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ARDMS Abdominal Review > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

The right and left hepatic ducts join to form the

A

Common hepatic duct

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2
Q

Where is the gallbladder located

A

at the inferior end of the main lobar fissure

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3
Q

The neck tapers to form the _____ which joins with the _______ to form the _____

A

cystic duct, common hepatic duct, common bile duct

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4
Q

The common bile duct and the main pancreatic duct (Duct of Wirsung) join to form the

A

Ampulla of Vater

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5
Q

At the porta hepatis, the portal triad consists of what 3 things

A

1) main portal vein
2) common hepatic duct
3) proper hepatic duct
( refered to as the mickey mouse sign)

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6
Q

What is a spiral fold which controls bile flow in the cystic duct

A

Valve of Heisters

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7
Q

What is an abnormal sacculation (diverticulum) of the neck of the gallbladder

A

Hartmann’s pouch

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8
Q

What is a fold in the fundus of the gallbladder

A

Phrygian cap

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9
Q

A ______ is a fold between the body and infundibulum of the gallbladder

A

Junctional fold

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10
Q

The ampulla of Vater empties through the duodenal papilla, controlled by the

A

Sphincter of Oddi

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11
Q

What is the most common cause of gallbladder wall thickening?

A

cholecystitis

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12
Q

Name 5 other causes of gallbladder wall thickening

A

1) hypoalbuminemia
2) ascites
3) hepatitis
4) congestive hear failure
5) pancreatitis

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13
Q

What type of jaundice is due to hepatic disease such as viral hepatitis

A

Hepatic jaundice

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14
Q

What type of jaundice is due to destructive red blood cell disease such as sickle cell anemia

A

Hemolytic jaundice

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15
Q

What type of jaundice is due to obstructive pathology of the biliary tree such as choledocholihiasis

A

Surgical jaundice

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16
Q

Sludge in the GB is associated with biliary stasis secondary to

A

1) prolonged fasting
2) hyperalimentation
3) hemolysis
4) cystic duct obstruction
5) cholecysitis

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17
Q

What appears as nonshadowing, echogenic material which layers and shifts with patient postioning?

A

Sludge

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18
Q

What is the organization of sludge called

A

Tumefactive sludge or sludge balls

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19
Q

Name the 3 sonographic criteria of cholelithiasis

A

1) mobile
2) strongly echogenic
3) acoustic shadowing

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20
Q

Name 3 things gallstones are composed of

A

1) cholesterol
2) calcium bilirubinate
3) calcium carbonate

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21
Q

Name 5 things cystic duct obstruction may result in

A

1) acute cholecystitis
2) empyema
3) gallbladder perforation
4) pericholecystic abscess
5) bile peritonitis

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22
Q

A gallbladder filled with stones may be seen as a strong shadow in the RUQ this is called the

A

Double arc or WES sign (Wall-echo- shadow)

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23
Q

Acute cholecystitis is associated with

A

1) RUQ pain
2) fever
3) leukocytosis

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24
Q

Features of acute cholecystitis include

A

1) gallstones
2) murphys sign
3) diffuse wall thickening
4) gallbladder dilatation
5) sludge

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25
Q

Complications of acute cholecystitis include

A

1) empyema
2) gangrenous cholecystitis
3) gallbladder perforation
4) pericholecystic abscess

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26
Q

Elevation of what suggests obstruction at the level of the ampulla of Vater

A

amylase

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27
Q

What type of artifact is seen due to the presence of gas within the wall/lumen of the gallbladder due to gas forming bacteria

A

comet tail (reverberation ) artifact

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28
Q

Emphysematous Cholecystitis occurs more commonly in

A

Diabetic men

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29
Q

What is tissue loss due to decreased blood supply

A

Gangrenous

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30
Q

Signs suggestive of gangrenous cholecystitis include

A

1) asymmetric wall thickening
2) wall striations
3) intraluminal membranes
4) pericholecystic fluid

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31
Q

Purulent material within the gallbladder due to bacteria-containing bile associated with acute cholecystitis is called

A

Empyema of the gallbladder

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32
Q

What is a complication of acute cholecystitis and a localized fluid collection in the gallblader fossa called

A

Gallbladder perforation

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33
Q

Complications of gallbladder perforation include

A

1) peritonitis
2) pericholecystic abscess
3) biliary fistula

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34
Q

Acalculous Cholecystitis is associated with exsisting conditions such as

A

1) prolonged total parenteral (intravenous) nutrition
2) abdominal surgery
3) trauma
4) severe burns
5) sepsis
6) AIDS

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35
Q

What is a sludge like material with a high concentration of calcium associated with chronic cholecystitis and gallbladder obstruction of the cystic duct that may be seen as a fluid filled layer that results in distal acoustic shadowing

A

Milk of calcium bile (Limy bile)

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36
Q

what is calcification of the gallbladder wall that is associated with chronic cholecystitis

A

Porcelain gallbladder

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37
Q

What is another name for hydrops of the gallbladder

A

Mucocele

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38
Q

Cholesterolosis is a condition referred to as

A

Strawberry gallbladder

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39
Q

gallbladder carcinoma presents as an

A

1) intraluminal mass
2) asymmetric wall thickening
3) a mass that fills the gallbladder lumen

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40
Q

Associated findings of gallbladder carcinoma include

A

1) liver metastases
2) lymphadenopathy
3) bile duct dilatation
4) cholelithaisis

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41
Q

The gallbladder typically has a bile capacity of

A

30 to 60 mL

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42
Q

What is the function of the gallbladder

A

Concentrate and store bile until needed and regulate biliary pressure

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43
Q

When food enters the small intestine, what is secreted by the proximal small intestine causing the gallbladder to contract the sphincter of Oddi to relax

A

Cholecystokinin (CCK)

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44
Q

What is the most common type of obstructive biliary disease in infants and young children

A

Biliary atresia

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45
Q

What is the most common type of choledochal cyst

A

Fusiform dilatation of the CBD

46
Q

A patient presents with ampulla of Vater obstruction, distention of the GB, and painless jaundice. Which of the following is the presentation associated with?

a) hydropic gallbladder
b) choledochal cyst
c) courvoisiers sign
d) mirizzi syndrome
e) caroli’s disease

A

c) courvoisiers sign

47
Q

Which of the following will long-standing cystic duct obstruction give rise to?

a) porcelain gb
b) hydropic gb
c) sepated gb
d) gb septations
e) gb contraction

A

b) hydropic gb

48
Q

a patient presents with a dilated interhepatic duct, dilated gb, and a dilated cbd. This is most characteristic of which one of the following levels of obstruction?

a) proximal CBD
b) distal CBD
c) distal CHD
d) cystic duct
e) neck of the gb

A

b) distal CBD

49
Q

Which of he following describers adenomyomatosis of the gallbladder?

a) a congenital anomaly that presents itself in the 4th or 5th decade of life
b) an inflammation of the GB and biliary ducts
c) associated with chronic pancreatitis
d) proliferation of the mucosal layer, which extends into the muscle layer
e) a malignant process that invovles the GB wall and lumen

A

d) proliferation of the mucosal layer, which extends into the muscle layer

50
Q

A GB sonographic examination is performed and a small GB with intrahepatic dilatation is seen. This may indicate that the level of obstruction is at the level of which of the following?

a) neck of the GB
b) CBD
c) cystic duct
d) CHD
e) none of the above

A

d) CHD

51
Q

A patient presents with empyema of the GB. what should the sonographer expect to find?

a) pus within the GB
b) CBD obstruction
c) stones within the GB
d) abscess surrounding the GB
e) duplication of the GB

A

a) pus within the GB

52
Q

What is the cause of small gallbladder?

a) prolonged fasting
b) insulin-dependent diabetes
c) chronic cholecystitis
d) hydrops
e) ascites

A

c) chronic cholecystitis

53
Q

Which of the following most likely appears as nonshadowing, nonmobile, echogenic foci imaged within the GB lumen?

a) polyps
b) calculi
c) biliary gravel
d) sludge balls
e) thin bile

A

b) calculi

54
Q

What is hydrops of the gallbladder?

a) a small contracted GB
b) a GB with a thickened wall
c) a thick walled GB filled with stones
d) congenital duplication of the GB
e) an enlarged GB

A

e) an enlarged GB

55
Q

A 6 year old child presents with recurrent fever, RUQ pain, and jaundice. An abdominal sonogram is performed. The liver and GB appear normal, but a 2 cm cysts is seen communicating with the CBD. What does this cystic structure most likely represent?

a) a choledochal cyst
b) a pseduocyst
c) an aortic aneurysm
d) a mucocele
e) hydatid cyst

A

a) a choledochal cyst

56
Q

What type of gallbladder is a large gallbladder caused by an obstruction at the distal portion of the common bile duct

A

Courvoisier gallbladder

57
Q

What is calcification of the gallbladder wall called?

a) cholesterolosis
b) courvoisiers gallbladder
c) hydropic gallbladder
d) porcelain gallbladder

A

d) porcelain gallbladder

58
Q

When performing a GB examination, why is the patient asked to be NPO for approx 6 hours before the exam

a) to eliminate any overlying bowel gas
b) to make the patient more cooperative
c) to bring out dehydrationm which will make the patient easier to scan
d) causes bile to collect in the GB
e) causes bile ducts to dilate

A

d) causes bile to collect in the GB

59
Q

The causes of large gallbladder include all of the following except

a) adenomyomatosis
b) pancreatic carcinoma
c) diabetes mellitus
d) a fasting patient
e) common bile duct obstruction

A

a) adenomyomatosis

60
Q

Which of the following is an echogenic linear line extending from the portal vein to the neck of the gallbladder

a) cystic duct
b) right hepatic duct
c) left portal vein
d) main lobar fissure
e) round ligament

A

d) main lobar fissure

61
Q

Which of the following may a jaundiced male child with a hemolytic disorder be found to have

a) increase in direct bilirubin
b) increase in indirect bilirubin
c) increase in alpha-fetoprotein
d) increase in prothrombin time
e) normal liver function test results

A

b) increase in indirect bilirubin

62
Q

Hydrops of the GB may be secondary to all of the following except which one?

a) sludge
b) mass in the head of the pancreas
c) obstruction of the distal common bile duct by a mass of the ampulla of vater
d) stones in Hartmanns pouch
e) surgery

A

a) sludge

63
Q

Which of the following terms describes the malformation variant in the GB that involves an acutely angulated pouch of the fundus

a) Phrygian cap
b) duplication of the GB
c) harmann pouch
d) junctional fold
e) murphys cap

A

a) Phrygian cap

64
Q

Where is the spiral values of Heister located?

a) ampulla of vater
b) junction of the cystic duct and common duct
c) junction of the right and left common hepatic duct
d) proximal portion of the cystic duct
e) fundus of the GB

A

d) proximal portion of the cystic duct

65
Q

Which of the following describes how carcinoma of the GB would most likely appear

a) thin-walled GB
b) small GB with thickened walls
c) large GB with a halo surrounding it
d) diffusely thickened GB with gallstones
e) echogenic mass with no distinguishing features of a GB

A

d) diffusely thickened GB with gallstones

66
Q

A 32 year old female presents to the sonography department with vague abdominal pain. The sonographic investigation of the GB reveals a focal area of GB wall thickening that produces comet tail artifact. These findings are consistent with

a) gangrenous cholecystitis
b) gallbladder perforation
c) acalculous cholecystitis
d) adenomyomatosis

A

d) adenomyomatosis

67
Q

What is hyperplastic changes invovling the gallbladder wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula

A

Adenomyomatosis

68
Q

In majority of patients, biliary obstruction is due to pathology in the

A

Distal CBD

69
Q

Name the 7 causes of biliary obstruction

A

1) choledocholithiasis
2) pancreatic carcinoma
3) cholangiocarcinoma
4) cholangitis
5) Mirizzi syndrome
6) choledochal cyst
7) gallbladder carcinoma

70
Q

_______ or ______ refer to the dilated hepatic duct adjacent to the portal vein

A

Parallel channel sign or shotgun sign

71
Q

This is a hormone that is released into the blood by the ingestion of fatty foods, causing gallbladder contractions

A

Cholecystokinin

72
Q

What is the formation or presence of calculi in the bile ducts

A

Choledocholithaisis

73
Q

What is the most common cause of extrahepatic obstructive jaundice

A

Choledocholithiasis

74
Q

What lab values increase with choledocholithasis

A

Conjugated serum bilirubin
Alkaline phosphatase
GGT

75
Q

Name 3 complications of choledocholithiasis

A

1) biliary cirrhosis
2) cholangitis
3) Pancreatits

76
Q

Name 4 diagnostic tests to detect choledocholithiasis

A

1) ERCP
2) PTC (percutaneous transhepatic cholangiography)
3) CT
4) Ultrasound

77
Q

What is extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct

A

Mirizzi syndrome

78
Q

Name 4 associated findings of Mirizzi syndrome

A

1) intrahepatic duct dilatation
2) cystic duct stone
3) curved segmental stenosis of CHD
4) Cholecystocholedochal fistula

79
Q

What tumor is a cholangiocarcinoma located at the hepatic hilum resulting in intrahepatic but not extrahepatic biliary dilation

A

Klastskin tumor

80
Q

Another name for bile duct carcinoma is

A

Cholangiocarcinoma

81
Q

Name 6 predisposing conditions of cholangiocarcinoma

A

1) ulcerative colitis
2) sclerosing cholangitis
3) carolis disease
4) choledochal cyst
5) parasitic infestation
6) chemical toxins

82
Q

What is an infection and inflammation of the biliary ducts resulting in wall thickening that comprises the lumen of the bile duct

A

Cholangitis

83
Q

What 3 things are associated with cholangits

A

1) choledocholithiasis
2) biliary tract interventions
3) ulcerative colits

84
Q

Cholangitis results in increased

A

1) serum conjugated bilirunin
2) serum alkaline phosphatase
3) tansaminases
4) serum amylase and lipase
5) leukocytosis

85
Q

What is air in the biliary system called

A

Pneumobilia

86
Q

What are congenital anomalies of the bile ducts consisting of cystic dilatation of the intra and extrahepatic bile ducts

A

Choledochal cyst

87
Q

Name the 2 sonographic findings of choledochal cysts

A

1) 2 cystic structures in the RUQ

2) intrahepatic bile duct dilatation `

88
Q

Choledochal cysts are prevalent in what country

A

Asia

89
Q

Name 6 associated findings for choledochal cysts

A

1) pancreatitis
2) cholangits
3) hepatic abscesses
4) cirrhosis
5) portal hypertension
6) cholangiocarcinoma

90
Q

What is a congential abnormality of the biliary tract characterized by mulifocal segmental dilatation of the intrahepatic bile ducts

A

Carolis disease

91
Q

Name 6 things carolis disease is associated with

A

1) congential hepatic fibrosis
2) portal hypertension
3) medullary sponge kidney
4) infantile polycystic kidney disease
5) renal tubular ectasia
6) choledochal cyst

92
Q

Name 4 complications of carolis disease

A

1) recurent cholangitis
2) biliary calculi and obstruction
3) hepatic abscess
4) cholangiocarcinoma

93
Q

What is the most common cause of malignant neoplasm obstructing the biliary tree

A

Pancreatic Adenocarcinoma

94
Q

Pancreatic adenocarcinoma at the head of the pancreas typically causes

A

Courvoisier gallbladder

95
Q

increased unconjugated bilirubin results from

A

1) increased bilirubin production (hemolysis

2) decreased liver conjugation

96
Q

ALP increases in diseases that impair bile formation, specifically

A

bile duct obstruction

97
Q

Name 5 things ALP increases with

A

1) biliary obstruction
2) liver disease
3) bone growth and diseases
4) hyperparathyroidism
5) pregnancy

98
Q

What is the most common pathology of the biliary tract

A

Choledocholithiasis

99
Q

A patient presents for an abdomen ultrasound with RUQ pain, nausea, fever, and leukocytosis. An abnormal enlarged gallbladder demonstrates thickened walls at 1.2 cm. An anterior segment of the wall is echogenic and ring down artifact and dirty shadowing are present posterior to this area. Which of the following conditions is identified on this exam?

a) chronic cholecystitis
b) cholesterol polyps
c) adenomyomatosis
d) emphysematous cholecystitis

A

d) emphysematous cholecystitis

100
Q

Primary GB carcinoma most commonly presents as

a) enlarged GB surrounded by fluid
b) focal wall mass without stones
c) diffusely thickened GB wall with stones
d) small GB with thickened walls

A

c) diffusely thickened GB wall with stones

101
Q

The WES sign indicates a diagnosis of

a) portal thrombosis
b) GB stone
c) solid mass in GB
d) cyst in GB

A

b) GB stone

102
Q

What are 2 other names for gallbladder sludge?

A

1) billiary sand

2) microlithaisis

103
Q

Charcot triad is used to describe the classic clinical presentation of

a) pyloric stenosis
b) abdominal aortic aneurysm
c) Hashimoto thyroiditis
d) acute cholangitis

A

d) acute cholangitis

104
Q

What is another name for Hartmanns pouch

A

Infundibulum

105
Q

Which of the following is not a congenital anomaly/disorder?

a) sclerosing cholangitis
b) choledochal cyst
c) caroli disease
d) billiary atresia

A

a) sclerosing cholangitis

- sclerosing cholangitis is an aquired inflammatory disorder of the billiary tree

106
Q

Which of the following is leas likely to be associated with gallbladder sludge

a) elevated cholecystokinin levels
b) alcoholism
c) cystic duct obstruction
d) fasting

A

a) elevated cholecystokinin levels

107
Q

Which of the following is caused by infection or ischemia of the gallbladder wall

a) hartmann pouch
b) adenomyomatosis
c) bouveret syndrome
d) membranous gangrenous gallbladder

A

d) membranous gangrenous gallbladder

108
Q

A patient with choledochal cysts has an increased risk of developing

a) polycystic liver disease
b) biliary atresia
c) cholangiocarcinoma
d) portal HTN

A

c) cholangiocarcinoma

109
Q

Which of the following gallbladder abnormalities have a very similar appearance on ultrasound evaluation and clinical history is necessary for differentiation

a) porcelain gallbladder and tumefactive sludge
b) acalculous cholecystitis and adenomyomatosis
c) hemobilia and sludge
d) chronic cholecystitis and Courvoisier gallbladder

A

c) hemobilia and sludge

110
Q

What term describes a gallbladder that is filled with bile that is isoechoic to the liver and is difficult to identify on ultrasound

a) Mirizzi syndrome
b) charcot triad
c) hepatization
d) courvoisier gallbladder

A

c) hepatization

ARDMS Abdominal Review (14 decks)

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