Ch. 4 Bile Ducts

Question 1

A vital digestive fluid that is produced by the liver

Answer 1

Bile

Question 2

_________ is a major component of bile, although it includes other elements such as bilirubin, biliverdin, and bile acids.

Answer 2

Cholesterol

Question 3

What is the function of the biliary tree?

Answer 3

provide a conduit for bile to drain from the liver into the small intestine

Question 4

The gallbladder is attached to the biliary tree by the??

Answer 4

cystic duct

Question 5

Liver -> biliary radicles -> right or left hepatic duct -> common hepatic duct -> cystic duct -> gallbladder -> common bile duct -> ampulla of Vater -> sphincter of Oddi -> duodenum

Answer 5

Name the order of bile flow

Question 6

The merging point of the pancreatic duct and common bile duct just before the sphincter of Oddi

Answer 6

Ampulla of Vater

Question 7

Other term for ampulla of vater

Answer 7

Hepatopancreatic ampulla

Question 8

The muscle that controls the emptying of bile and pancreatic juices into the duodenum

Answer 8

Sphincter of Oddi/Hepatopancreatic sphincter

Question 9

The patient should have nothing to eat or drink for at least _____ hours before examining the biliary tree.

Answer 9

Four

Question 10

A common bile duct diameter that exceeds ____mm is typically considered abnormal

Answer 10

6mm

Question 11

If the CBD is enlarged, what should a sonographer do?

Answer 11

Diligently scan the entire right upper quadrant, including the complete biliary tree, liver, gallbladder, and pancreas.

Question 12

How should a sonographer measure the CBD?

Answer 12

Caliper placement should be from inner to inner wall

Question 13

For patients older than 60 years who have had a cholecystectomy a max diameter of _____ may be normal.

Answer 13

10mm

Question 14

When biliary tree obstruction or disease is suspected, look for an elevation in

Answer 14

ALP, ALT, serum bilirubin, GGT, urobilirubin (in additon to amylase and lipase)

Question 15

Intrahepatic ducts are considered dilated if they exceed

Answer 15

2mm

Question 16

The enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis is referred to as

Answer 16

double barrel “shotgun sign” or “parallel tube sign”

Question 17

Coexisting dilation of the common duct and pancreatic duct is referred to as

Answer 17

“double-duct sign”

Question 18

The CBD segment closest to the pancreatic head is considered

Answer 18

most distal segment of the biliary tree

Question 19

Biliary dilation will occur where to the level of obstruction?

Answer 19

proximal

Question 20

Most common level of obstruction to occur is

Answer 20

the distal CBD

Question 21

Where the most distal segment of the biliary tree

Answer 21

The common bile segment closest to the pancreatic head

Question 22

Where is the most common level of obstruction of the bile ducts is likely to occur?

Answer 22

Distal common bile duct

Question 23

Name the most common causes of CBD obstruction

Answer 23

1.Choledocholithiasis
2. chronic pancreatitis
3. Acute pancreatitis
4. Pancreatic carcinoma

Question 24

This occurs as a consequence of bilirubin accumulation within the tissues of the body

Answer 24

Jaundice

Question 25

The yellowish pigment found in bile which can turn the skin and the whites of the eyes yellow if allowed to accumulate

Answer 25

Bilirubin

Question 26

A condition in which bile is stagnant and allowed to develop into sludge or stones

Answer 26

biliary stasis

Question 27

Obstruction within the bilary tree the patient will eventually suffer from

Answer 27

posthepatic (obstructive) jaundice

Question 28

Excessive bilirubin leads to elevated

Answer 28

serum bilirubin

Question 29

What is infant jaundice usually caused by?

Answer 29

inability of the newborn liver to eliminate bilirubin from the bloodstream

Question 30

The presence of gallstones within the bile ducts

Answer 30

choledocholithiasis

Question 31

Gallstones located in the CBD are considered the most common cause of???

Answer 31

Obstructive jaundice

Question 32

An uncommon manifestation of choledocholithiasis is

Answer 32

Mirizzi syndrome

Question 33

A clinical condition when the patient presents jaundice, pain, and fever secondary to a lodged stone in the cystic duct causing compression of the common duct

Answer 33

Mirizzi syndrome

Question 34

the clinical findings of _____ jaundice, elevated bilirubin, elevated alkaline phosphate, RUQ pain -jaundice, elevated ALP/ALT/GGT/bilirubin, RUQ PAIN

Answer 34

choledocholithiasis

Question 35

the sonographic findings of ______ 1. echogenic foci within the bile duct that may or may not shadow 2. may have biliary dilation but not always

Answer 35

choledocholithiasis

Question 36

Inflammation of the biliary ducts

Answer 36

cholangitis

Question 37

When the bile duct walls thicken greater than ____mm, One should suspect some form of cholangitis

Answer 37

5 mm

Question 38

What is the most common cause of cholangitis?

Answer 38

choledocholithiasis or an obstructive disease

Question 39

the clinical findings of ____ 1. Charcot triad: fever, RUQ pain, jaundice 2. Leukocytosis 3. Elevated ALP, ALT, GGT, and bilirubin

Answer 39

cholangitis

Question 40

the sonographic findings of _____ 1. biliary dilation 2. biliary sludge 3. choledocholithiasis 4. bile duct wall thickening

Answer 40

cholangitis

Question 41

What is Charcot's triad?

Answer 41

RUQ pain, fever, jaundice

Question 42

Patients with acute bacterial cholangitis are often present with fever, RUQ pain, and jaundice, a condition referred to as

Answer 42

Charcot triat

Question 43

Type of cholangitis associated with advanced HIV/AIDS most often resulting from infection with Crytosporidium or cytomegalovirus

Answer 43

AIDS cholangitis

Question 44

Type of cholangitis seen in America because of immigration, endemic to asia

Answer 44

Oriental cholangitis

Question 45

Type of cholangitis caused by bacterial accumulation secondary to obstruction, can be introduced during ERCP for choledocholithiasis

Answer 45

acute baterial cholangitis

Question 46

Type of cholangitis characterized by fibrotic thickening of the bile ducts, more common in young men, associated w inflammatory bowel disease/ulcerative colitis with an increased risk for cholangiocarcinoma

Answer 46

sclerosing cholangitis

Question 47

Air within the biliary tree is called, produces ring down or dirty shadowing artifact

Answer 47

pneumobilia (symptoms of acute cholecystitis)

Question 48

the clinical findings of ______ 1. Recent biliary or gastric surgery, emphysematous or acute cholecystitis or fistula formation 2. Symptoms of acute cholecystitis

Answer 48

pneumobilia

Question 49

the sonographic findings of ______ echogenic linear structures within the ducts that produce ring-down artifacts and may have dirty shadowing

Answer 49

Pneumobilia

Question 50

An infection of the small intestine that is caused by Ascaris lumbricoides, a parasitic roundworm

Answer 50

Ascariasis

Question 51

The round worm, which is transmitted the fecal-oral route, develops in the small intestine and makes its way to the biliary tree is called?

Answer 51

Ascariasis

Question 52

the clinical findings if _____ 1. Asymptomatic 2. May have symptoms of inflammation of the biliary tree, gallbladder, or pancreas

Answer 52

Ascariasis

Question 53

the sonographic findings of _____ 1. The worm will be noted within the biliary duct as an echogenic linear structure in the sagittal plane 2. Movement of the worm within the duct confirms diagnosis

Answer 53

ascariasis

Question 54

Primary biliary tree cancer is referred to as:

Answer 54

Cholangiocarcinoma

Question 55

What condition is the most common risk factor for cholangiocarcinoma?

Answer 55

Primary sclerosing cholangitis

Question 56

What kind of tumors are the most common manifestation of cholangiocarcinoma?

Answer 56

Klatskin tumors

Question 57

Where are Klatskin tumors located?

Answer 57

Located at the junction of the right and let hepatic ducts., forming the common hepatic duct.

Question 58

the clinical findings of ______ 1. Jaundice 2. Pruritus 3. Unexplained weight loss 4. Abdominal pain 5. Elevated bilirubin 6. Elevated ALP

Answer 58

cholangiocarcinoma

Question 59

the sonographic findings of ____ 1. Dilated intrahepatic ducts that abruptly terminate at the level of the tumor 2. A solid mass may be noted within the liver or ducts

Answer 59

cholangiocarcinoma

Question 60

A congenital disease described as the narrowing or obliteration of all or a portion of the biliary tree

Answer 60

Biliary atresia

Question 61

the clinical findings of _____ 1. Neonatal jaundice 2. Elevated ALT, AST, and bilirubin

Answer 61

biliary atresia

Question 62

the sonographic findings of ____ 1. Absent biliary ducts 2. Triangular cord sign (avascular, echogenic, triangular or tubular structure anterior to the portal vein) 3. Pseudogallbladder sign(cystic structure in the area of the gallbladder fossa without evidence of a true gallbladder) 4. Sonographic signs of cirrhosis and portal hypertension

Answer 62

biliary atresia

Question 63

What is the most common type of choledochal cyst?

Answer 63

cystic dilatation of the CBD

Question 64

the clinical findings of a ____ 1. Jaundice 2. Pain 3. Fever

Answer 64

choledochal cyst

Question 65

the sonographic findings for ____ 1. Cystic mass in the area of the porta hepatis 2. Biliary dilatation

Answer 65

choledochal cyst

Question 66

A congenital disorder characterized by segmental dilatation of the intrahepatic ducts.

Answer 66

Caroli disease

Question 67

the clinical findings of _____ 1. Pain 2. Fever 3. Jaundice 4. Signs of portal hypertension

Answer 67

caroli disease

Question 68

the sonographic findings of _____ 1. Segmental dilatation of the intrahepatic ducts 2. The patient may also have cystic renal disease 3. Central dot sign (echogenic dots in the nondependent part of the dilated duct)

Answer 68

caroli disease

Question 69

Cholangiocarcinoma is most often

Answer 69

adenocarcinoma

Question 70

A congenital disease described as a narrowing or obliteration of all or a portion of the biliary tree, caused by a viral infection at birth

Answer 70

biliary atresia (poor prognosis)

Question 71

Infants with biliary atresia eventually suffer from _____ and _____.

Answer 71

cirrhosis, portal hypertension

Question 72

"triangular cord sign" (avascular, echogenic triangular or tubular structure anterior to portal vein) & "pseudogallbladder sign" (cystic structure in the area of the gallbladder fossa w/o evidence of an actual gallbladder) are associated with what pediatric pathology of the bile ducts

Answer 72

biliary atresia

Question 73

a green pigment found in the bile

Answer 73

biliverdin

Question 74

The spiral valves of Heister are located within the:

Answer 74

cystic duct (allows bile to flow into GB but not leak out until GB is contracted)-prevents the cystic duct from collapsing or distending

Question 75

Which segment of the biliary tree tends to dilated first with obstruction? a. intrahepatic b. extrahepatic

Answer 75

b. extrahepatic (tend to dilate first due to larger size and pivotal role in bile transport)

Question 76

a radiographic procedure in which contrast is injected into the bile ducts to asses for the presence of disease

Answer 76

cholangiography

Question 77

endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancrease

Answer 77

endoscopic retrograde cholangiopancreatography (ERCP)