Test 3 - Biliary

Question 1

Where are the spiral valves of Heister located?

Answer 1

Cystic duct

Question 2

Which portion of the gallbladder is most likely to extend inferior to the edge of the liver?

Answer 2

Fundus

Question 3

Where is the distal common bile duct located?

Answer 3

at the ampulla of vater

Question 4

What is the expected diameter of the common bile duct in a normal 30 year old female?

Answer 4

4 - 7 mm

Question 5

On transverse scans, the fundus of the gallbladder presents as a(n) :

Answer 5

Circular, echo-free structure

Question 6

Which hormone is released by the presence of fat in the intestine and regulates the gallbladder contraction and gastric emptying?

Answer 6

Cholecystokinin

Question 7

At what location would you expect to see a Hartmans pouch in a gallbladder?

Answer 7

Neck

Question 8

In what anatomic variant is the fundus of the gallbladder folded over the body?

Answer 8

Phrygian cap

Question 9

What are three common symptoms that call for a gallbladder exam?

Answer 9

Jaundice

Nausea / vomiting

RUQ pain

Question 10

The most efficient method to differentiate a bile duct from other structures is…

Answer 10

By the use of color Doppler

Question 11

What is the most important factor associated with the formation of cholelithiasis ?

Answer 11

Abnormal bile composition

Question 12

You are requested to image the gallbladder fossa following a cholecystectomy. Which of the following would best demonstrate this location?

Answer 12

Longitudinal view: including the right portal vein and main lobar fissure

Question 13

What is unconjugated bilirubin associated with?

Answer 13

Massive hemolysis

Question 14

What are three characteristics of acute calculus cholecystitis?

Answer 14

1. Diffuse gallbladder wall thickening
2. Cholelithiasis
3. The halo sign

Note: NOT “loss of elasticity of gallbladder”

Question 15

What are three labs that can be done to help in diagnosing gallbladder disease?

Answer 15

1. Direct bilirubin
2. ALT
3. ALP

Note:
NOT “AFP”

Question 16

Between males and females, which one has a higher prevalence of gallstones?

Answer 16

Females

Question 17

What are two precursors to stone formation?

Answer 17

Abnormal gallbladder emptying &
Altered absorption

Question 18

True/False

The majority of gallstones cause symptoms

Answer 18

False

Question 19

The majority of stones in the US population are made up of (blank)

Answer 19

Cholesterol

Question 20

What is the normal relationship of the gallbladder to the right kidney?

Answer 20

The right kidney is posterior to the gallbladder

Question 21

What is one of the gallbladders physiologic functions regarding bile?

Answer 21

Concentrate

Question 22

What describes a positive Murphy sign?

Answer 22

Pain with transducer pressure over the gallbladder

Question 23

Which patient would most likely be diagnosed with biliary atresia?

Answer 23

A neonate male

Question 24

True/False

The gallbladder remains stationary despite changes in the patients position.

Answer 24

False

Question 25

You see an echogenic area in the gallbladder lumen. How would you determine if it was a stone, sludge ball, sludge, or an adenoma ? (You need to give specific details on the sonographic characteristics, maneuvers, or modes used to make you differential diagnosis. Do not simply type one has this and the other doesn’t. Be specific in your answer. For full credit you need to discuss all the possibilities.)

Answer 25

• Start exam w/ patient in supine position. Examine the Shape of the echogenic area, if it is shaped more as a mass, then the diagnosis is narrowed down to gallstones or sludge balls If not, then it is narrowed to sludge or an adenoma. To narrow down the mass-type structures, use the gain and TGC's to clear out echoes and then asses the appearance of the gallblacker. If the echogenic area is costing a Shadou, this is an indication of gallstones. If the area. casts no shadow, then it would have to be Sludge balls. To narrow down the non Circular, non Shadowing structures, adenomas Sludge, have the patient turn in Left Lateral Decubitus position 3 assess (carefuly) if the echogenic area has moved. If it has stayed Stagnant, the diagnosis would be an adenomc. If it has slowly moved, then the diagnosis would be sludge.

Question 26

Where are you most likely to find choledocholithiasis?

Answer 26

Common bile duct

Question 27

What are four of the “F” words used to make you at higher risk for gallstones?

Answer 27

Female Fertile Fat Forty Fair

Question 28

List two things that appear similar to choledocholithiasis? (Stone in CBD)

Answer 28

1. When there are calcifications in the head of the pancreas 2. When the beam is refracting