Test ch 11 Gallbladder and Biliary System Flashcards
- In cases of choledocholithiasis, stones tend to lodge in the:
a. Pancreatic duct
b. Common bile duct
c. Ampulla of Vater
d. Common hepatic duct
ANS: C
In cases of choledocholithiasis, stones tend to lodge in the ampulla of Vater and may project into the duodenum.
The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the:
a. Common hepatic duct
b. Cystic duct
c. Common bile duct
ANS: A
The right and left hepatic ducts unite to form the common hepatic duct, which then passes caudally and medially.
The diameter of the common hepatic duct is approximately ________ millimeters (mm).
a. 2
b. 3
c. 4
d. 5
ANS: C
The common hepatic duct is approximately 4 mm in diameter and descends within the edge of the omentum.
The hepatic duct is joined by the ___________ to form the ___________ .
a. Pancreatic duct; cystic duct
b. Cystic duct; common bile duct
c. Common bile duct; cystic duct
d. Right hepatic duct; common bile duct
ANS: C
The common hepatic duct is joined by the cystic duct to form the common bile duct.
In a 60-year-old adult, the normal common bile duct should not measure more than _____ mm.
a. 5
b. 6
c. 8
d. 10
ANS: B
The normal common bile duct has a diameter of up to 6 mm
The distal duct lies ___________ with the anterior wall of the inferior vena cava (IVC).
a. Parallel
b. Perpendicular
c. Lateral
d. Horizontal
ANS: A
The distal common bile duct lies parallel with the anterior wall of the IVC
The cystic duct connects the ___________ of the gallbladder with the common hepatic duct to form the ___________.
a. Fundus; common hepatic duct (CHD)
b. Fundus; common bile duct (CBD)
c. Neck; CBD
d. Body; CHD
ANS: C
The cystic duct is about 4 cm long and connects the neck of the gallbladder with the CHD to form the CBD.
A Phrygian cap of the gallbladder is:
a. Partial septation
b. Calcification of the gallbladder wall
c. Septations within the organ
d. Folding of the fundus
ANS: D
The folding of the gallbladder fundus is termed a Phrygian cap.
Which one of the following is a function of the gallbladder?
a. Storage for extra cholesterol
b. Storage for enzymes
c. Reservoir for bile
d. Reservoir for biliary salts
C
The gallbladder serves as a reservoir for bile, which is drained from the hepatic ducts in the liver.
. A gallbladder that folds near the area of the neck is called:
a. Murphy pouch
b. Phyrgian cap
c. Hartmann pouch
d. Murphy sign
ANS: C
The gallbladder may fold on itself at the neck, forming a Hartmann pouch
The bright linear echo within the liver connecting the gallbladder and the right or main portal vein is called the:
a. Right lobar fissure
b. Main lobar fissure
c. Ligamentum teres
d. Left lobar fissure
ANS: B
The main lobar fissure is a sonographic landmark leading to the gallbladder fossa. It is a bright linear echo connecting the right portal vein to the neck of the gallbladder.
Gas-forming bacteria in the gallbladder appear on ultrasound as:
a. Dilated round shape
b. Nonshadowing echogenic mass
c. Localized dilation
d. Bright echo with a comet tail artifact
ANS: D
Emphysematous cholecystitis is gas-forming bacteria in the gallbladder, which appear on ultrasound as a bright echo in the area of the gallbladder with a ring down or comet tail artifact.
A positive Murphy sign is a clinical finding associated with:
a. Cholelithiasis
b. Cholecystitis
c. Porcelain gallbladder
d. Adenomyomatosis
ANS: B
A presenting sign of cholecystitis is acute right-upper quadrant pain upon palpation of the gallbladder (positive Murphy sign).
. Classic symptoms of gallbladder disease include all of the following except:
a. Hematuria
b. Right upper quadrant pain
c. Right shoulder pain
d. Nausea and vomiting
ANS: A
The most common symptom of gallbladder disease is right upper quadrant pain, usually after ingesting a fatty meal. Other symptoms include nausea and vomiting, right shoulder blade pain, and epigastric pain.
Thickening of the gallbladder wall may be caused by all of the following except:
a. Hepatitis
b. Pancreatitis
c. Adenomyomatosis
d. Cholecystitis
ANS: B
A thickening of the gallbladder wall may be caused by cholecystitis, acquired immunodeficiency syndrome, cholangiopathy, sclerosing cholangitis, ascites, right heart failure, renal failure, severe hypoalbuminemia states, and nonfasting state
Which one of the following describes the most common sonographic appearance of gallbladder carcinoma?
a. “Comet tail” shadowing posterior to a hypoechoic focus
b. Irregular echogenic mass projecting from the gallbladder wall
c. Shadowing posterior to mobile echogenic mass
d. Comet tail shadowing posterior to a hyperechoic focus
B
The sonographic appearance of gallbladder carcinoma is described as a heterogeneous, solid, immobile mass projecting into the gallbladder from a thickened gallbladder wall.
The common bile duct is joined by the main pancreatic duct. Together they open through the _____ into the duodenal wall.
a. Ampulla of Oddi
b. Ampulla of Water
c. Ampulla of Vater
d. Ampulla of Santorini
ANS: C
The pancreatic duct (Wirsung duct) and the common bile duct join and enter through the ampulla of Vater into the duodenum.
A fusiform dilation of the common bile duct that causes obstruction is known as:
a. Choledochal cyst
b. Adenomyomatosis
c. Cholangitis
d. Phrygian cap
ANS: A
Choledochal cysts are classified as one of the following: (1) localized cystic dilation of the common bile duct; (2) diverticulum from the common bile duct; (3) dilation of the entire common bile duct and common hepatic duct. ; and (4) invagination of common bile duct into the duodenum.
. Inflammation of the gallbladder is:
a. Cholecystitis
b. Choledocholithiasis
c. Cholesterosis
d. Adenomyomatosis
ANS: A
Cholecystitis is the inflammation of the gallbladder that may have several forms—acute or chronic, acalculous, emphysematous, or gangrenous.
. A condition causing RUQ pain in which small polypoid masses arise from the gallbladder wall is:
a. Choledocholithiasis
b. Cholesterosis
c. Adenomyomatosis
d. Pruritus
ANS: C
An immobile echogenic focus (i) protruding from the gallbladder wall demonstrating a “comet tail” posterior shadow describes adenomyomatosis
The sonographic appearance of cholelithiasis is best described as:
a. Nonshadowing mobile hyperechoic focus
b. Mobile, hyperechoic focus demonstrating posterior shadowing
c. Immobile, echogenic focus demonstrating a comet tail artifact
d. Mobile, hypoechoic focus demonstrating posterior shadowing.
ANS: B
A gallstone generally appears as mobile hyperechoic intraluminal focus (i) demonstrating posterior acoustic shadowing. Gallstones are typically mobile.
The most common cause of biliary ductal obstruction is the presence of a ductal:
a. Cyst
b. Tumor
c. Stone
d. Stricture
ANS: B
The most common cause of biliary ductal obstruction is the presence of a ductal tumor or thrombus in the ductal system
A thick calcified gallbladder wall describes which one of the following conditions?
a. Wall-echo-shadow (WES) sign
b. Gangrenous gallbladder
c. Porcelain gallbladder
d. Emphysematous gallbladder
ANS: C
A porcelain gallbladder is associated with gallstones and demonstrates a thick hyperechoic (calcified) gallbladder wall with posterior acoustic shadowing. WES sign demonstrates a gallbladder wall and then a hyperechoic focus with posterior shadowing.
Which one of the following is most characteristic of nonshadowing, low-amplitude echoes in a dependent gallbladder?
a. Cholelithiasis
b. Porcelain gallbladder
c. Cholecystitis
d. Sludge
ANS: D
Sludge is described as low-level internal echoes that are gravity dependent.
The valves of Heister are tiny valves found with the:
a. Cystic duct
b. Common bile duct
c. Pancreatic duct
d. Common hepatic duct
ANS: A
The valves of Heister are tiny valves located within the cystic duct.
. All of the following sonographic appearances are found in cases of gallbladder carcinoma except:
a. Sludge
b. Wall thickening
c. Cholelithiasis
d. Intraluminal wall mass
ANS: A
Sonographic findings in cases of gallbladder carcinoma generally demonstrate a thickening of the gallbladder wall with a global-shaped heterogeneous mass projecting into the lumen of the gallbladder. Between 80% and 90% of patients have associated gallstones
The physiologic effect of a fatty meal includes all of the following except:
a. Stimulation of cholecystokinin (CCK)
b. Contraction of the gallbladder
c. Decrease bile flow to the liver
d. Relaxation of the sphincter of Oddi
ANS: C
After a fatty meal, CCK stimulation causes the contraction of the gallbladder; the sphincter of Oddi relaxes with the outpouring of bile into the duodenum.
Patients positive for the AIDS are at risk for developing:
a. Hepatitis
b. Cholangitis
c. Pancreatitis
d. Nephritis
ANS: B
AIDS patients are at risk for developing cholangitis.
Air within the biliary tree, secondary to common bile duct stents, is called:
a. Pneumobilia
b. Hemobilia
c. Pneumothorax
d. Cholangitis
ANS: A
Pneumobilia is air within the biliary tree, secondary to biliary intervention, biliary-enteric anastamoses, or common bile duct stents
The most common tumor sites that can spread carcinoma to the biliary tree include all of the following except the:
a. Colon
b. Breast
c. Melanoma
d. Kidney
ANS: D
Metastatic carcinoma in the gallbladder occurs secondary to melanoma, colon, or breast carcinoma
