Chapter 4: The Bile Ducts Flashcards
inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
acute pancreatitis
the merging point of the pancreatic duct and common bile duct just before the sphincter of Oddi; also referred to as the hepatopancreatic ampulla
ampulla of Vater
a conjenital disease described as the narrowing or obliteration of all or a portion of the biliary tree
biliary atresia
a condition in which bile is stagnant and allowed to develop into sludge or stones
biliary stasis
a congenital disorder characterized by segmental dilatation of the intrahepatic ducts
Caroli disease
primary bile duct cancer
cholangiocarcinoma
inflammation of the bile ducts
cholangitis
the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring, and the development of calcification within the gland
chronic pancreatitis
a malignant biliary tumor located at the junction of the right and left hepatic ducts
Klatskin tumor
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 hepatic duct
Mirizzi syndrome
the area of the liver where the portal vein and hepatic artery enter and the hepatic ducts exit; also referred to as the liver hilum
porta hepatis
the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic sphincter
sphincter of Oddi
folds located within the cystic duct that prevent it from collapsing and distending
spiral valves of Heister
contents of a portal triad
small branches of hepatic artery, portal vein, and intrahepatic duct
normal diameter of the common duct in adults at the level of the porta hepatis
between 1 and 7 mm
maximum diameter of the bile duct that is considered normal if the patient is over 60 or has had a cholecystectomy
10 mm
what are the structures in the “shotgun sign”?
common bile duct and adjacent portal vein
biliary dilatation will occur ________ to the level of obstruction
proximal
3 parts of the biliary tree that are considered extrahepatic
common bile duct
cystic duct
part of the common hepatic duct
most common level for an obstruction to occur in the biliary tree
distal common bile duct
most common cause of obstructive jaundice
gallstones located within the common bile duct
Clinical findings: jaundice elevated bilirubin elevated alkaline phosphatase RUQ pain
choledocholithiasis
Sonographic findings:
echogenic foci within the bile duct that may or may not shadow
may have biliary dilatation but not always
choledocholithiasis
cholangitis should be suspected when the bile ducts walls exceed:
5 mm
Clinical findings: fever leukocytosis jaundice RUQ pain elevated alkaline phosphatase elevated bilirubin
cholangitis
Sonographic findings: biliary dilatation biliary sludge choledocholithiasis bile duct wall thickening
cholangitis
Clinical findings:
recent biliary surgery
symptoms of acute cholecystitis
pneumobilia
Sonographic findings:
echogenic linear structures within the ducts that produce ring-down artifacts and may have dirty shadowing
pneumobilia
most common manifestation of cholangiocarcinoma
Klatskin tumors
dilated intrahepatic ducts that abruptly terminate at the level of the tumor are suggestive of:
cholangiocarcinoma
Clinical findings: jaundice pruritus unexplained weight loss abdominal pain elevated bilirubin elevated alkaline phosphatase
cholangiocarcinoma
Sonographic findings:
dilated intrahepatic ducts that abruptly terminate at the level of the tumor
a solid mass may be noted within the liver or ducts
cholangiocarcinoma
Sonographic findings:
absent biliary ducts
cirrhosis and portal hypertension findings
biliary atresia
most common type of choledochal cyst
cystic dilatation of the common bile duct
Clinical findings: (pediatric patient)
jaundice
pain
fever
choledochal cyst
Sonographic findings: (pediatric patient)
cystic mass in the area of the porta hepatis (separate from the gallbladder)
biliary dilatation
choledochal cyst
Sonographic findings: (pediatric patient)
segmental dilatation of the intrahepatic ducts
patient may also have cystic renal disease
Caroli disease
The merging point of the pancreatic duct and common bile duct at the level of the duodenum is referred to as the: A. sphincter of Oddi B. ampulla of Vater C. common bile duct D. cystic duct
ampulla of Vater
The Klatskin tumor is located:
A. at the junction of the right and left hepatic ducts
B. at the junction of the cystic and common bile ducts
C. at the junction of the common bile duct and common hepatic duct
D. between the pancreatic head and duodenum
at the junction of the right and left hepatic ducts
A patient presents with jaundice, pain, and fever, secondary to an impacted stone in the cystic duct. This is referred to as: A. Caroli syndrome B. Mirizzi sundrome C. choledochal cysts D. biliary atresia
Mirizzi syndrome
The spiral valves of Heister are located within the: A. common bile duct B. pancreatic duct C. common hepatic duct D. cystic duct
cystic duct
If a gallstone, causing obstruction, is located within the distal common hepatic duct, which of the following would become dilated? A. common bile duct only B. gallbladder only C. intrahepatic ducts D. all of the above
intrahepatic ducts
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
intrahepatic radicles
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
common bile duct
If an obstructive biliary calculus is located within the distal common duct, which of the following could ultimately dilate? A. common bile duct B. gallbladder C. common hepatic duct D. all of the above
all of the above
The gallbladder is connected to the biliary tree by the: A. cystic duct B. ampulla of Vater C. sphincter of Oddi D. common bile duct
cystic duct
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. biliary atresia B. choledocholithiasis C. Caroli syndrome D. cholangiocarcinoma
cholangiocarcinoma
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
dilation of the intrahepatic ducts
Which of the following is not associated with the development of pneumobilia? A. cholangiopneumonia B. gastric surgery C. acute cholecystitis D. fistula formation
cholangiopneumonia
The biliary duct wall should never measure more than: A. 2 mm B. 9 mm C. 4 mm D. 5 mm
5 mm
Clinical findings of choledocholithiasis include all of the following except: A. jaundice B. elevated bilirubin C. elevated blood urea nitrogen D. elevated alkaline phosphatase
elevated blood urea nitrogen
Which segment of the biliary tree tends to dilate first with obstruction?
A. intrahepatic
B. extrahepatic
extrahepatic
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
choledochal cyst
All of the following are forms of cholangitis except: A. acute bacterial B. AIDS C. oriental D. parabolic
parabolic
