Biliary Workbook Key Terms

Question 1

Small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions

Answer 1

Ampulla of Vater

Question 2

Yellow pigment in bile formed by the breakdown of red blood cells

Answer 2

Bilirubin

Question 3

Cholecystectomy

Answer 3

Removal of the GB.

Question 4

Extends from the point where the common hepatic duct meets the cystic duct; drains into the duodenum after it joins within the main pancreatic duct.

Answer 4

Common Bile Duct

Question 5

Common Duct

Answer 5

Refers to common bile and hepatic ducts when the cystic duct is not seen.

Question 6

Bile duct system that drains the liver into the common bile duct.

Answer 6

Common Hepatic Duct

Question 7

Connect the GB to the common Hepatic Duct

Answer 7

Cystic Duct

Question 8

Storage Pouch for Bile

Answer 8

Gallbladder

Question 9

A small part of the GB that lies near the cystic duct where stones may collect.

Answer 9

Hartmann’s Pouch

Question 10

Tiny valves found within the cystic duct.

Answer 10

Heister’s Valve

Question 11

Massive enlargement of the GB.

Answer 11

Hydrops

Question 12

Travels horizontally through the pancreas to join the common bile duct at the ampulla of Vater.

Answer 12

Pancreatic Duct

Question 13

Phrygian Cap

Answer 13

GB variant in which part of the fundus is bent back on itself.

Question 14

The Central area of the liver where the portal vein, common duct, and hepatic artery enter.

Answer 14

Porta Hepatis

Question 15

A small muscle that guards the ampulla of Vater.

Answer 15

Sphincter of Oddi

Question 16

small polypoid projections from the gallbladder wall

Answer 16

adenomyomatosis

Question 17

inflammation of the gallbladder may be acute or chronic

Answer 17

cholecystitis

Question 18

cholangitis

Answer 18

Inflammation of the bile duct

Question 19

cholecystokinin

Answer 19

a hormone secreted into the blood by the mucosa of the upper small intestine; stimulates contraction of the gallbladder and pancreatic secretion of enzymes

Question 20

Choledochal cyst

Answer 20

cystic growth on the common duct that may cause obstruction

Question 21

stones in the bile duct

Answer 21

choledocholithiasis

Question 22

Gallstones in the gallbladder

Answer 22

cholelithiasis

Question 23

Cholesterolosis

Answer 23

variant of adenomyomatosis; cholesterol polyps

Question 24

jaundice

Answer 24

excessive bilirubin accumulation causes yellow pigmentation of the skin; 1st seen in the whites of the eyes

Question 25

junctional fold

Answer 25

small septum within the gallbladder, usually arising from the posterior wall

Question 26

cancer at the bifurcation of the hepatic ducts; may cause asymmetrical obstruction of the biliary tree

Answer 26

Klatskin's tumor

Question 27

positive sign implies exquisite tenderness over the area of the gallbladder upon palpation

Answer 27

Murphy's sign

Question 28

small, well-defined soft tissue projection from the gallbladder wall

Answer 28

polyp

Question 29

calcification of the gallbladder wall is termed

Answer 29

porcelain gallbladder

Question 30

Low-level echoes found along the posterior margin of the gallbladder; move with a change in position

Answer 30

sludge

Question 31

wall echo shadow (WES) sign

Answer 31

sonographic pattern found when the gallbladder is packed with stones

Question 32

The gallbladder serves a reservoir for ___ that is drained from the hepatic ducts in the liver.

Answer 32

bile

Question 33

The common hepatic duct is joined by the cystic duct to form the __ duct.

Answer 33

common bile

Question 34

The main pancreatic duct joins the common bile duct, and together they open through a small ampulla (the ampulla of _ ) into the duodenal wall.

Answer 34

Vater

Question 35

The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the

Answer 35

sphincter of oddi

Question 36

The arterial supply of the gallbladder is the _ artery, which is a branch of the right hepatic artery.

Answer 36

cystic

Question 37

List the 2 primary functions of the extrahepatic biliary duct.

Answer 37

The transportation of bile from the liver to the intestine and regulation of its flow

Question 38

Bile is the principal medium for excretion of bilirubin and

Answer 38

cholesterol

Question 39

The __ from the small intestine stimulates the liver to make more bile. This activates intestinal and pancreatic enzymes.

Answer 39

bile salts

Question 40

The sign that indicates an extrahepatic mass compressing the CBD, which can produce an enlarged gallbladder, is called ___

Answer 40

Courvoiser's sign

Question 41

Sonographically, the common duct lies ___ and to the ___ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.

Answer 41

anterior/right

Question 42

The hepatic artery lies ___ and to the ___ of the portal vein.

Answer 42

anterior/left

Question 43

To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for at least _ hours before the ultrasound exam.

Answer 43

8-12

Question 44

The patient is initially examined with ultrasound in full

Answer 44

Inspiration

Question 45

The patient should also be rolled into a steep ___ or upright position (to ensure there are no stones in the gallbladder) in an attempt to separate small stones from the gallbladder wall or cystic duct.

Answer 45

decubitis

Question 46

The gallbladder may be identified as a(n) ___ oblong structure located anterior to the right kidney, lateral to the head of the pancreas and duodenum.

Answer 46

sonolucent

Question 47

The gallbladder commonly resides in a ___ on the medial aspect of the liver.

Answer 47

fossa

Question 48

Because ___ tissue within the main lobar fissure of the liver (which lies between the gallbladder and the right portal vein), this bright linear reflector is a reliable indicator of the location of the gallbladder.

Answer 48

fat/fibrous

Question 49

A small ___ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum.

Answer 49

Echogenic

Question 50

On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _ _ sign.

Answer 50

mickey mouse

Question 51

On sagittal scans, the right branch of the hepatic artery usually passes ___ to the common duct.

Answer 51

Posterior

Question 52

The common duct is seen just _ to the portal vein before it dips posteriorly to enter the head of the pancreas.

Answer 52

Anterior

Question 53

When the right subcostal approach used, the common hepatic duct is seen as a tubular structure anterior to the portal vein. The right branch of the ___ artery can be seen between the duct and the portal vein as a small circular structure.

Answer 53

Hepatic

Question 54

The most classic symptom of gallbladder disease is ___ pain, usually occurring after ingestion of greasy foods.

Answer 54

RUQ

Question 55

A gallbladder attack may cause pain in the _ shoulder.

Answer 55

Right

Question 56

The normal wall thickness of the gallbladder is less than _ mm.

Answer 56

3

Question 57

Clinically the patient with acute cholecystitis presents with these symptoms:

Answer 57

Acute RUQ pain.

Question 58

The _ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.

Answer 58

WES (wall echo shadow)

Question 59

A fairly rare complication of acute cholecystitis associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts is called ___.

Answer 59

emphysematous cholecystitis

Question 60

Clinically the patient falls under the five F's:

Answer 60

fat, forty, fertile, female, and fair

Question 61

The ___ may be the result of pancreatic juices refluxing into the bile duct bc of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and an outpouching of the ductal walls.

Answer 61

Choledochal cyst

Question 62

A hyperplastic change in the gallbladder wall is _

Answer 62

adenomyomatosis

Question 63

The differential for a porcelain gallbladder would include a packaged bag or ___ sign.

Answer 63

WES

Question 64

What is the most notable sonographic finding with carcinoma of the gallbladder?

Answer 64

GB wall is markedly abnormal and thickened

Question 65

The most common cause of biliary ductal system obstruction is the presence of a ___ or ___ within the ductal system.

Answer 65

tumor/thrombus

Question 66

3 primary areas where obstruction occurs:

Answer 66

intrapancreatic obstruction, suprapancreatic obstruction, and porta hepatic obstruction

Question 67

An uncommon cause of extrahepatic biliary obstruction as a result of impacted stone in the cystic duct creating extrinsic mechanical compression of the common hepatic duct is ___ syndrome. ___ causes increased pressure in the biliary tree with pus accumulation.

Answer 67

Mirizzi/cholangitis

Question 68

The majority of stones in the CBD have migrated from the gallbladder. Common duct stones are usually associated with _ _.

Answer 68

calculous cholecystitis

Question 69

_ or _ within duodenum may also give rise to a dirty shadow in the right upper quadrant.

Answer 69

air or gas

Question 70

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ___ disease.

Answer 70

Caroli's