assignments for test 1 Flashcards
Which of the following hormones is primarily responsible for contraction of the gallbladder?
Cholecystokinin
The spleen is a(n) __________________ organ
intraperitoneal
The spleen is covered with peritoneum over its entire extent, except for a small area _____________________
at the splenic hilum
The vessel that serves the spleen and runs across the superioanterior aspect of the pancreas is called the
splenic artery
When a spleen is not found in its normal location it may be termed:
wandering spleen
T/F
Primary tumors of the spleen are common
False
they are rare
A 25-year-old female patient presents to the sonography department for a complete abdominal sonogram. She complains of right lower quadrant pain and nausea. The right upper abdomen appears normal. A small mass is noted in the area of the splenic hilum. This mass appears isoechoic to the spleen. What does this most likely represent?
A) Pancreatic cystadenocarcinoma
B) Splenic hemangioma
C) Splenunculus
Splenunculus
Splenunculus is another name for an accessory spleen. In this case, the finding was purely incidental and not related to the cause of the pain. This finding still must be reported as part of the patient’s medical records.
The process of making red blood cells is termed:
erythropoiesis
The splenic vein marks the:
posterior aspect of the pancreatic body and tail
Where is the most common location of an accessory spleen?
Splenic hilum
What is the most likely clinical finding of a patient who has a splenic hemangioma?
asymptomatic
Which of the following describes the implantation of ectopic splenic tissue possibly secondary to splenic rupture?
Splenosis
Small echogenic foci scattered throughout the spleen most likely represent:
A) multiple benign hemangioma.
B) multiple benign granulomas.
C) malignant lymphoma.
B) multiple benign granulomas.
Although it is rare, what is the primary malignant tumor of the spleen
Angiosarcoma
What is the most common benign mass of the spleen?
Hemangioma
What is the maximum diameter of a normal pancreatic duct in a young adult?
2mm
What vessel courses superior and anterior to the body of the pancreas?
Splenic artery
Red blood cells (RBC) have a life span of 120 days in humans. The process by which the red pulp destroys the degenerating red blood cells is called_______________________.
phagocytosis
Non-shadowing, non-mobile, echogenic foci seen within the gallbladder are called:
polyps
What is the most common location for a pancreatic pseudocyst?
lesser sac
Which of the following regulates the flow of bile from the gallbladder into the duodenum?
Sphincter of Oddi
A patient presents with RUQ pain. You scan to rule out gallstones. You are unable to find the gallbladder and there are no surgical incisions seen. The patient denies a previous cholecystectomy. What can you use as a guide to find the gallbladder?
main lobar fissure
A patient presents with midepigastric pain radiating to the back. Labs indicate an elevated lipase. What pathology do you suspect?
pancreatitis
T/F
Pancreatic pseudocysts can be a congenital finding.
false
A 45 year old woman presents to the ultrasound department. She is post-cholecystectomy and has RUQ pain. She has an elevated serum bilirubin and lab values show that she also has bilirubin present in her urine. You can expect that:
A) She probably has hepatitis
B) She probably has a stone, tumor, or stricture obstructing the bile duct
C) The common duct will probably be less than 5mm in diameter
D) That her alkaline phosphatase lab values will be normal
She probably has a stone, tumor, or stricture obstructing the bile duct
A phrygian cap is:
a fold at the gallbladder fundus
The causes of a large gallbladder may include all of the following except:
A) adenomyomatosis
B) cystic duct obstruction
C) pancreatic carcinoma
D) diabetes mellitus
E) a fasting patient
F) common duct obstruction
A) adenomyomatosis
Which of the following is associated with Caroli disease
A) dilated intrahepatic ducts
B) dilated extrahepatic ducts
C) Courvoisier gallbladder
D) diffuse thickening of the common duct
dilated intrahepatic ducts
Caroli disease is a rare inherited disorder characterized by dilatation of the intrahepatic bile ducts.
There are two types of Caroli disease, the most common being the simple, or isolated case where the bile ducts are widened by ectasia.
The second, which is more complex, cause is known as Caroli Syndrome. This complex form is also linked with portal hypertension and congenital hepatic fibrosis. The differences between the causes of the two cases have not yet been discovered.
Caroli disease is also associated with liver failure and polycystic kidney disease.
Courvoisier’s sign is associated with all of the following except:
a) pancreatic carcinoma
b) dilated gallbladder
c) hepatocellular carcinoma
d) biliary duct dilatation
e) painless jaundice
hepatocellular carcinoma
The most common primary neoplasm of the pancreas is adenocarcinoma. This may do or result in all of the following except:
A) is usually found in the head of the pancreas
B) is accompanied by weight loss and jaundice
C) is accompanied by a dilated gallbladder
D) causes dilatation of the common bile duct
E) complicates the lesser sac
complicates the lesser sac
The portion of the pancreas that lies posterior to the SMA and vein is the:
uncinate process
Occasionally, a pseudocyst may have internal echoes and be confused with an abscess. The distinguish between the two, one should look for:
A) calcifications
B) fluid in the lesser sac
C) gas
D) septations
gas
Pseudocysts can have all of the features mentioned above….but when you add “gas” to the picture, the pseudocyst is infected and air production means an abscess.
Chronic pancreatitis may be associated with all of the following except:
A) increased echogenicity
B) increased cystic duct
C) calcifications
D) dilated pancreatic duct
E) decrease in pancreas size
increased cystic duct
Choledocholithiasis may result in
A) an increase in indirect bilirubin
B) an increase in direct bilirubin and a slight increase in indirect bilirubin
C) bilirubin is not elevated in choledocholithiasis
D) an increase in Meckel’s enzyme
B) an increase in direct bilirubin and a slight increase in indirect bilirubin
Hemolytic disorders may result in
a predominant increase in indirect bilirubin
Islet tumors of the pancreas are most likely to be located:
rarely in the head, frequently in the body or tail
The common bile duct is joined with the pancreatic duct before entering the:
second portion of the duodenum
Which of the following will displace the SMA anteriorly?
left renal vein thrombosis
You should have been looking for ‘uncinate process’ here…but in not finding it you must think about all parts of the body. A pancreatic head mass would not move the SMA anteriorly–perhaps posteriorly and medially depending on the postition of the mass. If you cannot visualize this you must pull out your diagrams.
Elevated serum amylase may be secondary to all of the following except:
A) pancreatic duct obstruction
B) acute pancreatitis
C) liver disease
D) obstruction of the ampulla of vater
liver disease
Which laboratory value is specific for obstructive jaundice?
direct bilirubin
What is the most likely diagnosis in a patient with elevation of CEA, alkaline phosphatase, and GGT?
liver metastasis
Are you guessing at these or looking up the labs?
A 54 year old man undergoes a laparoscopic cholecystectomy for symptomatic gallstone disease. The surgery is uneventful but 2 days after the procedure the patient develops intense abdominal pain. His bilirubin and aspartat transaminases (AST) are elevated. There is no fever. The lipase is normal. What is the most likely cause of this patient’s symptoms?
A) bile leak
B) pancreatitis
C) post-operative infection
D) retained stone
retained stone
This patient most likely has a retained stone in the bile duct. It may have escaped the GB during surgery and now is in teh duct.
No fever rules out infection.
Normal lipase rules out pancreatitis
Bile leaks do not affect AST
The rise in bilirubin along with AST is consistent with obstruction of the CBD
All of the following may contribute to or cause primary sclerosing cholangitis except:
A) ulcerative colitis
B) autoimmune disorders
C) chronic pancreatitis
D) bilomas
bilomas
Hydrops of the gallbladder is
an enlarged gallbladder
Hydrops is dilatation of the gallbladder which is often caused by an obstruction of the cystic duct. It is important to remember this because you must FIND the stone in the cystic duct, and we normally do not see or image the cystic duct. Often the stone may be seen between the gallbladder and the common hepatic duct, but the cystic duct itself is not seen. Sonographers who do not make a conscious effort to look for this stone often miss it.
The gallbladder is a pear-shaped organ that stores and concentrates bile.
Bile
_________________is produced in the small intestine and triggers the gallbladder and pancreas to contract when fats and proteins are present.
Cholecystokinin
Select all correct choices:
Insulin resistance is a condition where cells in the body don’t respond properly to insulin, the hormone that regulates blood sugar. When this happens, the pancreas produces more insulin to compensate, which can lead to ____________________
A) Diabetes
B) Polycystic Ovaries (PCOS)
C) Infertility
D) Steatotic (fatty) liver disease
E) Hypertension
F) Correct answer
G) Metabolic Syndrome
H) Shingles
I) Abnormal lipids
J) Obesity
K) Fever
L) High white count
M) Elevated blood pressure
N) Damage to tiny blood vessels in the retina, which can lead to a condition called retinopathy
A) Diabetes
B) Polycystic Ovaries (PCOS)
C) Infertility
D) Steatotic (fatty) liver disease
E) Hypertension
F) Correct answer
G) Metabolic Syndrome
I) Abnormal lipids
J) Obesity
L) High white count
M) Elevated blood pressure
An ____________ is a rare tumor that grows in the pancreas and produces too much insulin, which can lead to hypoglycemia. They are usually benign and small, but there can be multiple small tumors.
insulinoma
Symptoms of pancreatitis can include (select all correct responses)
A) Pain radiating from the epigastric region to the back
B) Nausea and vomiting
C) Rapid heart rate
D) Fever
E) Swelling and tenderness in your upper abdomen
F) Ascites
G) Lowered blood pressure
H) Decreased lipase
I) Increased bilirubin
J) increased creatinine
K) Decreased BUN
A) Pain radiating from the epigastric region to the back
B) Nausea and vomiting
C) Rapid heart rate
D) Fever
E) Swelling and tenderness in your upper abdomen
F) Ascites
G) Lowered blood pressure
A 60-year-old patient presented to the emergency department with complaints of sudden onset abdominal pain x 1 day.
· Pain was described as severe and located in the right upper quadrant with radiation to the back.
· The patient denied any alcohol use, tobacco use, recreational drug use, or recent abdominal injury.
· Past surgical history: cholecystectomy five years ago.
· All vitals were within normal limits, except for an elevated blood pressure of 178/80 mmHg.
· Complete blood count (CBC) and complete metabolic panel (CMP) were unremarkable, aside from an elevated lipase level (4,986; normal range: 10-140 U/L).
Patient medications include Ozempic (GLP-1) and an occasional Tylenol.
What would you expect to find in this patient?
Pancreatitis
The gallbladder wall should measure not more than:
3mm
Primary biliary tree cancer is referred to as:_______________
cholangiocarcinoma (spelling counts)
t/f
Ascites can cause focal GB wall thickening
false
Thickening caused by ascites will affect the entire GB wall
The innermost layer of the gallbladder wall is the:
mucosal layer.
What hormone causes the gallbladder to contract?
Cholecystokinin
Where does the pancreatic head lie?
caudad to the portal vein and anterior to the IVC
Caudad or Caudal: Inferior to another structure, in the sense of being below it
A congenital disease that is described as narrowing or obliteration of the bile ducts is referred to as:
biliary atresia.
key word is congenital
Diffuse thickening of the gallbladder wall can be seen sonographically in all of the following except
portal hypertension
A patient presents with ampulla of Vater obstruction, distention of the gallbladder, and painless jaundice. Which of the following is this presentation associated with?
Courvoisier’s sign
What is hydrops of the gallbladder?
an enlarged gallbladder
Hydrops is the dilatation (enlargement) of the gallbladder which is caused by an obstruction of the cystic duct. The GB may be palpable.
What is a cause of a small gallbladder?
chronic cholecystitis
What is the normal thickness of the gallbladder wall?
3mm
Which of the following will long-standing cystic duct obstruction give rise to?
A) porcelain gallbladder
B) hydropic gallbladder
C) septated gallbladder
B) hydropic gallbladder
Which of the following would not be a laboratory finding typically analyzed with suspected gallbladder disease?
A) ALT
B) Bilirubin
C) Alpha-fetoprotein
C) Alpha-fetoprotein
Which vessel courses along the posterior surface of the body and tail of the pancreas?
splenic vein
The Klatskin tumor is located:
at the junction of the right and left hepatic ducts
Inflammation of the bile ducts is referred to as:
cholangitis
The common bile duct is joined by the pancreatic duct as they enter the
second portion of the duodenum
The most common variant of gallbladder shape is the:
Phrygian cap.
A gallstone located within the biliary tree is referred to as:
choledocholithiasis
The merging point of the pancreatic duct and common bile duct at the level of duodenum is referred to as the:
ampulla of Vater.
Which of the following is associated with cholelithiasis and is characteristically found in Africans or people of African descent?
Sickle cell disease
What three structures comprise the portal triad?
hepatic artery, portal vein, and bile duct
A patient presents with a dilated intrahepatic duct, dilated gallbladder, and a dilated common bile duct. This is most characteristic of which one of the following levels of obstruction?
distal common bile duct
34 year old patient presents with a positive Murphy sign and elevated WBC. What is the most likely diagnosis?
Acute cholecystitis
Which of the following disorders is associated with the sonographic triangular cord sign?
Biliary atresia
Please see article in module one for more information on the triangular cord sign
Which structure is a useful landmark for identifying the gallbladder?
Main lobar fissure
A 71-year-old patient presents to the emergency department with painless jaundice and an enlarged, palpable gallbladder. These findings are highly suspicious for:
Courvoisier gallbladder.
What GI peptide hormone stimulates gallbladder contraction?
cholecystokinin
Which of the following describes adenomyomatosis of the gallbladder?
A) a congenital anomaly that presents itself in the fourth or fifth decade
B) an inflammation of the gallbladder and biliary ducts
C) associated with chronic hepatitis
D) proliferation of the mucosal layer, which extends into the muscle layer
D) proliferation of the mucosal layer, which extends into the muscle layer
-Adenomyomatosis is a benign condition that can present with right upper quadrant pain.
-It is characterized by hyperplasia of the gallbladder wall mucosa and muscularis propria, with formation of invaginations (diverticula) called Rokitansky-Aschoff sinuses.
-The sonographic finding is the presence of calculi or cholesterol crystals within the sinuses
-More common in women
The cystic artery is most often a direct branch of the:
right hepatic artery.
