Biliary System Flashcards
hepatization of the GB occurs when the GB:
perforates
becomes hydropic
fills with sludge
undergoes torsion
fills with sludge
A 71 year old patient presents to the ER with painless jaundice and an enlarged, palpable GB. These findings are highly suspicious for:
acute cholecystitis
chronic cholecystitis
courvoisier GB
porcelain GB
courvoisier GB
the innermost layer of the GB wall is:
fibromuscular layer
mucosal layer
serosal layer
muscularis layer
mucosal layer
which of the following would NOT be a lab finding typically analyzed with suspected GB disease?
ALP
ALT
bilirubin
AFP
AFP
the cystic artery is most often a direct branch of the:
main pancreatic artery
celiac artery
right hepatic artery
left hepatic artery
right hepatic artery
the middle layer of the GB wall is the:
fibromuscular layer
mucosal layer
serosal layer
muscularis layer
fibromuscular layer
which structure is a useful landmark for identifying the GB?
MLF
hepatoduodenal ligament
falciform ligament
Lig venosum
MLF
which would be least likely to cause focal GB wall thickening?
GB polyp
adenomyomatosis
ascites
adhered gallstone
ascites
what hormone causes the gallbladder to contract?
estrogen
cholecystokinin
bilirubin
biliverdin
cholecystokinin
the GB wall should measure not more than:
5 mm
6 mm
4 mm
3 mm
3 mm
which is associated with cholelithiasis and is characteristically found in Africans or people of African descent?
sickle cell disease
GB torsion
cholesterolosis
Arland-Berlin syndrome
sickle cell disease
the direct blood supply to the GB is the:
cholecystic artery
common hepatic artery
MPV
cystic artery
cystic artery
the outermost layer of the GB wall is the:
fibromuscular layer
mucosal layer
serosal layer
muscularis layer
serosal layer
which part of the GB is involved in Hartman pouch?
neck
fundus
body
phrygian cap
neck
the GB is connected to the biliary tree by the:
CHD
CBD
cystic duct
right hepatic duct
cystic duct
at which level of the GB is the junctional fold found?
neck
fundus
body
phrygian cap
neck
empyema of the GB denotes:
GB hydrops
GB filled with pus
GB completely filled with air
GB completely filled with polyps
GB filled with pus
what is cholelithiasis?
inflammation of the GB
gallstones
hyperplasia of the GB wall
polyps within the biliary tree
gallstones
The diffuse polyploid appearance of the gallbladder referred to as strawberry gallbladder is seen with:
cholesterolosis
adenomyomatosis
cholangitis
Kawasaki disease
cholesterolosis
the most common variant of the GB shape is the:
phrygian cap
hartmann pouch
separated GB
junctional fold
phrygian cap
the diameter of the GB should not exceed:
8 cm
5 cm
7 mm
3 cm
5 cm
Acute cholecystitis that leads to necrosis and abscess development within the GB wall describes:
emphysematous cholecystitis
gangrenous cholecystitis
chronic cholecystitis
GB perforation
gangrenous cholecystitis
all of the following are sources of diffuse GB wall thickening EXCEPT:
acute cholecystitis
AIDS
hepatitis
GB polyp
GB polyp
which statement is NOT true of cholelithiasis?
men have an increased likelihood of developing
patients who have been or are pregnant have increased occurrence
a rapid weight loss may increase the likelihood of development
patients who have hemolytic disorders have an increased occurrence
men DO NOT have an increased likelihood of developing cholelithiasis
WES sign denotes:
the presence of a gallstone lodged in the cystic duct
multiple biliary stones and biliary dilatation
GB filled with cholelithiasis
sonographic sign of porcelain GB
GB filled with cholelithiasis
which is the most likely clinical finding of adenomyomatosis?
Murphy sign
hepatitis
congestive heart failure
asymptomatic
asymptomatic
tumefactive sludge can resemble the sonographic appearance of:
cholelithiasis
GB carcinoma
cholecystitis
adenomyomatosis
GB carcinoma
the champagne sign is associated with:
adenomyomatosis
cholangiocarcinoma
emphysematous cholecystitis
acalculous cholecystitis
emphysematous cholecystitis
A 32 year old female patient presents with vague abdominal pain. The sonographic investigation of the GB reveals a focal area of GB wall thickening that produces comet tail artifact. These findings are consistent with:
gangrenous cholecystitis
GB perforation
acalculous cholecystitis
adenomyomatosis
adenomyomatosis
the sequela of acute cholecystitis that is complicated by gas within the GB wall is:
emphysematous cholecystitis
membranous cholecystitis
chronic cholecystitis
GB perforation
emphysematous cholecystitis
which would be the least likely finding of acalculous cholecystitis?
GB wall thickening
pericholecystic fluid
choleithiasis
positive Murphy sign
cholelithiasis
intermittent obstruction of the cystic duct by a gallstone results in:
emphysematous cholecystitis
gangrenous cholecystitis
chronic cholecystitis
acute cholecystitis
chronic cholecystitis
which is NOT a risk factor for the development of gallstones?
phrygian cap
pregnancy
total patenter nutrition
oral contraceptive use
phrygian cap
a non mobile, nonshadowing focus is seen within the GB lumen. this most likely represents a:
gallstone
GB carcinoma
GB polyp
sludge ball
GB polyp
focal tenderness over the GB with probe pressure describes:
Murphy sign
strawberry sign
Courvoisier sign
hydrops sign
Murphy sign
diabetic patients suffering from acute cholecystitis have an increased risk for developing:
emphysematous cholecystitis
gangrenous cholecystitis
chronic cholecystitis
GB torsion
emphysematous cholecystitis
cholesterol crystals within the Rotkitansky-Aschoff sinuses are found with:
acute cholecystitis
acalculous cholecystitis
adenomyomatosis
GB perforation
adenomyomatosis
the spiral valves of Heister are found within the:
GB neck
cystic duct
GB fundus
GB wall
cystic duct
which of the following is courvoisier GB associated?
a pancreatic head mass
a stone in the cystic duct
cholecystitis
chronic diverticulitis
a pancreatic head mass
calcification of the GB wall is termed:
concrete GB
Heister syndrome
porcelain GB
hyperplasticity cholecysosis
porcelain GB
You are having difficulty locating the gallbladder in a patient with RUQ pain. What anatomic landmark will help you identify the gallbladder fossa?
Lig Venosum
Lig Teres
interlobar hepatic fissure
falciform ligament
coronary ligaments
interlobar hepatic fissure
in what anatomic variant is the fundus of the gallbladder folded over the body?
cholesdochal cyst
phrygian cap
duplicated collecting system
biliary atresia
junction fold
phrygian cap
what is the normal diameter of the GB wall?
< 3 mm
< 0.5 mm
< 35 mm
> 3 mm
> 3 cm
< 3 mm
what is a common cause of artifactual echoes within the GB?
reverberation
side lobes
slice thickness artifact
reverberation and side lobes only
all of the above
all of the above
You have a patient scheduled for a GB sonogram. What prep is required?
none
patient should drink 4-6 8oz glasses of water prior to study
patient should eat a fatty meal 30 min prior
patient should be fasting 8-12 hours prior
patient should be fasting at least 24 hours prior
patient should be fasting 8-12 hours prior
what is cholelithiasis?
GB carcinoma
gallstones
GB polyps
adenomyosis
GB wall thickening
gallstones
which is NOT a cause of gallbladder wall thickening?
inflammation
hepatic dysfunction
congestive heart failure
malignant ascites
GB wall varices
malignant ascites - usually associated with normal GB wall
the diagnostic accuracy of GB sonography is:
> 90%
50%
100%
75%
cannot be determined
> 90%
During GB sonography, you notice echogenic foci within the gallbladder but do not detect distal acoustic shadowing. What changes will improve the detect ability of stone shadowing?
increase transducer frequency & increase transducer focusing
decrease transducer frequency & increase gain
increase output power & decrease transducer frequency
increase dynamic range & increase gain
increase transducer focusing & decrease transducer frequency
increase transducer frequency & increase transducer focusing
what does a porcelain GB mean?
GB wall is asymmetrically thick
GB is enlarged and tender
GB wall calcification
GB is enlarged and nontender
GB contains multiple small polyps
GB wall calcification
which of the following best describes the location of the distal CBD?
anterior and superior to the pancreatic tail
medial and caudal to the pancreatic neck
posterior and slightly lateral to the pancreatic head
inferior and medial to the pancreatic neck
posterior and medial to the pancreatic head
posterior and slightly lateral to the pancreatic head
What is the appearance of the GB in the postprandial state?
dilation of thin walled GB
contraction with diffuse wall thickening
nonvisible due to complete contraction
minimal contraction with sludge filled lumen
contraction with diffuse wall thickening
which lab test would best indicate the presence of bile duct obstruction?
serum creatine
serum amylase
serum lipase
serum direct bilirubin
AFP
serum direct bilirubin
what is the most common cause of acute cholecystitis?
hepatitis
gallstone lodge in the GB fundus
pancreatitis
HCC
calculus obstruction of GB neck or cystic duct
calculus obstruction of GB neck or cystic duct
tenderness over the GB with probe pressure is termed:
murphy’s sign
morison’s pouch
douglas’ sign
tenderness of trietz
courvoisier’s GB
murphy’s sign
You are performing an abdominal ultrasound study and detect a dilated, nontender GB. What should you look for?
right kidney hydronephrosis
mass in the head of pancreas
mass in the posterior RLL
AAA
PV thrombosis
mass in the head of pancreas
which is a symptom associated with acute cholecystitis?
nausea
vomiting
epigastric pain
RUQ pain
all of the above
all of the above
complications of acute cholecystitis that you should look for include all of the following EXCEPT:
pancreatitis
pancreatic carcinoma
GB perforation
gangrenous cholecystitis
emphysematous cholecystitis
pancreatic carcinoma
You have been asked to rule out the presence of choledocholithiasis. What are you looking for?
inflammation with thick GB wall
stones in the CBD
calcified GB wall
contracted GB filled with stones
GB carcinoma
stones within the CBD
identification of what anatomic structure would most help a sonographer locate a contracted GB?
Lig Teres
MLF
RHV
Lig venosum
coronary ligament
MLF
The transverse diameter measurement of the GB in a fasting patient measure 5.3 cm. This measurement is:
within normal limits
consistent with hydropic GB
consistent with abnormal contract GB
diagnostic of chronic cholecystitis
diagnostic of phrygian cap deformity
consistent with hydropic GB
You are scanning a patient in the ICU and notice low level echoes within the GB consistent with sludge. The GB wall is not thickened. Which statement below is true?
patient most likely has acute acalculous cholecystitis
these findings represent GB perforation
the patient has sludge most likely due to bile stasis
the patient has porcelain GB
the patient has pancreatic abnormality
the patient has sludge most likely due to bile stasis
comet tail or V shaped reverberation artifact originating from the anterior wall of the GB most likely results from:
adenomyomatosis
GB carcinoma
side lobes
porcelain GB
floating cholesterol stones
adenomyomatosis
A small echogenic focus is seen in the posterior aspect of the GB fundus. How can you determine if this represents a polyp or a stone?
shadowing is not present with polyps but is present with stones
unlike a stone, a polyp should move with varying patient positions
a stone will produce ring down artifact and a polyp will produce a shadow
a polyp is always located in a dependent position
stones are always larger than polyps
shadowing is not present with polyps but is present with stones
what is the sonographic appearance of tumefactive sludge within the GB?
an echogenic mass with prominent color doppler signals
a mass with low level echoes with prominent color doppler signals
a mass containing ringdown artifacts and no color doppler signals
an avascular mass with low level echoes
an adherent echogenic mass with weak color doppler signals
an avascular mass with low level echoes
You are scanning a 34 year old multiparous woman with symptoms of severe RUQ pain, nausea, and vomiting. The GB is thick walled with stones and adjacent complex fluid collection is seen. These findings most likely represent:
adenomyomatosis complicated by stones
GB carcinoma
acute cholecystitis complicated by GB perforation
acalculous cholecystitis
emphysematous cholecystitis
acute cholecystitis complicated by GB perforation
You are scanning a 44 year old man with diabetes. He complains of severe epigastric pain radiating to the back, vomiting, chills, and fever. Ultrasound findings include a large GB with dependent hyperechoic foci associated with ringdown artifacts. These findings are most consistent with:
adenomyomatosis complicated by stones
GB carcinoma
acute cholecystitis complicated by GB perforation
acalculous cholecystitis
emphysematous cholecystitis
emphysematous cholecystitis
hypervascularity associated with acute cholecystitis is best evaluated with doppler interrogation of what artery?
common hepatic artery
gastroduodenal artery
pacreaticoduodenal artery
cystic artery
proper hepatic artery
cystic artery
which is NOT a sign of acalculous cholecystitis?
GB wall thickening
murphy’s sign
cholelithiasis
pericholecystic fluid
GB wall edema
cholelithiasis
You are scanning a GB and notice posterior acoustic shadowing and are unsure if the shadowing is due to bowel gas or gallstones. Which would be helpful in making this distinction?
roll the patient into the LLD position
have patient perform valsalva
use lower frequency transducer
increase the system overall gain
increase the system dynamic range
roll the patient into the LLD position
You are imaging the GB in a transverse orientation and noticed a long shadow at both edges. What is the etiology of this shadow?
normal shadowing from cystic duct
small stones within the GB
refraction artifact
volume averaging artifact
slick thickness artifact
refraction artifact
refraction of the beam occurs at the edges of the GB because of the curved interface and difference between the agoutis velocities of the GB and surrounding tissue
An ultrasound image obtained from the GB shows an irregular mass within the lumen which demonstrates hypervascularity by color doppler imaging. Multiple stones are also seen within the GB lumen. These findings are most consistent with:
GB carcinoma
adenomyomatosis
tumefactive sludge
emphysematous cholecystitis
GB perforation
GB carcinoma
Rokitansky-Aschoff sinuses are associated with:
GB carcinoma
adenomyomatosis
tumefactive sludge
emphysematous cholecystitis
GB perforation
adenomyomatosis
the best way to identify the intrahepatic biliary system is to image:
HVs
all fissures and ligaments
intrahepatic lymphatics
intrahepatic PVs
intrahepatic biliary system cannot be detected
intrahepatic PVs
what is pneumobilia?
perforation of the bile ducts
biliary duct dilation
common bile duct stones
air in the GB
air in the bile ducts
air in the bile ducts
How can you differentiate dilated bile ducts from intrahepatic veins?
A. dilated bile ducts demonstrate irregular, torturous walls
B. intrahepatic PVs show increased through transmisssion
C. bile ducts will not demonstrate flow with color doppler
all of the above
A and C only
A and C only
what forms the CBD?
cystic duct and CHD
right and left hepatic ducts
CHD, right and left hepatic ducts
cystic duct and right hepatic duct
duct of Santorini and duct of Wirsung
cystic duct and CHD
During ultrasound evaluation of the GB system, you notice thickening of the bile duct walls. This finding may be related to:
sclerosing cholangitis
pancreatitis
choledocholithiasis
cholangiocarcinoma
all of the above
all of the above
what are the arrows pointing to?
junctional folds
polyps
adenomyomatosis
Rotitansky-Aschoff sinuses
tumefactive sludge
junctional folds
You have been asked to perform an ultrasound to evaluate for biliary obstruction in a patient with a history of weight loss and mid-epigastric pain. You find both intrahepatic and extrahepatic biliary dilation. The GB is hydropic. Which of the following conditions causing ductal dilation should you look for?
A. choledocholithiasis
B. pancreatic carcinoma
C. chronic pancreatitis with stricture formation
A and B only
all of the above
all of the above
cystic dilation of the CBD is known as:
Klatskin cyst
choledochal cyst
Mirizzi cyst
cyst if Oddi
peribiliary cyst
choledochal cyst
A 51 year old male is referred for abdominal ultrasound with abnormal LFTs and jaundice. Which lab work would aid in differentiation of an intrahepatic vs extrahepatic cause of jaundice?
AFP
ALP
AST
serum bilirubin
serum creatine
serum bilirubin
You are scanning at the area of the porta hepatis in a patient with alcoholic liver cirrhosis. Two large tubular structures are identified. How can you identify which structure is the duct and which is the hepatic artery?
HA is always located between the PV and bile duct
bile duct can be compressed with probe pressure
bile duct will dilate with valsalva
doppler signals can be elicited from the artery but not the bile duct
all of the above
doppler signals can be elicited from the artery but not the bile duct
A patient presents for abdominal ultrasound with a history of jaundice, weight loss, and nausea. You detect dilation of the CBD at the level of the porta hepatis but are unable to see the distal CBD due to overlying bowel gas. Which would be most helpful in improving visualization of the CBD?
place the patient in trendelenberg position
have the patient cough several times
roll the patient into the right posterior oblique position
roll the patient into a prone position
roll the patient into a LLD position
roll the patient into the right posterior oblique position
the most common anatomic variant of the GB is:
agenesis
GB folds
phrygian cap
duplication
GB folds
what is the most accurate test for acute cholecystitis?
ultrasound
cholescintigraphy
endoscopic retrograde cholangiography
oral cholecystogram
angiography
cholescintigraphy
You are scanning a patient with a porcelain GB. You must carefully evaluate the GB because these patients are at increased risk for:
adenomyomatosis
cholesterolosis
choledocholithiasis
GB carcinoma
GB perforation
GB carcinoma
A patient is referred for GB ultrasound with a history of RUQ pain and nausea, you suspect the presence of a stone in the region of the GB neck but are not sure. Which would be helpful in confirming the presence of a stone?
roll the patient into LLD position
have patient perform valsalva
place patient in trendelenberg position
increase the dynamic range
increase overall gain
roll the patient into LLD position
You have been asked to administer cholecystokinin to a patient. Which do you expect to occur if the study is normal?
GB will contract
CBD will dilate
intrahepatic biliary system will dilate
pancreatic duct will dilate
HVs will dilate
GB will contract
You are attempting to locate the CHD at the porta hepatis. What is the most common anatomic relationship of the portal triad at this location?
CBD is posterior to the HA and anterior to the PV
CBD is anterior to the HA and posterior to the PV
CBD is anterior to the HA and PV
CBD is posterior to the HA and PV
CBD bears no relationship to the HA and PV
CBD is anterior to the HA and PV
A patient is referred for ultrasound with jaundice, pain, nausea and vomiting and a history of cholecystectomy. Which is most likely?
acute cholecystitis
chronic cholecystitis
adenomyomatosis
emphysematous cholecystitis
choledocholithiasis
choledocholithiasis
You have detected a stone impacted in the distal CBD in a patient with jaundice and abdominal pain. You will tailor your exam to evaluate what complication of this condition?
AAA
pancreatitis
PV aneurysm
PHTN
choledochal cyst
pancreatitis
You are requested to perform an ultrasound evaluation of the GB and biliary tree on an elderly female with a small frame. Which transducer is most suited to this task?
2.5MHz phased array
5.0MHz curved linear array
3.5MHz linear array
10MHz curved linear array
13MHz linear array
5.0MHz curved linear array
You notice a patient has a yellow discoloration of the eyes and skin. This condition is called:
hypoalbuminemia
biliary stasis
erythema
priority’s
jaundice
jaundice
You are asked to perform an ultrasound study on a patient with suspected cholangiocarcinoma. What associated findings should you look for?
dilation of the biliary tree
cholesterolosis
PHTN
HA pseudoaneurysm
adenomyomatosis
dilation of the biliary tree
what is the etiology of the low level echoes seen in the near field of this GB?
biliary sludge
tumefactive sludge
floating cholesterol stones
reverberation artifact
gas due to emphysematous cholecystitis
reverberation artifact
what is the etiology of the layered echoes seen in the posterior aspect of this GB?
biliary sludge
tumefactive sludge
floating cholesterol stones
reverberation artifact
gas due to emphysematous cholecystitis
biliary sludge
You are scanning a patient with sickle cell anemia and note the presence of gallstones and GB wall thickening. What else should you do to determine if acute cholecystitis is present?
A. press with the probe over the GB to determine if it is painful
B. look carefully to see if a gallstone is lodged in the GB neck
C. check for the presence of pericholecystic fluid
A and B only
all of the above
all of the above
You are scanning a patient with symptoms of cholelithiasis. Although you clearly identify a GB, you detect a bright band of echoes with post shadowing in the RUQ. How can you determine if this represents a contracted GB filled with stones?
A. connection of the shadowing echoes to the interlobar fissure confirms identification of the GB
B. wall-echo-shadow (WES) sign confirms identification of the GB
C. “dirty” shadowing from bowel gas can be differentiated from “clean” shadowing from stones by the presence of ringdown artifact in the bow shadow.
A and C only
All of the above
all of the above
a tumor that may be located in an intrahepatic or extrahepatic bile duct is known as:
cholangiocarcinoma
angiosarcoma
angiomyolipoma
cholesterolosis
adenomyomatosis
cholangiocarcinoma
Ultrasound images you obtained on an 81 year old man with acute RUQ pain shows gallstones and bright echoes in the GB wall with ringdown artifacts. Which is most likely?
emphysematous cholecystitis
GB carcinoma
cholangiocarcinoma
acalculous cholecystitis
uncomplicated cholelithiasis
emphysematous cholecystitis
