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Penny abdomen > Ch. 4 Bile Ducts > Flashcards

Ch. 4 Bile Ducts Flashcards

1
Q

A vital digestive fluid that is produced by the liver

A

Bile

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2
Q

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

A

Cholesterol

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3
Q

What is the function of the biliary tree?

A

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

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4
Q

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

A

cystic duct

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5
Q

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

A

Name the order of bile flow

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6
Q

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

A

Ampulla of Vater

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7
Q

Other term for ampulla of vater

A

Hepatopancreatic ampulla

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8
Q

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

A

Sphincter of Oddi/Hepatopancreatic sphincter

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9
Q

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

A

Four

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10
Q

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

A

6mm

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11
Q

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

A

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

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12
Q

How should a sonographer measure the CBD?

A

Caliper placement should be from inner to inner wall

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13
Q

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

A

10mm

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14
Q

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

A

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

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15
Q

Intrahepatic ducts are considered dilated if they exceed

A

2mm

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16
Q

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

A

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

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17
Q

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

A

“double-duct sign”

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18
Q

The CBD segment closest to the pancreatic head is considered

A

most distal segment of the biliary tree

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19
Q

Biliary dilation will occur where to the level of obstruction?

A

proximal

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20
Q

Most common level of obstruction to occur is

A

the distal CBD

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21
Q

Where the most distal segment of the biliary tree

A

The common bile segment closest to the pancreatic head

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22
Q

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

A

Distal common bile duct

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23
Q

Name the most common causes of CBD obstruction

A

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

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24
Q

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

A

Jaundice

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25
Q

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

A

Bilirubin

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26
Q

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

A

biliary stasis

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27
Q

Obstruction within the bilary tree the patient will eventually suffer from

A

posthepatic (obstructive) jaundice

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28
Q

Excessive bilirubin leads to elevated

A

serum bilirubin

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29
Q

What is infant jaundice usually caused by?

A

inability of the newborn liver to eliminate bilirubin from the bloodstream

30
Q

The presence of gallstones within the bile ducts

A

choledocholithiasis

31
Q

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

A

Obstructive jaundice

32
Q

An uncommon manifestation of choledocholithiasis is

A

Mirizzi syndrome

33
Q

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

A

Mirizzi syndrome

34
Q

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

A

choledocholithiasis

35
Q

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

A

choledocholithiasis

36
Q

Inflammation of the biliary ducts

A

cholangitis

37
Q

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

A

5 mm

38
Q

What is the most common cause of cholangitis?

A

choledocholithiasis or an obstructive disease

39
Q

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

A

cholangitis

40
Q

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

A

cholangitis

41
Q

What is Charcot’s triad?

A

RUQ pain, fever, jaundice

42
Q

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

A

Charcot triat

43
Q

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

A

AIDS cholangitis

44
Q

Type of cholangitis because of immigration, endemic to asia

A

Oriental cholangitis

45
Q

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

A

acute baterial cholangitis

46
Q

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

A

sclerosing cholangitis

47
Q

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

A

pneumobilia (symptoms of acute cholecystitis)

48
Q

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

A

pneumobilia

49
Q

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

A

Pneumobilia

50
Q

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

A

Ascariasis

51
Q

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?

A

Ascariasis

52
Q

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

A

Ascariasis

53
Q

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

A

ascariasis

54
Q

Primary biliary tree cancer is referred to as:

A

Cholangiocarcinoma

55
Q

What condition is the most common risk factor for cholangiocarcinoma?

A

Primary sclerosing cholangitis

56
Q

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

A

Klatskin tumors

57
Q

Where are Klatskin tumors located?

A

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

58
Q

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

A

cholangiocarcinoma

59
Q

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

A

cholangiocarcinoma

60
Q

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

A

Biliary atresia

61
Q

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

A

biliary atresia

62
Q

the sonographic findings of ____
1. Absent biliary ducts
2. Triangular cord sign (avascular, echogenic, triangular or tubular structure anterior to the portal vein)
3. Sonographic signs of cirrhosis and portal hypertension

A

biliary atresia

63
Q

What is the most common type of choledochal cyst?

A

cystic dilatation of the CBD

64
Q

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

A

choledochal cyst

65
Q

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

A

choledochal cyst

66
Q

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

A

Caroli disease

67
Q

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

A

caroli disease

68
Q

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)

A

caroli disease

69
Q

Cholangiocarcinoma is most often

A

adenocarcinoma

70
Q

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

A

biliary atresia (poor prognosis)

71
Q

Infants with biliary atresia eventually suffer from _____ and _____.

A

cirrhosis, portal hypertension

72
Q

“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

A

biliary atresia

Penny abdomen (8 decks)

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