ABD 2 — Biliary/GB

Question 1

What is it called when the gallbladder is isoechoic to the liver?

Answer 1

Hepatization

Question 2

What pathology is a sign of gallbladder inflammation and is often confused with subserosal edema?

(Subserosal edema is edematous wall thickening of the gallbladder)

Answer 2

Pericholecystic fluid

Question 3

What are three things that can cause a small or non-visualized gallbladder?

Answer 3

-chronic cholecystitis (gb inflammation)
-obstruction of the common hepatic duct
-a recent fatty meal

(Note: NOT obstruction of the common bile duct)

Question 4

What are three things that are included in the classic definition of gallstones?

Answer 4

Shadowing
Mobility
Seen in two planes

(Note: NOT wall thickening)

Question 5

What is the term for diffuse or localized hyperplasia of the gallbladder mucosa resulting in mucosal diverticula?

Answer 5

Adenomyomatosis

Question 6

Mirizzi syndrome:

Answer 6

Creates a connection between the cystic duct and common hepatic duct

Question 7

What should be suspected with the finding of dilation of the intrahepatic biliary ducts without evidence of extra hepatic dilation?

Answer 7

Klatskin tumor

Question 8

What is the most important factor associated with the formation of cholelithiasis?

Answer 8

Abnormal bile composition

Question 9

A 43 year old jaundiced female arrived at the ultrasound department for an abdominal scan. She has a marked elevated serum bilirubin level and the sonogram revealed intrahepatic dilated tubular structures that do not change with respiration. The most likely diagnosis is:

Answer 9

Obstructive jaundice

Question 10

Sydney is a 5 year old who presents to the emergency room with recurrent fever, right upper quadrant pain, and jaundice. A sonogram demonstrates a 4cm cyst at the porta hepatis that appears to communicate with the common bile duct. What is this most likely representing?

Answer 10

Choledocal cyst

Question 11

What are three risk factors for developing a calculus cholecystitis ?

Answer 11

extrinsic obstruction of the cystic duct
total parenteral nutrition
diabetes mellitus

Note: NOT Abnormal bile composition

Question 12

What is the most likely cause of a thick fibrous gallbladder wall that does not contract properly after a cholecystokinin injection?

Answer 12

Chronic Cholecystitis

Question 13

Primary gallbladder carcinoma typically occurs in patients who are…

Answer 13

50 years or older

Question 14

***Written
There are many non-inflammatory causes of gallbladder wall thickening. Name three of them

Answer 14

-Renal Disease
-Ascites
-Congenital heart failure

Question 15

What is the cause if extrahepatic biliary obstruction?

Answer 15

Choledocholithiasis

Question 16

True/False

A junctional fold is the most common gallbladder variant where there is an incomplete wall between the body and the fundus.

Answer 16

False

Between the body and the neck

Question 17

True/False

The gallbladder is Intraperitoneal

Answer 17

True

Question 18

What are three risk factors for cholangiocarcinoma?

Answer 18

-cholelithiasis
-worker in automotive, textile, rubber, and metal-fabricating industries
-primary sclerosis cholangitis

(Note: NOT Cholesterolosis)

Question 19

What is it called when there is a tear in the GB?

Answer 19

Gallbladder perforation

Question 20

Term for worm in GB:

Answer 20

Ascariasis

Question 21

What is the MOST difficult portion of the biliary system in which to diagnose stones?

Answer 21

Cystic duct

Question 22

True/False

Porcelain Gallbladder and empyema of the gallbladder are often confused for one another but non contrast CT can be performed to help distinguish the which is the calcified porcelain gallbladder

Answer 22

False

Question 23

What is one characteristic of a hydropic gallbladder?

Answer 23

Thin walls

Question 24

Which of the following isn’t diagnosed sonographically?

1. Biliary atresia
2. Adenomyomatosis
3. Diffuse cholesterolosis
4. Chronic cholecystitis

Answer 24

Diffuse cholesterolosis

Question 25

Your next patient is a 52 year old female. While scanning the GB you find the image below. What abnormality would you expect it to be? How did you make that decision? List one possible differential diagnosis and what made you exclude it from your final decision. (28)

Answer 25

This is a cholesterol polyp. It appears to be a non-shadowing mass that is attached to the wall of the gallbladder and is protruding into the gallbladder lumen. I would eliminate cholelithiasis as a diagnosis because the mass is attached to the gallbladder wall (no mobility) and because there is no shadowing coming from the mass as there would be if it was a gallstone.

Question 26

What does porcelain gallbladder refer to?

Answer 26

Calcifications in the gallbladder wall.

Question 27

**Written You found pneumobilia when scanning Mr. Kilgore. What would be the best question to ask him to help validate your finding?

Answer 27

“Have you received any procedures or had any major injuries lately?

Question 28

**Written Name one of the primary cancer sites that metasizes via direct invasion into the gallbladder most commonly

Answer 28

Bile duct

Question 29

***Written Name that pathology!! Do you know your risk factors? You are going to be given a list of risk factors and you need to state what you believe the pathology to be. —pancreatic head mass —ampulla of vater mass —Distal CBD mass —duodenal papilla mass

Answer 29

Courvoisier gallbladder

Question 30

Your next patient is a 12 year old male that has been complaining of abdomen pain off and on. The patient's mother says that she periodically notices a yellowing of his skin as well. While scanning the liver you find the image below. With the sonographic findings and the patient's history what is the most likely diagnosis?

Answer 30

Caroli’s disease