Gallbladder and Biliary Ducts Final Exam Review

acute cholecystitis has a

+ Murphy sign

for patients older than 60, or those who have had a cholecystectomy, a maximum diameter of ___ may be considered normal

1 cm

the gallbaldder is a pear shaped organ with normally smooth walls. If the walls are greater than ___ thick, this would suggest a pathologic finding

3 mm

the GB wall should not measure more than

3mm

the diameter of the GB wall should not exceed

3mm

which of the following is not assocaited with the development of pneumobillia A - cholangiopneumonia B - gastric surgery C - acute cholecystitis D - fistula formation

A - cholangiopneumonia

which of the following is a sonographic finding for a dilated CBD A - double barrel shotgun sign B - too many cystic structures seen in liver parenchyma D - hepatomegaly

A - double barrel shotgun sign

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 - commone bile duct

A - intrahepatic radicles

which structure is a useful landmark for identifying the GB A - main lobar fissure B - hepatoduodenal ligament C - falciform ligament D - ligamentum venosum

A - main lobar fissure

a patient presents with an enlarged GB, no jaundice, and otherwise normal findings on sonography. Which condition is the most likely cause of obstruction? A - stone in cystic duct B - Klatzkin tumor C - pancreatic head mass D - phrygian cap stone

A - stone in cystic duct

WES sign denotes

A GB filled with cholelithiasis

a 32 year old patient presents to the sonography department with vauge abdominal pain. The sonographic investigation of the GB reveals a focal area of the GB wall thickening that produces comet tail artifact. These findings are consistent with

Adenomyomatosis

consider the severly jaundiced pateint due to obstruction. which of the following would you not expect to find A- enlarged GB B - clear sclera C - elevated bilirubin D - possible dilated biliary system

B - clear sclera

which one of the following is not considered to be criteria for the osnographic diagnosis of cholelithiasis A - intraluminal reflectors B - increased thru transmission C - reflector movement with position change D - ultrasonic shadowing

B - increased thru transmission

which of the following would be least likely to cause focal GB wall thickening A - GB poylp B - adenomyomatosis C - ascites D - adhered gallstone

C - ascites

which of the following is not a plausible cause of CBD obstruction in adults A - choledocholithiasis B - chronic pancreatitis C - cholecochal cyst D - pancreatic carcinoma

C - cholecochal cyst

A patient presents with dialted intra hepatic ducts and otherwise normal findings on sonography. Where is the most likely location of obstruction A - CBD B - duct of santorini C - CHD D - cystic duct

C - common hepatic duct

clinical findings of choledocholithiasis include all of the following except A - jaundice B - elevated bilirubin C - elevated BUN D - elevated ALP

C - elevated BUN

if a gallstone, causing obstruction, is lodged within the distal common hepatic duct, which of the following becomes dilated A - main pancreatic duct B - gallbladder only C - intrahepatic ducts D - distal CBD

C - intrahepatic ducts

which of the following is the most distal portion of the biliary tree A -CBD B - CHD C - GB D - intrahepatic radicles

CBD

the presence of an echogenic dot in the nondependent part of the dialted duct representing small fibrovascualr bundles is seen with

Caroli's Disease

which congenital anaomaly presents as a cystic mass in the porta hepatis which is separate from the GB

Choledochocele

a 71 year old pt presents to the ED with painless jaundice and an enlarged, palpable GB. These findings are highly suspicious for

Courvoisier GB

which of the following would be the least helpful laboratory value to analyze in patients with suspected biliary tract disease A - ALT B - ALP C - GGT D - Creatine

Creatine

A patient presents with obstructive jaundice. On the ultrasound, low level echoes are noted in the dependent portion of the GB. This finding represents A - viscid bile B - cholelithiasis C - sludge D - A and C

D - A and C

which of the following would be be a lab finding analyzed with suspected GB disease A - ALP B - ALT C - bilirubin D - AFP

D - AFP

which of the following would be the most common cause of obstructive jaundice A - Klatskin tumor B - cholangiocarcinoma C - bilioary atresia D - Choledocholithiasis

D - Choledocholithiasis

all of the following are sources of diffuse GB wall thickening except A - acute cholecystitis B - AIDS C - Hepatitis D - GB polyp

D - GB polyp

sonographic non-visualization of the GB is due to A - patient ate B - cholecystectomy C - GB with WES sign D - all of the above

D - all of the above

which of the following is the most likely clinical finding of adenomyomatosis A - Murphy sign B - Hepatitis C - congestive heart failure D - asymptomatic

D - asymptomatic

all of the following are clinical findings consistent with cholangiocarcinoma except A - pruritus B - weight loss C - elevated bilirubin D - dialtion of the intrahepatic ducts

D - dialtion of the intrahepatic ducts

all of the following are forms of cholangitis except A- Acute bacerial B - AIDS C - Oriental D- Parabolic

D- Parabolic

tumerfactive sludge can resemble the SA of

GB carcinoma

a nonmobile, nonshadowing focus is seen within the GB lumen. This most likely represents a

GB polyp

a patient presents with jaundice, pain, fever, secondary to an impacted stone in the cystic duct

Mirizzi syndrome

The most common variant of gallbladder shape is the:

Phrygian cap

A pateint presents with epigastric pain, nausea, and vomitting. The sonogrpaher notes that the GB wall appears similar to "onion skin" and theres no sonogrpahic evidence of stones. the pancreas appears to be sonographically normal. the most possible diagnosis would be

acalculous cholecystitis

A pateitn comes to US department with the hisotry of weight loss and anorexia. The ultrasound demonstates a non-shadowing, intra-lumnial mass with focal GB wall thickening. This finding must raise the question of

adenocarcinoma

Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with:

adenomyomatosis

if an onbstructive biliary calculus is located within the distal CBD which of the following would ultimately dialte A - CBD B - GB C - Common hepatic duct D - all of the above

all of the above

which technique may be used to enhance the imaging of gallstones A - switching to a higher frequency B - changing the patients position C - changing the scanning approach/angle D - all of the above

all of the above

the merging point of the pancreatic duct and the CBD at the level of the duodenum is referred to as the

ampulla of Vater

the Klatskin tumor is located

at the junction of the right and left hepatic ducts

A NPO neonate comes to the ultrasound department from the NICU. The sonographer cannot locate the GB. The sonographer should consider a congenital anomaly known as

biliary atresia

a congenital disease in which there is narrowing or obliteration of the bile ducts

biliary atresia

which of the following disorders is assocaited with the sonographic triangular cord sign

biliary atresia

the yellowish pigment found in bile that is produced by the breakdown of old RBC by the liver is

bilirubin

at what level is the junctional fold found

body

ascariasis is

caused by a parasitic roundworm

A klatskin tumor is a form of

cholangiocarcinoma

primary bilary tree cancer is referred to a

cholangiocarcinoma

a 32 year old female patient presents to the sonogrpahy 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 liekly diagnosis

cholangitis

inflammation of the bile ducts is referred to as

cholangitis

which of the following is associated with charcot triad

cholangitis

what hormone causes the GB to contract

cholecystokinin

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 a cystic mass within the CBD that is causing focal enlargement. This is most suggestive of

choledochal cyst

which of the following is typically found in pediatric patients and is described as the cystic diliation of the common bile duct

choledochal cyst

A gallstone located within the bilary tree

choledocholithiasis

which of the following would not be the least likely finding of acalculous cholecystitis

cholelithiasis

the diffuse polypoid appearance of the gallbladder referred to as strawberry GB is seen with

cholesterolosis

A sonographer has documented a small gallbaldder with stones on an elderly patient who was NPO for a RUQ study. The patient has negative murphy's sign. The patient may be diagnosed with

chronic cholecystitis

Intermittent obstruction of the cystic duct by a gallstone results in

chronic cholecystitis

a choledochal cyst is a _____ abnormality

congenital

The direct blood supply to the gb is the

cystic artery

the GB is connected to the biliary tree by

cystic duct

the spiral valves of heister are found within the

cystic duct

the spiral valves of heister are located within the

cystic duct

upon discovering a mass in the head of the pancreas, the sonographer should evaluate the biliary system for A - hemangiomata B - dilated ducts C - pseduocysts D - abscesses

dialted ducts

penumobilia will produce

dirty shadow

the most common level for bilary obstruction is

distal common bile duct

Gangrenous cholecystitis must be considered when the following SA is/are present in the GB lumen

echogenic air and dirty shadowing

diabetic patients suffering from acute cholecystisis have an increased risk for developing

emphysematous cholecystitis

the champagne sign is associated with

emphysematous cholecystitis

the sequela of acute cholecystitis that is complicated by gas within the GB wall is

emphysematous cholecystitis

Courvoisiers Law refers to

enlarged GB due to CBD obstruction

which segment of biliary tree tends to dilate first with obstruction

extrahepatic

the middle layer of the GB wall

fibromuscular layer

hepatization of gallbladder occurs when the GB

fills with sludge

empyema of the GB denotes a

gallbladder filled with pus

what is/are cholelithiasis

gallstones

acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes

gangernous cholecystitis

causes of extrinisic GB wall thickening

hepatitis portal HTN cirrhosis ETOH pancreatitis renal disease recent meal hypoproteinemia cardiac failure congestive heart failure

the yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or bilary obstruction is referred to as

jaundice

the innermost layer of the GB wall is the

mucosal layer

focal tenderness over the gallbladder with probe pressure describes

murphy sign

which portion of the GB is involved in Hartmans pouch

neck

what is courvoisier GB associated with

pancreatic head mass

air within the biliary tree is referred to as

pneumobilia

sonographically, you visualize scattered echogenic linear structures within the liver parechyma that produce ring down artifact. What is your most likely dx?

pneumobilia

calcification of the GB wall

porcelain GB

what are some risk factors for developing gallstones

pregnancy, TPN, oral contraceptive use

the cystic artery is most often a direct branch of the

right hepatic artery

which of the following is characterized by fibrotic thickening of the bile ducts, found most often in young males, and is assocaited with inflammatory bowel disease or ulcerative colitis

sclerosing cholangitis

the outermost layer of the GB is the

serosal layer

what is associated with cholelithiasis and characteristically found in Africans or people of African decent

sickle cell disease

the muscle that controls the emptying of bile and pancreatic juices into the duodenum is the

sphincter of odi

choledocholithiasis refers to

stones in the bile ducts

TRUE OR FALSE: the bile ducts follow the same course as the portal venous system and branches of the hepatic arteries within the liver parenchyma

true