at the junction of the right and left hepatic ducts

6. The klatskin tumor is located: a. at the junction of the right and left hepatic ducts b. at the junction of the cystic and CBD c. at the junction of the CBD and common hepatic duct d. between the pancreatic head and duodenum

d. cholangitis

7. inflammation of the bile ducts is referred to as: a. pneumobilia b. choledocholithiasis c. cholelithiasis d. cholangitis

b. mirizzi syndrome

8. A patient presents with jaundice, pain, 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

a. pneumobilia

9. Air within the biliary tree is referred to as: a. pneumobilia b. cholangitis c. choledocholithiasis d. cholesterolosis

cystic renal disease

Caroli's disease is associated with _______

cholangitis portal hypertension pancreatitis liver failure

Choledochal cysts can lead to:

1. recent biliary surgery 2. symptoms of acute cholecystitis

Clinical finding of pneumobilia include:

1. jaundice 2. pain 3. fever

Clinical findings of choledochal cysts:

1. jaundice 2. elevated bilirubin 3. elevated alkaline phosphatase 4. RUQ pain

Clinical findings of choledocholithiasis

10mm

For patients older than 60 who have had a cholecystectomy, the maximum diameter of the CBD to be considered normal is ____mm

these tumors are located at the junction of the right and left hepatic ducts and cause dilation of the intrahepatic ducts. associated with cholangiocarcinoma

Klatskin tumor

endoscopic retrograde cholangiopancreatography

Mirizzi syndrome is suspected on ultrasound, but is confirmed by cholangiography or _____________

7mm

Normal AP diameter of the CBD is between 1mm and ___ mm

1. echogenic foci within the bile duct that may or may not shadow 2. may have biliary dilatation but not always

Sono findings of choledocholithiasis

1. sonographically absent biliary ducts 2. cirrhosis and portal hypertension

Sonographic findings of biliary atresia:

true

True or False.Jaundice occurs as a consequence of bilirubin accumulation within the tissues of the body.

-acute bacterial -AIDS -oriental (recurrent pyogenic cholangitis) -sclerosing

Types of cholangitis include:

common bile duct (CBD)

When stimulated by the hormone CCK (cholecystokinin) that is produced in the duodenum, the GB contracts and empties bile into the biliary tree at the level of the proximal ________ duct

the liver

Where is bile produced?

biliary stasis

a condition in which bile is stagnant and allowed to develop into sludge or stones

biliary atresia

a disease described as the narrowing or obliteration of all or portion of the biliary tree

bilirubin

a yellow pigment found in bile that is produced by the breakdown of red blood cells by the liver

pneumobilia

air within the biliary tree is known as

pneumobilia

air within the biliary tree is referred to as

Mirizzi syndrome

an uncommon manifestation of choledocholithiasis; clinical condition when the patients presents with pain, jaundice, and fever secondary to a stone lodged in the cystic duct.

porta hepatis aka liver hilum

area of the liver where the portal vein and hepatic artery enter and the hepatic ducts exit

congenital disease that is thought to be caused by a viral infection at birth

biliary atresia

the presence of a gallstone within the biliary tree

choledocholithiasis

1. jaundice 2. pruritis 3. unexplained weight loss 4. abdominal pain 5. elevated bilirubin 6. elevated alkaline phosphatase

clinical findings of cholangiocarcinoma:

1. fever 2. leukocytosis 3. jaundice 4. RUQ pain 5. elevated alkaline phosphatase 6. elevated bilirubin

clinical findings of cholangitis include:

Caroli disease

congenital disorder characterized by segmental dilation of the intrahepatic ducts

"shotgun" or "parallel tube" sign

enlargement of the common duct to the size of the adjacent portal vein is known as the ________ or _______ sign

cholangitis

inflammation of the biliary ducts, where the bile ducts walls thicker than 5mm

1. choledocholithiasis 2. chronic pancreatitis 3. acute pancreatitis 4. pancreatic carcinoma

most common causes of CBD obstruction are:

distal CBD

most common location of obstruction in the CBD is prox/mid/or distal?

Klatskin tumor

most common manifestion of cholangiocarcinoma

CBD

most distal segment of the biliary tree

chyme

partially digested food

cholangiocarcinoma

primary biliary tree cancer.

severe itchiness to the skin

pruritus

1. biliary dilatation 2. sludge 3. stones 4. duct wall thickening

sono findings of cholangitis include:

1. segmental dilatation of the intrahepatic ducts 2. patient may also have cystic renal disease

sonographic finding of caroli disease

echogenic linear structure within the ducts that produce ring down artifacts and have dirty shadowing

sonographic finding of pneumobilia include:

1. dilated intrahepatic ducts that abruptly terminate at the level of the tumor 2. solid mass may be noted within the liver or ducts

sonographic findings of cholangiocarcinoma:

1. cystic mass in the area of porta hepatis 2. biliary dilatation

sonographic findings of choledochal cysts:

serum bilirubin

the amount of bilirubin found in the blood

spiral valves of Heister that prevent the duct from collapsing

the cystic duct contains

digestion

the function of bilirubin is to assist in _______

small

the function of the biliary tree is to provide a conduit for bile to drain from the liver into the ________ intestine

cystic duct

the gallbladder is attached to the biliary tree by the

ampulla of vater aka hepatopancreatic ampulla

the merging point of the pancreatic duct and common bile duct just before the sphincter of Oddi, where the pancreatic juices and bile are mixed together

ampulla of Vater

the merging point of the pancreatic duct and common bile ducts at the level of the duodenum

sphincter of oddi aka hepatopancreatic sphincter

the opening that allows bile and pancreatic juices to flow into the DUODENUM

false, have poor prognosis and will suffer from cirrhosis and portal hypertension

true or false. Pediatric patient with biliary atresia have a good prognosis and infants will not suffer from cirrhosis and portal hypertension.

Klatskin tumor

tumor located at the junction of the right and left hepatic ducts