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Sonographic Topics > Chapter 4: The Bile Ducts > Flashcards

Chapter 4: The Bile Ducts Flashcards

1
Q

inflammation of the pancreas secondary to leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ

A

acute pancreatitis

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2
Q

the merging point of the pancreatic duct and common bile duct just before the Sphincter of Oddi; also referred to as the hepatopancreatic ampulla

A

ampullar of Vater

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3
Q

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

A

ascariasis

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4
Q

a congenital disease described as the narrowing or obliteration of all or part of the bilary tree

A

biliary atresia

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5
Q

pain secondary to a blockage of the biliary tree

A

biliary colic

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6
Q

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

A

biliary stasis

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7
Q

a yellowish pigment found in bile that is produced by the breakdown of old red blood cells by the liver

A

bilirubin

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8
Q

a green pigment found in bile

A

biliverdin

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9
Q

a congenital disorder characterized by segmental dilatation of the intrahepatic ducts

A

Caroli disease

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10
Q

the presence of echogenic dots in the nondependent part of the dilated duct representing small fibrovascular bundles; seen with caroli disease

A

central dot sign

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11
Q

fever, RUQ pain, and jaundice associated with cholangitis

A

Charcot triad

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12
Q

primary bile duct cancer

A

cholangiocarcinoma

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13
Q

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

A

cholangiography

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14
Q

inflammation of the bile ducts`

A

cholangitis

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15
Q

the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring, and the development of calcifications within the gland

A

chronic pancreatitis

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16
Q

coexisting dilation of the common bile duct and pancreatic duct

A

double-duct sign

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17
Q

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

A

endoscopic retrograde cholangiopancreatography

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18
Q

the level of the biliary tree where the common bile duct and the main pancreatic duct meet; may also be referred to as the ampulla of Vater

A

hepatopancreatic ampulla

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19
Q

the muscle that controls the emptying of bile and pancreatic juices into the duodenum; may also be referred to as the sphincter of Oddi

A

hepatopancreatic sphincter

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20
Q

chronic inflammation of all or part of the bowel

A

inflammatory bowel disease

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21
Q

a malignant biliary tumor located at the junction of te right and left hepatic ducts

A

Klaskin tumor

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22
Q

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

A

Mirrizzi syndrome

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23
Q

the enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis

A

parallel tube sign

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24
Q

air within the biliary tree

A

pneumoblia

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25
Q

severe itchiness of the skin

A

pruritus

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26
Q

a sign associated with biliary atresia in children where there is evidence of a cystic structure in the gallbladder fossa without the presence of an actual gallbladder

A

pseudogallbladder sign

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27
Q

the enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis; also referred to as the parallel tube sign

A

shotgun sign

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28
Q

the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic sphincter

A

sphincter of Oddi

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29
Q

a sign associated with biliary atresia in children that is described as an avascular, echogenic, triangular, or tubular structure anterior to the portal vein, representing the replacement of the extrahepatic duct with fibrous tissue in the porta hepatis

A

triangular cord sign

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30
Q

an inflammatory bowel disease that leads to the development of ulcers within the bowel

A

ulcerative colitis

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31
Q

caused by bacterial accumulation secondary to obstruction; bacteria can be introduced during an ERCP for choledocholithiasis; pus may be noted within the bile ducts as low-level echoes

A

acute bacterial cholangitis

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32
Q

associated with advanced HIV and AIDS; most often results from infection with Cryptospordium or cytomegalovirus

A

AIDS cholangitis

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33
Q

endemic to Asia; seen in America because of immigration

A

Oriental cholangitis

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34
Q

characterize by fibrotic thickening of the bile ducts; most often affects young men; associated with inflammatory bowel disease or ulcerative colitis; increased risk for cholangiocarcinoma

A

sclerosing cholangitis

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35
Q

Charcot triad

A

fever, RUQ pain, jaundice

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36
Q

charcot triad, leukocytosis, elevated ALP, ALT, GGT, and bilirubin

A

clinical findings of cholangitis

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37
Q

biliary dilatation; biliary sludge or pus; choledocholithiasis; bile duct wall thickening

A

sonographic findings of cholangitis

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38
Q

recent biliary or gastric surgery; emphysematous or acute cholecystitis; fistula formation; symptoms of acute cholecystitis

A

clinical findings of pneumobilia

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39
Q

echogenic linear structures within the ducts that produce ring-down artifacts and dirty shadowing

A

sonographic findings of pneumobilia

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40
Q

may have symptoms of inflammation of the biliary tree, gallbladder, or pancreas

A

clinical findings of ascariasis

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41
Q

worm will be noted within the biliary duct as an echogenic linear structure in the sagittal plane; movement of the worm within the duct confirms the diagnosis

A

sonographic findings of ascariases

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42
Q

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

A

clinical findings of cholangiocarcinoma

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43
Q

dilated intrahepatic ducts that abruptly terminate at the level of the tumor; a solid mass may be noted within the liver or ducts

A

sonographic findings of cholangiocarcinoma

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44
Q

neonatal jaundice; elevated AST, ALT, and bilirubin

A

clinical findings of Biliary Atresia

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45
Q

absent biliary ducts, triangular cord sign, pseudogallbladder sign, sonographic signs of cirrhosis and portal hypertension

A

sonographic findings of biliary atresia

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46
Q

jaundice, pain, fever

A

clinical findings of choledochal cyst

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47
Q

cystic mass in the area of the porta hepatis; biliary dilatation

A

sonographic findings of a choledochal cyst

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48
Q

pain, fever, jaundice, signs of portal hypertension

A

clinical findings of caroli disease

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49
Q

segmental dilatation of the intrahepatic ducts; patient may also have cystic renal disease; central dot sign

A

sonographic findings of Caroli disease

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50
Q

vital digestive fluid

A

bile

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51
Q

Bile is produced by the:

A

liver

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52
Q

major component of bile

A

cholesterol

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53
Q

bile is made up of:

A

cholesterol
bilirubin
biliverdin
bile acids

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54
Q

Function of the biliary tree

A

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

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55
Q

Bile first accumulates in the

A

small intrahepatic biliary radicles throughout the liver

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56
Q

The portal triads contain

A

hepatic artery
portal vein
intrahepatic ducts (biliary radicles)

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57
Q

From the biliary radicles, bile flows into either right or left _____

A

hepatic ducts

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58
Q

Bile is stored and concentrated in the:

A

gallbladder

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59
Q

attaches the gallbladder to the biliary tree

A

cystic duct

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60
Q

The point of attachment of the cystic duct to the gallbladder marks the proximal portion of the:

A

CBD

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61
Q

The cystic duct contains:

A

the spiral valves of Heister

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62
Q

prevent the cystic duct from collapsing or distending

A

the spiral valves of Heister

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63
Q

produced by the duodenum, makes the gallbladder contract and empty the bile

A

cholestokynin

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64
Q

also referred to as hepatopancreatic sphincter

A

Sphincter of Oddi

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65
Q

opening that allows bile and pancreatic juices to flow into duodenum

A

Spincter of Oddi

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66
Q

The fluid is mixed with chyme in the ______ and appropriate chemical reaction ensures

A

duodenum

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67
Q

A CBD diameter that exceeds __mm is abnormal

A

6

68
Q

Intrahepatic ducts are considered dilated when they exceed __mm

A

2

69
Q

describes enlargment of common duct to size of adjacent portal vein within porta hepatis

A

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

70
Q

coexisting dilation of CBD and pancreatic duct

A

“double-duct sign”

71
Q

Most distal segment of biliary tree

A

CBD segment closest to pancreatic head

72
Q

Biliary dilatation will occur _____ to level of obstruction

A

proximal

73
Q

Extrahepatic parts of biliary tree

A

CBD
cystic duct
part of common hepatic duct

74
Q

most common level for an obstruction to occur

A

distal CBD

75
Q

Most common causes of biliary obstruction

A

choledocholithiasis
chronic pancreatitis
acute pancreatitis
pancreatic carcinoma

76
Q

result of obstruction within the biliary tree; occurs as a consequence of bilirubin accumulation within tissues of the body

A

jaundice

77
Q

Excessive bilirubin leads to elevated ______

A

serum bilirubin

78
Q

presence of gallstones within the bile ducts

A

choledocholithiasis

79
Q

Most common cause of obstructive jaundice

A

gallstones located within the CBD

80
Q

Most gallstones in choledocholithiasis are located near the _____

A

ampulla of Vater

81
Q

uncommon manifestation of choledocholithiasis; clinical condition in which the patient presents with jaundice, pain, and fever secondary to a lodged stone in the cystic duct with subsequent compression of the common duct

A

Mirizzi syndrome

82
Q

inflammation of the biliary ducts

A

cholangitis

83
Q

In cholangitis, the bile duct wall thickens to greater than __mm

A

5

84
Q

Types of cholangitis

A

acute bacterial or ascending cholangitis
AIDS
oriental
sclerosing

85
Q

Charcot triad

A

fever
RUQ pain
jaundice

86
Q

sonographic findings of cholangitis

A

biliary dilatation
biliary sludge
bile duct thickening

87
Q

Cholangitis can lead to _____ and _____

A

cirrhosis
portal hypertension

88
Q

air within the biliary tree

A

pneumobilia

89
Q

_______ may be associated with:
recent biliary or gastric surgery
emphysematous or prolonged acute cholecystitis
fistula formation

A

cholangitis

90
Q

sonographic findings of pneumobilia

A

echogenic linear structures seen within the ducts; air will produce ring-down artifact and have dirty shadowing

91
Q

infection of the small intestine that is caused by Ascaris lumbricoides, a parasitic roundworm that is transmitted fecal-oral route

A

ascariasis

92
Q

In ascariasis, the roundworm develops in the _____ and makes its way to the biliary tree through the ______

A

small intestine
ampulla of Vater

93
Q

primary biliary tree cancer

A

cholangiocarcinoma

94
Q

most common risk factor for cholangiocarcinoma is

A

primary sclerosing cholangitis

95
Q

most common manifestation of cholangiocarcinoma

A

Klastkin tumors

96
Q

located at the junction of the right and left hepatic ducts

A

Klastkin tumors

97
Q

dilated intrahepatic ducts that abruptly terminate at level of tumor; solid mass may be noted in the liver

A

cholangiocarcinoma

98
Q

congenital disease that is thought to be caused by a viral infection at birth; although some think it is an inherited disorder

A

Biliary atresia

99
Q

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

A

biliary atresia

100
Q

sonographic findings of biliary atresia

A

absent ducts
gallbladder may be absent or small
triangular cord sign
pseudogallbladder sign

101
Q

avascular, echogenic, triangular, or tubular structure anterior to portal vein, representing replacement of extrahepatic duct with fibrous tissue in the porta hepatis

A

triangular cord sign

102
Q

cystic structure in the area of the gallbladder fossa without evidence of an actual gallbladder

A

pseudogallbladder sign

103
Q

The most common type of ______ is described as the cystic dilatation of the CBD

A

choledochal cyst

104
Q

signs and symptoms of choledochal cyst

A

abdominal mass
jaundice
pain
fever

105
Q

Choledochal cysts can lead to:

A

cholangitis
portal hypertension
pancreatitis
liver failure

106
Q

sonographic findings of choledochal cysts

A

fusiform cystic mass in the area of the porta hepatis and biliary dilatation

107
Q

congenital disorder characterized by segmental dilatation of the intrahepatic ducts; often seen in association with cystic renal disease; may precede development of cholangiocarcinoma, hepatic abscess, cholangitis, and sepsis

A

Caroli disease

108
Q

signs and symptoms of Caroli disease

A

pain
fever
jaundice
signs of portal hypertension

109
Q

sonographic findings of Caroli disease

A

segmental dilatation of intrahepatic ducts; central dot sign

110
Q

presence of echogenic dots in the nondependent part of the dilated duct represent small fibrovascular bundles

A

central dot sign

111
Q

A congenital disease that is described as narrowing or obliteration of the bile ducts is referred to as:

A

Caroli disease

112
Q

Ascariasis is caused by:

A

a parasitic roundworm

113
Q

Primary biliary tree cancer is referred to as:

A

cholangiocarcinoma

114
Q

Which of the following is associated with Charcot triad?
a. cholangitis
b. cholesterolosis
c. Klatskin tumor
d. choledochal cyst

A

a

115
Q

The merging point of the pancreatic duct and common bile duct at the level of the duodenum is referred to as the:

A

ampulla of Vater

116
Q

Which of the following would be the least helpful laboratory value to analyze in patients with suspected biliary tree disease?
a. ALT
b. ALP
c. GGT
d. creatinine

A

d

117
Q

A gallstone located within the biliary tree is referred to as:

A

choledocholithiasis

118
Q

Which of the following disorders is associated with the sonographic triangular cord sign?
a. cholangitis
b. choledocholithiasis
c. biliary atresia
d. ascariasis

A

c

119
Q

The yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as:

A

jaundice

120
Q

The Klatskin tumor is located:

A

at the junction of the right and left hepatic ducts

121
Q

Inflammation of the bile ducts is referred to as:

A

cholangitis

122
Q

A patient presents with jaundice, pain, and fever secondary to an impacted stone in the cystic duct. This is referred to as:

A

Mirizzi syndrome

123
Q

Air within the biliary tree is referred to as:

A

pneumobilia

124
Q

The presence of an echogenic dot in the nondependent part of a dilated duct representing small fibrovascular bundles is seen with:

A

Caroli disease

125
Q

The spiral valves of Heister are located within the:

A

cystic duct

126
Q

Which of the following is characterized by fibrotic thickening of the bile ducts, found most often in young males, and is associated with inflammatory bowel disease or ulcerative colitis?
a. Ulcerative biliary atresia
b. oriental cholangitis
c. sclerosiing cholangitis
d. AIDS biliary atresia

A

c

127
Q

If a gallstone, causing obstruction, is located with the distal common hepatic duct, which of the following would become dilated?
a. main pancreatic duct
b. gallbladder only
c. intrahepatic ducts
d. distal common bile duct

A

c

128
Q

Which of the following is considered the most proximal portion of the biliary tree?
a. intrahepatic radicles
b. cystic duct
c. common hepatic duct
d. common bile duct

A

a

129
Q

Pneumobilia will produce:

A

ring-down artifact

130
Q

Which of the following would be the most distal portion of the biliary tree?
a. common bile duct
b. common hepatic duct
c. gallbladder
d. intrahepatic radicles

A

a

131
Q

Which of the following could accidentally introduce bacteria into the biliary tree and thus cause cholangitis?
a. CT
b. ERCP
c. MRI
d. Radiography

A

b

132
Q

If an obstructive biliary calculus is loacted in the distal common duct, which of the following could ultimately dilate?
a. common bile duct only
b. gallbladder and cystic duct
c. common hepatic duct and intrahepatic duct
d. common bile duct, gallbladder, common hepatic duct, and intrahepatic ducts

A

d

133
Q

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

A

sphincter of Oddi

134
Q

The most common level for biliary obstruction to occur is the:

A

distal common bile duct

135
Q

A 32 year old female presents to the sonography department with a history of fever, leukocytosis, and RUQ pain. Sonographically, you visualize dilated bile ducts that have thickened walls and contain sludge. What is the most likely diagnosis?

A

cholangitis

136
Q

Sonographically, you visualize scattered echogenic linear structures within the liver parenchyma that produce ring-down artifact. What is the most likely diagnosis?

A

pneumobilia

137
Q

A 64 year old man presents to the sonography department for a RUQ sonogram. He is complaining of abdominal pain, weight loss, and pruritus. Sonographically, you visualize an area of dilated ducts that abruptly end. What is the most likely diagnosis?

A

cholangiocarcinoma

138
Q

An abdominal sonogram is ordered for an infant in the intensive care unit who is suffering from jaundice and fever. Sonographically, you visualize an anechoic mass within the common bile duct that is causing a focal enlargement. This is most suggestive of:

A

choledocal cyst

139
Q

All of the following are clinical findings consistent with cholangiocarcinoma except:
a. pruritus
b. weight loss
c. elevated bilirubin
d. dilation of the intrahepatic ducts

A

d

140
Q

Which of the following is not associated with the development of pneumobilia?
a. cholangiopneumonia
b. gastric surgery
c. acute cholecystitis
d. fistula formation

A

a

141
Q

A Klastkin tumor is a manifestation of:

A

cholangiocarcinoma

142
Q

The biliary duct wall should never measure more than:

A

5mm

143
Q

Clinical findings of choledocholithiasis include all of the following except:
a. jaundice
b. elevated bilirubin
c. elevated blood urea of nitrogen
d. elevated ALP

A

c

144
Q

Which segment of the biliary tree tends to dilate with obstruction?

A

extrahepatic

145
Q

Which of the following is not a plausible cause of common bile duct obstruction in adults?
a. choledocholithiasis
b. chronic pancreatitis
c. choledochal cyst
d. pancreatic carcinoma

A

c

146
Q

All of the following are forms of cholangitis except:
a. acute bacterial
b. AIDS
c. oriental
d. parabolic

A

d

147
Q

The yellowish pigment found in bile that is produced by the breakdown of old red blood cells by the liver is:

A

bilirubin

148
Q

Which of the following is typically found in pediatric patients and is described as the cystic dilation of the common bile duct?
a. biliary atresia
b. Mirizzi syndrome
c. Caroli disease
d. choledocal cyst

A

d

149
Q

For patients older than 60 years, or those who have had a cholecystectomy, a maximum diameter of ____ may be considered normal.

A

1cm

150
Q

Which of the following would be the most common cause of obstructive jaundice?
a. Klatskin tumor
b. cholangiocarcinoma
c. biliary atresia
d. choledocholithiasis

A

d

151
Q

Which of the following is associated with the “pseudogallbladder” sign?
a. biliary strictures
b. charcot triad
c. pruritus
d. biliary atresia

A

d

152
Q

Which of the following is a fluoroscopic procedure typically performed in ithe radiology department that involves an analysis of the biliary tree and pancreas?
a. MRCP
b. ERCP
c. Nuclear medicine cholangiography
d. Cholangiofluoroscopy

A

d

153
Q

Which of the following is associated with a biliary obstruction?
a. posthepatic jaundice
b. prehepatic jaundice
c. hepatic jaundice
d. biliary jaundice

A

a

154
Q

What is another name for the sphincter of Oddi?

A

hepatopancreatic sphincter

155
Q

Among the following list. which of teh following is located just distal to the cystic duct?
a. right hepatic duct
b. common hepatic duct
c. Duct of Wirsung
d. Common bile duct

A

d

156
Q

Severe itchiness of the skin is referred to as:

A

pruritus

157
Q

Enlargement of the common bile duct and pancreatic duct is referred to as the:

A

double-duct sign

158
Q

Which of the following is not a sonographic finding of cholangitis?
a. biliary dilatation
b. biliary sludge
c. choledocholithiasis
d. triangular cord sign

A

d

159
Q

Which of the following is the most common risk factor for cholangiocarcinoma?
a. pruritus
b. biliary atresia
c. sclerosing cholangitis
d. choledocholithiasis

A

c

160
Q

What is the most common location of choledocholithiasis?

A

near the ampulla of Vater

161
Q

Which type of cholangitis is found in severely immunocompromisedpatients and results from infections caused by Cryptosporidium or cytomegalovirus?

A

AIDS cholangitis

162
Q

What is the most common form of cholangitis?

A

adenocarcinoma

163
Q

How is ascariasis transmitted?

A

fecal-oral route

164
Q

Infants with biliary atresia often ultimately suffer from:

A

cirrhosis

165
Q

Which of the following is the major component of bile?

A

cholesterol

166
Q
A

Sonographic Topics (35 decks)

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