Biliary System

Question 1

What is acalculus cholecystitis?

Answer 1

Inflammation without associated GB stones

Question 2

What hormone causes the GB to contract? Where is it produced?

Answer 2

Cholecystokinin –produced in the duodenum

Question 3

What is Courvoisier GB?

Answer 3

the clinical detection of an enlarged, palpable GB caused by a biliary obstruction in the area of the pancreatic head. Pt’s will have painless jaundice

Question 4

What is the IV administration of nutrients and vitamins called?

Answer 4

Hyperalimentation

Question 5

What are Rokitansky-Aschoff sinuses?

Answer 5

Tiny pockets within the GB wall

Question 6

What are risk factors and predisposing factors for stones?

Answer 6

pregnancy
obesity
increased parity
gestational diabetes
estrogen therapy
rapid weight loss programs
hemolytic disorder
total parental nutrition

Question 7

Polyps should measure under?

Answer 7

5mm –otherwise they may be suspicious for carcinoma

Question 8

Acalculus cholecystitis is most commonly seen in?

Answer 8

Children, hospitalized patients and those who are immunocompromised

Question 9

Is GB carcinoma associated w gall stones?

Answer 9

Yes

Also associated w porcelain GB and chronic cholecystitis

Question 10

The most common metastatic disease of the GB is?

Answer 10

Melanoma

Question 11

The cystic artery is a branch of the?

Answer 11

Right hepatic artery

Question 12

The middle layer of the GB wall is the:

Answer 12

fibromuscular layer

Question 13

WES sign denotes:

Answer 13

A GB filled with cholelithiasis

Question 14

Intermittent obstruction of the cystic duct by a gallstone results in:

Answer 14

chronic cholecystitis

Question 15

A nonmobile, nonshadowing focus seen in the GB lumen is likely a:

Answer 15

polyp

Question 16

The sequela of acute cholecystitis that is found more often in diabetic patients is:

Answer 16

Emphysematous cholecystitis

Question 17

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

Answer 17

Adenomyomatosis

Question 18

Courvoisier’s GB is most associated with:

Answer 18

Pancreatic head mass

Question 19

What type of choledochal cyst is most common?

Answer 19

Type 1 – a fusiform dilation of the CBD

Question 20

What type of choledochal cyst are true diverticula of the bile ducts and are very rare?

Answer 20

Type 2

Question 21

What type of choledochal cyst are confined to the intraduodenal portion of the CBD?

Answer 21

Type 3

Question 22

What’s the difference between type 4a and 4b choledochal cysts?

Answer 22

A- multiple intrahepatic and extrahepatic biliary dilations

B- only extrahepatic dilations

Question 23

Caroli syndrome is associated with?

Answer 23

Renal tubular ectasia (medullary sponge kidneys)

Question 24

What’s the difference between primary and secondary choledocholithiasis?

Answer 24

Primary - stones likely caused by diseases that cause strictures/dilations to the bile ducts
Secondary - migration of stones from GB to CBD

Question 25

Where are CBD stones most likely to be located?

Answer 25

Distal portion or at the ampulla of Vater

Question 26

What are the symptoms of Mirizzi syndrome?

Answer 26

Pain
Jaundice
Fever

Question 27

What’s the difference between Mirizzi syndrome and acute/chronic cholecystitis?

Answer 27

Sonographically very similar, but the dilation will be to the CHD and there will be surrounding edema

Question 28

Metastases to the biliary tree most commonly come from?

Answer 28

Breast, colon and melanoma