Biliary Tract

Question 1

calcification of gb wall associated with chronic cholecystitis

Answer 1

porcelain GB

Question 2

majority of patients with biliary obstruction have pathology where?

Answer 2

distal CBD

most common lesions are gallstones and carcinoma of pancreas head

elevated alk phos, conjugated bilirubin, gamma glutamyl transpeptidase

Question 3

cholangiocarcinoma located at the hepatic hilum

Answer 3

klatskin tumor

Question 4

hepatic causes of jaundice

Answer 4

acute liver inflammation

chronic liver disease

infiltrative disease

inflammation of bile ducts

genetic disorders

Question 5

chronic cholecystitis

Answer 5

chronic GB disease characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis. sono findings same as acute

Question 6

Fold between the body and neck (infundibulum) of the GB

Answer 6

junctional fold

Question 7

most common cause of extrahepatic obstructive jaundice

Answer 7

choledocholithiasis

Question 8

extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing compression on the CHD

Answer 8

mirizzi syndrome

findings: intrahepatic dilatation, stone, curved segmental stenosis of CHD, cholecystocholedochal fistula

Question 9

overdistended gb filled with mucoid or clear, watery contents

Answer 9

hydrops of gb

bile is reabsorbed and gb filled instead from secretion of mucosa

AKA mucocele

asymptomatic

Question 10

congentital bile duct anomaly consisting of cystic dilatation of the intra or extrahepatic bile ducts. five classes of cysts.

Answer 10

choledochal cysts

prevalent in Asia

Question 11

emphysematous cholecystitis

Answer 11

due to GB wall ischemia and infection

gas produced by aneorbic bacteria, found in wall, lumen, or biliary tree

reverberation or comet-tail artifact

diabetic men

Question 12

GB perforation

Answer 12

localized fluid collection in the GB

peritonitis, pericholecystic abscess, biliary fistula

Question 13

type V choledochal cyst. associated with congenital hepatic fibrosis, portal hypertension, renal tubular ectasia

Answer 13

caroli’s disease

multiple cysts converge toward the porta hepatis communicating with the bile ducts

Question 14

enlarged nondiseased gb due to mechanical obstruction of the CBD associated with pancreatic adenocarcinoma at the head

Answer 14

courvoisier GB

Question 15

in acute cholecystitis, amylase elevation suggests obstruction where?

Answer 15

ampulla of Vater

Question 16

total bilirubin

Answer 16

conjugated bilirubin + unconjugated bilirubin

Question 17

most common cause of GB wall thickening

Answer 17

cholecystitis

hypoalbuminemia, ascites, hepatitis, congestive heart failure, pancreatitis

Question 18

empyema of the gallbladder

Answer 18

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

Question 19

choledocholithiasis complications

Answer 19

biliary cirrhosis

cholangitis

pancreatitis

Question 20

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

Answer 20

adenomyomatosis

Question 21

post hepatic jaundice

Answer 21

obstruction of biliary tree

Question 22

cholangiocarcioma

Answer 22

typically originate within extrahepatic bile ducts

predisposing condition of primary sclerosing cholangitis is most common

intrahepatic duct dilatation

jaundice, weight loss, abd pain

Question 23

lipids are deposited in the GB wall. condition referred to as strawberry GB

Answer 23

cholesterolosis

vary in size, can be as large as 1 cm

Question 24

bacterial infection superimposed on an obstruction of the biliary tree

Answer 24

cholangitis

Question 25

galstones are composed of what

Answer 25

cholesterol calcium bilirubinate calcium carbonate

Question 26

GB carcinoma

Answer 26

intraluminal mass asymmetric wall thickening mass that fills GB

Question 27

hormone released into blood by ingestion of fatty foods, caused by gallbladder contraction

Answer 27

cholecystokinin

Question 28

primary sclerosing cholangitis

Answer 28

inflammation and fibrosis of the intra and extrahepatic duct results in liver failure thickened bile duct walls, cirrhosis

Question 29

sludge like material with high concentration of calcium

Answer 29

milk of calcium bile (limy bile) layering of sludge

Question 30

gallbladder wall inflammation due to cystic duct obstruction by a gallstone. RUQ pain, fever, and leukocytosis

Answer 30

acute cholecystitis gallstones, murphys sign, gallbladder dilatation, sludge

Question 31

Hartmann's pouch

Answer 31

an abnormal sacculation (diverticulum) of the neck of the GB

Question 32

air in the biliary tract commonly associated with endoscopic retrograde cholangiopancreatogram (ERCP)

Answer 32

pneumobilia

Question 33

prehepatic causes of jaundice

Answer 33

hemolysis ineffective erythropoiesis absorption of large amounts of hemoglobin

Question 34

end product of hemoglobin breakdown

Answer 34

bilirubin

Question 35

gallbladder polyps

Answer 35

\<10mm unlikely to be cancerous \>10mm more likely

Question 36

primary biliary cirrhosis

Answer 36

chronic and progressive cholestasis due to destruction of the small intrahepatic ducts leading to end stage liver disease etiology unknown ultrasound findings nonspecific

Question 37

CBD in relation to the duodenum and pancreatic head

Answer 37

passes posterior

Question 38

surgical drainage with the Kasai portoenterostomy is most successful in the treatment of what?

Answer 38

biliary atresia

Question 39

what is GB sludge composed of

Answer 39

calcium bilirubinate granules and cholesterol crystals

Question 40

common duct measurement

Answer 40

\<5mm normal in elderly patients, one mm per decade rule age 60, normal 6mm duct postcholecystecomy up to 10mm

Question 41

acute cholecystitis without the presence of gallstones. typically secondary event in critically ill hospitalized patients

Answer 41

acalculous cholecystitis sonofindings: wall thickening, murphys sign, pericholecystic fluid

Question 42

lab value specific to bile duct obstruction

Answer 42

alkaline phosphatase