Biliary Tract

Question 1

The neck tapers to for the cystic duct which joins with the common_________ duct to form the common_________ duct.

Answer 1

CHD

CBD

Question 2

__________&__________ join to form the ampulla of vater

Answer 2

CBD & pancreatic duct ( duct of wirsung)

Question 3

The gb is located at the inf end of the ______________.

Answer 3

Main lobar fissure

Question 4

The portal triad consists of

Answer 4

MPV
CHD
PROPER HEP ART

Question 5

Spiral fold which controls bile flow in the cystic duct

Answer 5

Valve of heister

Question 6

Abnormal sacculation of the neck of the gb

Answer 6

Hartmanns pouch

Question 7

Fold in the fundus of the gb

Answer 7

Phrygian cap

Question 8

The______ passes posterior to the first part of the duodenum and pancreatic head joining the pain panc. Duct( of wirsung) at the ampulla of vater

Answer 8

CBD

Question 9

The ampulla of vater empties through the duodenal papilla controlled by the ______________

Answer 9

Sphincter of oodi

Question 10

The most common cause of gb wall thickening

Answer 10

Cholecystitis

Question 11

Name 5 causes beside cholecystitis that cause gb wall thickening

Answer 11

Hyperalbunemia 
Ascites
Hepatitis
CHF
Pancreatitis

Question 12

3 types of jaundice and examples of each

Answer 12

Hepatic jaundice: hep dz such as viral hepatitis

Hemolytic jaundice: destructive RBC such as sickle cell

Surgical jaundice: obstructive pathology

Question 13

What type of jaundice causes pale stool and dark urine

Answer 13

Surgical jaundice

Question 14

Sludge is associated with biliary stasis secondary to

Answer 14

* prolonged fasting
Hyperalimentation
Hemolysis
Cystic duct obstruction
Cholecystitis

Question 15

Gs are composed of these 3 things

Answer 15

Cholesterol
Calcium bilirubinate
Calcium carbonate

Question 16

Cystic duct obstruction may result in : ( hint 5 of them)

Answer 16

Gb perf
Acute cholecystitis 
Pericholecystic abscess
Empyema
Bile peritonitis

Question 17

Complications of acute cholecystitis include: (4)

Answer 17

Empyema
Gangrenous cholecystitis
Gb perf
Pericholecystic abscess

Question 18

In an acute cholecystitis setting an increase of amylase suggest an obstruction at the level of_______

Answer 18

The ampulla of vater

Question 19

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

Answer 19

The sphincter of oddi

Question 20

Acute cholecystitis d/t gb wall ischemia and infection

• comet tail artifact d/t presence of gas within the wall from gas- forming bacteria
• more commonly seen in diabetic men

Answer 20

Emphysematous cholecystitis

Question 21

Purulent material within the gb d\t bacteria containing bile

* symptoms are the same as acute cholecystitis with the addition of fever

Answer 21

Empyema of the gb

Question 22

Sludge like material with a high concentration of calcium

Assoc. with : chronic cholecystitis cystic duct obstruction

Answer 22

Milk of calcium bile ( limy bile)

Question 23

Calcification of the gb wall and associated with chronic chole and gb cancer

Answer 23

Porcelain gb

Question 24

Mucocele of the gb aka_______

Answer 24

Hydrops

Question 25

Palpable ruq mass -pt asymptomatic

Gb transverse/ap measurement greater than 5cm

Answer 25

Hydrops

Question 26

Lipids( triglycerides and cholesterol) deposits in gb wall, but has no comet tail artifact. Aka__________

Answer 26

Cholesterolosis

Aka : strawberry gb

Question 27

Hyper plastic changes involving the gb wall causing overgrowth of the mucosa , thickening of the wall and formation of diverticula. With comet tail( reverberation artifact)

Answer 27

Adenomyomatosis

Question 28

Elevated lab for biliary obstruction

Answer 28

Alk phos
Conjugated bilirubin
GGT

Question 29

Most common locations for biliary obstruction

Answer 29

Distal CBD

Gs and carcinoma at head of pancreas

Question 30

Causes of biliary obstruction

Answer 30

Choledocholithiasis
Panc carcinoma 
Cholangiocarcinoma
Cholangitis
Mirrizzi syndrome
Choledochal cyst
Gb carcinoma