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Generalist Exam Questions > Gallbladder and ducts > Flashcards

Gallbladder and ducts Flashcards

1
Q

What should the wall thickness of the GB be under?

A

<3mm

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2
Q

Normal dimensions of the GB?

A

Length = 8cm
TRV and AP = 4-5cm

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3
Q

What valve located in the neck, prevents kinking of cystic duct?

A

Heister valve

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4
Q

What forms the CBD? hint: two ducts

A

Cystic duct and CHD

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5
Q

Intra-heptic bile ducts should measure less than?

A

<2mm

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6
Q

What structures make up the “mickey mouse” sign?

A

HA (more medial) and CBD (more lateral)

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7
Q

What structure forces bile into the GB?

A) Ampulla of vater
B) Sphincter of Oddi
C) Cystic duct
D) GB neck

A

B

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8
Q

What is NOT a function of the GB?

A) Secretes bile
B) Produces bile
C) Concentrates bile

A

B - the liver produces bile

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9
Q

What is known as the absence of CHD & cystic duct causing main hepatic ducts to drain into
GB and the GB draining into the CBD?

A

GB interposition - can cause jaundice and abdominal pain

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10
Q

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

A

Biliary atresia - more common in males

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11
Q

What SF would exclude atresia?

A) Intraheptaic DD
B) Intrahepatic and extra hepatic DD
C) Hydropic GB
D) Contracted GB

A

B

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12
Q

What type of choledocal cyst is Caroli’s disease?

A) 2
B) 3
C) 4
D) 5

A

5

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13
Q

What other abnormalities are associated with Caroli’s?

A

Medullary sponge kidney, hepatic fibrosis

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14
Q

What abnormality is strongly associated with Caroli’s disease?

A) MCDK
B) Cholelithiasis
C) Medullary sponge kidney
D) Cholecystitis

A

C

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15
Q

SF of Caroli’s ?

A

Multiple cysts around porta hepatis. “Beaded appearance”

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16
Q

Name pathologies that cause GB wall thickening.

A

Cholecystitis, adenomyomatosis, polyps, gallbladder cancer, gallbladder torsion

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17
Q

What pathology will NOT cause GB wall thickening?

A) Adenomyomatosis
B) GB cancer
C) Polyp
D) Sludge

A

D

18
Q

Whats another name for a sludge ball?

A

Tumefactive

19
Q

What does GB hepatization mean?

A

Sludge completely fills the GB

20
Q

What is NOT part of the 6 F’s as a clinical presentation of cholelithiasis?

A) Fair
B) Fat
C) Forty
D) Fifty

A

D

21
Q

When there are multiple stones in the GB, what do we call that?

A) WES
B) Gravel
C) Hepatization
D) Tumefaction

A

Gravel

22
Q

What is the significance of WES?

A

GB completely filled with stones, we have to rely on the GB wall to delineate

23
Q

What is NOT a SF of acute cholecystitis?

A) Hydropic GB
B) GB wall thickening
C) Hyperemia
D) Small cystic artery

A

D - LARGE cystic artery will be seen

24
Q

Tumefactive sludge vs biliary slude?

A

Tumefactive - appears as a ball of sludge and can mimic a mass - use CD to differentiate from a mass

Biliary sludge - layers of sludge within GB lumen

25
Q

What is the most common cause of acute cholecystitis?

A

Stone impacted in GB neck or cystic duct

26
Q

What is another name for empyema cholecystitis?

A

Suppurative - pus in GB lumen and inflamed - typically in diabetics

27
Q

What is emphysematous cholecystitis associated with?

A

Diabetic patient and more common in men

28
Q

75 year old female patient comes in with RUQ pain and an interolance to fatty foods. Upon scanning you see a thickened, fibrotic GB wall and the GB itself appears contracted. What is the most likely diagnosis?

A) Acute cholecystitis
B) Emphysematous cholesyctitis
C) Acalculous cholecystitis
D) Chronic cholecystitis

A

D

29
Q

What is the term for when “all or part of the GB wall is calcified” ?

A

Porcelain GB - more common in females

30
Q

What is bouveret syndrome also called?

A

Gallstone ileus - fistula forms between GB and duodenum and allows stone to pass into small intestine causing bowel obstruction

31
Q

In Mirrizi syndrome, what will be dilated?

A) Intraheptic ducts
B) Extraheptaic ducts
C) IHDD and EHDD
D) EHDD and hydropic GB

A

A - since a stone is obstructing GB neck or cystic duct, everything before it will become dilated = IHDD

32
Q

Where in the GB does perforation typically occur?

A) Neck
B) Body
C) Fundus
D) They are all equal in incidence

A

C

33
Q

Cholesterosis is also known as?

A

Strawberry Gallbladder

34
Q

Patient presents with jaundice and no other symptoms. Upon scanning, you see a large hydropic GB and a lesion at the pancreatic head. What is the possible diagnosis?

A) Bouveret syndrome
B) Courvoisier GB
C) Mirizzi syndrome
D) Gallstone ileus

A

B - typically occurs due to a pancreatic malignancy

35
Q

WHat is known as an “abnormally distended GB filled with thick bile, mucus or pus”?

A

Hydropic GB

36
Q

What is NOT a reason for GB wall thickening?

A) GB torsion
B) Cholelithiasis
C) Courvoisier GB
D) Adenomyomatosis

A

C

37
Q

Majority of GB cancers are of what kind?

A

Adenocarcinoma

38
Q

What is NOT a cause of IHDD with a normal CBD?

A) Klatskins tumor
B) Cholangitis
C) Choledocal cyst
D) Mirizzi Syndome

A

C

39
Q

Which of the following with cause proximal dilation of intrahepatic ducts without distal dilation of the CBD?

A) Sclerosing cholangitis
B) Acute pancreatitis
C) Choledocolithiasis
D) Choledocal cyst

A

A - all the others will also have a dilated CBD

39
Q

What pathology would you suspect when a patient has 7x the normal limit of ALP?

A) Panc carcinoma
B) Chronic pancreatitis
C) Acute pancreatitis
D) AIDS cholecystopathy

A

D

Generalist Exam Questions (21 decks)

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