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ABD BOARD > BILIARY TRACT > Flashcards

BILIARY TRACT Flashcards

1
Q

the right and left hepatic ducts join to form the _______

A

CHD

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2
Q

the GB is located at the _______ end of the main lobar fissure

A

inferior

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3
Q

the gallbladder neck tapers to form the _______ which joins with the CHD to form the CBD

A

cystic duct

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4
Q

the CBD & the main pancreatic duct (duct of wirsung) join to form the _______

A

ampulla of vater

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5
Q

what does the portal triad consist of?

A

MPV
proper hepatic a
common hepatic duct

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6
Q

_______ is a spiral fold which controls bile flow in the cystic duct

A

valve of heister’s

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7
Q

_______ is an abnormaal sacculation (diverticulum) of the neck of the GB

A

hartmann’s pouch

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8
Q

A _______ is a fold between the body & the fundus of the GB

A

phrygian cap

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9
Q

A _______ is a fold between the body and the neck (infundibulum) of the GB

A

junctional fold

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10
Q

the CBD passes _______ to the 1st part of the duodenum and pancreatic head joining the main pancreatic duct at the ampulla of vater

A

posterior

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11
Q

the ampulla of vater empties through the duodenal papilla, controlled by the _______

A

sphincter of oddi

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12
Q

what is the sonographic criteria of cholelithiasis

A

mobile
echogenic
shadowing

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13
Q

what are gallstones composed of?

A

cholesterol
calcium bilirubinate
calcium bicarbonate

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14
Q

A gallbladder filled with stones may be seen as a strong shadow in the RUQ, this is called _______

A

double arc or WES

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15
Q

_______ is when there is gallbladder wall thickening due to cystic duct obstruction by a gallstone

A

acute cholecystitis

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16
Q

features of acute cholesystitis include:

A 
gallstones
murphy's sign
diffuse wall thickening
gallbladder dilatation
sludge
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17
Q

_______ is defined as intense point tenderness transducer pressure directly on the GB

A

murphy’s sign

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18
Q

_______ elevated suggests obstruction at the level of the ampulla of vater

A

amylase

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19
Q

_______ is defined clinically by recurrent symptoms of biliary colic due to multiple episodes of acute cholecystitis

A

chronic cholecystitis

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20
Q

_______ is acute cholecystitis due to gallbladder wall ischemia and infection

A

emphysematous cholecystitis

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21
Q

emphysematous cholecystitis more commonly occurs in _______

A

diabetic men

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22
Q

with gangrenous cholecystitis, perforation is inevitable resulting in _______ & _______

A

pneumoperitoneum

peritonitits

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23
Q

the following causes of gas in the biliary system include:

A 
ERCP
sphincter of oddi papilotomy
choledochojejunoscopy
GB fistula
emphysematous choleystitis
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24
Q

_______ is purulent material within the GB due to bacteria-containing bile associated with acute cholecystitis

A

empyema of the GB

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25
Q

empyema of the GB is initiated with _______

A

obstruction of the cystic duct

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26
Q

_______ is a complication of acute cholecystitis resulting in a localized fluid collection in the GB fossa

A

GB perforation

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27
Q

peritonitis, pericholecystic absecess, and biliary fistula are complications of _______

A

GB perforation

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28
Q

_______ is inflammation of the GB without the presence of a gallstone. it is typically a secondary event in critically ill hospitalized patients

A

acalculous cholecystitis

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29
Q

other causes of GB wall thickening include _______ & _______

A

increased hypoalbuminemia causing ascites

congestive heart failure

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30
Q

_______ is sludge like material with a high concentration of calcium

A

milk of calcium bile

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31
Q

_______ is the calcification of the GB wall associated with chronic cholecystitis

A

prcelain GB

32
Q

_______ is an overdistended GB filled with mucoid or clear, watery contents

A

GB hydrops

33
Q

GB hydrops is aka _______

A

mucocele of the GB

34
Q

GB hydrops is typically suggested with an anterior/posterior or transverse dia of greater than _______

A

5 cm

35
Q

polyps less than _______ in dia are unlikely to be cancerous and generally don’t require treatment

A

10 mm

36
Q

_______ are lipids (triglycerides and cholesterol) are deposited in the GB wall

A

cholesterolosis

37
Q

cholesterolosis is aka _______

A

strawberry GB

38
Q

cholesterolosis may appear similar to adenomyomatosis without _______

A

reverberation artifact

39
Q

porcelain GB is associated with _______

A

GB carcinoma

40
Q

hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula

A

adenomyomatosis

41
Q

diverticula in the GB wall _______ accumulate stones or sludge within them

A

rokitansky-aschoff sinuses or RAS

42
Q

adenomyomatosis is associated with a _______ artifact

A

comet-tail (reverberation)

43
Q

in the majority of patients, biliary obstruction is due to pathology is the _______

A

diatal CBD

44
Q

elevated lab values in patients with biliary obstruction include:

A

alkaline phosphatase (ALP)
conjugated bilirubin
gamma glutamyl transpeptidase (GGT)

45
Q

the CHD is routinely measures at the point where the _______ courses between the portal vn and the biliary duct

A

right hepatic artery

46
Q

_______ refer to the dilated hepatic duct adj to the portal vein

A

parallel channel sign

shotgun sign

47
Q

biliary ducts are more _______ than the accompanying portal veins

A

tortuous

48
Q

bile ducts branch in a _______ configuration

A

star-shaped

49
Q

_______ is a hormone that is released into the blood by the ingestion of fatty foods, causing gallbladder contration

A

cholecystokinin

50
Q

the formation or presence of calculi in the bile ducts. most common cause of extraheaptic obstructive jaundice

A

choledocholithiasis

51
Q

extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct

A

mirizzi syndrome

52
Q

bile duct adenocarcinomas typically originate within _______

A

extrahepatic bile ducts (CHD or CBD)

53
Q

a _______ tumor is a cholangiocarcinoma located at the hepatic hilum (junction of right and left hepatic duct) resulting in intrahepatic but not extrahepatic biliary dilation

A

klatskin

54
Q

the most common predisposing condition of cholangiocarcinoma is _______

A

primary sclerosing cholangitis

55
Q

_______ is a bacterial infection superimposed on an obstruction of the biliary tree. bile is usually sterile, although with an obstruction, bacteria gains access to the biliary tree.

A

cholangitis

56
Q

most common cause of cholangitis is _______

A

choledocholithiasis

57
Q

_______ is suspected when jaundice (hyperbilirubinemia) persists beyond 14 days of age

A

biliary atresia

58
Q

_______ is the absence of extrahepatic bile ducts

A

biliary atresia

59
Q

biliary atresia is associated with:

A

polysplenia syndrome
absent IVC
situs inversus, situs ambiguous
cardiac anomalies (ASD, VSD)

60
Q

surgical drainage with the _______ is the most successful treatment of biliary atresia if performed before 90 days of life

A

kasai portoenterostomy

61
Q

_______ is air in the biliary tract

A

pneumobilia

62
Q

pneumobilia is commonly associated with _______

A

ERCP (endoscopic retrograde cholangiopancreatogram)

63
Q

_______ is a congenital bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts

A

choledochal cysts

64
Q

the most common choledochal cyst involves the dilatation of the _______

A

CBD

65
Q

choledochal cysts are more prevalent in _______ & symptoms usually occur before age 10.

A

Asia

66
Q

_______ is type V choledochal cyst which is a congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts

A

caroli’s disease

67
Q

caroli’s disease is associated with _______, _______, & _______

A

congenital hepatic fibrosis
portal HTN
renal tubular ectasia

68
Q

_______ is the most common cause of malignant neoplasm obstructing the biliary tree

A

pancreatic adenocarcinoma

69
Q

_______ is an enlarged, non-diseased GB due to a mechanical obstruction of the CBD

A

courvoisier GB

70
Q

pancreatic adenocarcinoma at the head of the pancreas typically cause _______

A

courvoisier GB

71
Q

_______ is an inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts. thought to be autoimmune.

A

primary sclerosing cholangitits

72
Q

_______ is a chronic progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end stage liver disease

A

primary biliary cirrhosis

73
Q

with primary biliary cirrhosis, what lab values are elevated?

A

aminotransferases (ALT/AST)
alkaline phospatase (ALP)
gamma glutamyl transpeptidase (GGT)
antimitochondrial antibodies

74
Q

_______ is the end product of hemoglobin breakdown

A

bilirubin

75
Q

_______ increases with bile duct obstruction

A

alkaline phosphatase (ALP)

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