Chapter 4: Bile ducts

Question 1

Bile is produced where

Answer 1

The liver

Question 2

What is the major component of bile

Answer 2

Cholesterol

Question 3

What is the function of the biliary tree

Answer 3

Provide a conduct for bile to drain from liver to intestine

Question 4

Each portal triad contains what three components

Answer 4

hepatic artery
Portal vein
Intrahepatic ducts (biliary radicales)

Question 5

What are the spiral valves of heister

Answer 5

Tiny structures within the cystic duct that prevent it from collapsing or distending

Question 6

The ampulla of vater is also called

Answer 6

Hepatopancreatic ampulla

Question 7

CBD diameter shouldn’t exceed ___ mm

Answer 7

6

Question 8

Intrahepatic ducts are considered dilated if they exceed ___mm

Answer 8

2

Question 9

What is the parallel sign or shotgun sign

Answer 9

CBD becomes so enlarged that it matches the size of the portal vein

Question 10

Biliary dilation will occur _____ to the level of obstruction

Answer 10

Proximal

Question 11

The most common level for an obstruction to occur is

Answer 11

The distal CBD

Question 12

The CBD segment closer to the pancreas head is considered the most ____ segment of the biliary tree

Answer 12

Distal

Question 13

The CBD, cystic duct, and part of the common hepatic duct are considered _______ in location

Answer 13

Extrahepatic

Question 14

What are the most common causes of CBD obstruction
(There are 4)

Answer 14

Choledocholithiasis
Chronic pancreatitis
Acute pancreatitis
Pancreas cancer

Question 15

If there’s an obstruction, patient will suffer from jaundice. This is called ____

Answer 15

Posthepatic (obstructive) Jaundice

Question 16

What is cholangitis

Answer 16

Inflammation of biliary ducts

Question 17

With cholangitis the walls of the biliary ducts will be thicker than ___mm

Answer 17

5

Question 18

What is the Charcot triad (clinical finding present with cholangitis)

Answer 18

Fever, RUQ pain, and jaundice

Question 19

What lab values may be elevated with cholangitis

Answer 19

WBCs, ALP, ALT, GGT, and obstructive bilirubin

Question 20

What are the sonographic findings of cholangitis

Answer 20

Biliary pus or sludge, biliary dilation, choledolithiasis, wall thickening

Question 21

Cholangitis is often caused by an ________ obstruction

Answer 21

Acute bacterial

Question 22

Describe sclerosing cholangitis

Answer 22

Fibrotic thickening of bile ducts, associated with inflammatory bowel disease or ulcerative colitis

Question 23

Sclerosing cholangitis often affects what group of people

Answer 23

Young men

Question 24

What is pneumobilia

Answer 24

Air within the biliary tree

Question 25

What does pneumobilia look like on ultrasound

Answer 25

Echogenic linear structures within the ducts, produce ring down artifact and shadowing

Question 26

What are the clinical findings of Pneumobilia

Answer 26

Same symptoms of acute cholecystitis Recent biliary or gastric surgery, emphysematous or acute cholecystitis or fistula formation

Question 27

What is ascariasis

Answer 27

When an intestinal parasitic round worm makes its way up to the biliary tree

Question 28

What are the symptoms of ascariasis

Answer 28

Asymptomatic

Question 29

What is the primary biliary tree cancer called

Answer 29

Cholangiocarcinoma

Question 30

What kind of tumor is the most common manifestation of cholangiocarcinoma

Answer 30

Klatskin tumor

Question 31

Klatskin tumors are located where

Answer 31

At the junction of the right and left hepatic ducts, causing dilation of intrahepatic ducts

Question 32

What are the clinical findings of cholangiocarcinoma

Answer 32

Jaundice, pruritus, unexplained weight loss, abdominal pain, elevated bilirubin, elevated ALP

Question 33

Cholangiocarcinoma has a poor prognosis. What patients are at most risk of developing it

Answer 33

Those with primary sclerosing cholangitis

Question 34

What is a choledochal cyst (pediatric pathology)

Answer 34

Cystic mass in the area of ports hepatis causing biliary dilation. Most commonly found in CBD

Question 35

What are the symptoms of a choledochal cyst

Answer 35

Jaundice, fever, pain

Question 36

What is Caroli disease (pediatric pathology)

Answer 36

Segmental dilation of Intrahepatic ducts. Associated with central dot sign

Question 37

What are the clinical findings of Caroli disease

Answer 37

Pain, jaundice, fever, portal hypertension

Question 38

Pts with Caroli disease may also have what other disease

Answer 38

Cystic renal disease

Question 39

What is biliary atresia (pediatric pathology)

Answer 39

Narrowing of obliteration of all or a portion of the biliary tree

Question 40

Biliary atresia has a poor prognosis. Pts will eventually suffer from what other disorders

Answer 40

Cirrhosis, and hypertension

Question 41

Biliary atresia is related to what two “signs”

Answer 41

Triangular cord sign and Pseudogallbladder sign

Question 42

Biliary atresia is caused by a viral infection at birth. What are other clinical findings related to it

Answer 42

Neonatal jaundice, elevated AST, ALT, and bilirubin

Question 43

What is the gold standard imaging for evaluating bile ducts

Answer 43

Magnetic resonance cholangiopancreatography (MRCP)