The Bile Ducts Flashcards
Bile first accumulates in the ______ that are located throughout the liver
small intrahepatic biliary radicles
The intrahepatic ducts are considered dilated if they exceed
2mm
An uncommon manifestation of chiledocholithiasis is
mirizzi syndrome
It is considered cholangitis when the bile duct walls thicken greater than
5mm
What are the types of cholangitis
acute bacterial, AIDS, oriental and sclerosing
______ are the most common manifestation of cholangiocarcinoma
Klatskin tumors
What is the triangular cord associated with
biliary atresia
What is the triangular cord
echogenic, triangular or tubular structure anterior to the portal vein, representing the replacement of the extrahepatic duct with fibrous tissue in the porta hepatis
Most common choledochal cyst is
dilation of the common bile duct
Fusiform cystic mass in the area of the porta hepatis and biliary dilatation
choledochal cyst
Central dot sign is associated with
caroli disease
What is the central dot sign
echogenic dots in the nondependent part of the dilated duct representing small fibrovascular bundles
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 green pigment found in the bile
biliverdin
coexisting dilation of the common bile duct and
pancreatic duct
double duct sign
the level of the biliary tree where the common
bile duct and the main pancreatic duct meet; may also be referred to as the
ampulla of Vater
hepatopancreatic ampulla
the muscle that controls the emptying of bile
and pancreatic juices into the duodenum; may also be referred to as the
sphincter of Odd
hepatopancreatic sphincter
the enlargement of the common duct to the size of the
adjacent portal vein within the porta hepatis
parallel tube sign
severe itchiness of the skin
pruritus
the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic
sphincter
sphincter of oddi
Bile flow=
liver, biliary radicles, right or left hepatic duct, common hepatic duct, cystic duct, gallbladder, common bile duct, ampulla of vater, sphincter of oddi, duodenum
When biliary tree obstruction is suspected, look for an elevation in
ALP, ALT, serum bilirubin, GGT and urobilirubin
The most common level for an obstruction to occur is the
distal common bile duct
What is the charcot triad
fever, right upper quadrant pain and jaundice
Klatskin tumors are located at the
junction of the right and left hepatic ducts and cause dilatation of the intrahepatic ducts
A congenital disease in which there is narrowing or obliteration of the
bile ducts is referred to as:
A. Caroli disease
B. Mirizzi disease
C. Choledochal cysts
D. Biliary atresia
D
Ascariasis is:
A. a form of biliary tree carcinoma
B. a congenital disorder characterized by segmental dilatation of the intrahepatic ducts
C. caused by a parasitic roundworm
D. A type of ringworm that invades the liver
C
Primary biliary tree cancer is referred to as:
A. Gallbladder carcinoma
B. biloma
C. cholangiocarcinoma
D. lymphangioma
C
Which of the following is associated with Charcot triad?
A. cholangitis
B. cholesterolosis
C. klatskin tumor
D. choledochal cyst
A
The merging point of the pancreatic duct and common bile duct at the
level of duodenum is referred to as the:
A. Sphincter of Oddi
B. Ampulla of Vater
C. Common bile duct
D. Cystic duct
A
Which of the following would be the least helpful laboratory value to
analyze in patients with suspected biliary tract disease?
A. ALT
B. ALP
C. GGT
D. creatine
D
A gallstone located within the biliary tree is referred to as:
A. Cholecystitis
B. Choledocholithiasis
C. Cholangitis
D. Cholangiocarcinoma
B
Which of the following disorders is associated with the sonographic
triangular cord sign?
A. Cholangitis
B. Choledocholithiasis
C. Biliary atresia
D. Ascariasis
C
The yellowish staining of the whites of the eyes and the skin secondary to
a liver disorder or biliary obstruction is referred to as:
A. AIDS cholangitis
B. pruritus
C. jaundice
D. bilirubinemia
C
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 duct
C. At the junction of the common bile duct and common hepatic duct
D. Between the pancreatic head and the duodenum
A
Inflammation of the bile ducts is referred to as:
A. Pneumobilia
B. Choledocholithiasis
C. Cholelithiasis
D. Cholangitis
D
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 syndrome
C. choledochal cysts
D. biliary atresia
B
Air within the biliary tree is referred to as:
A. Pneumobilia
B. Cholangitis
C. Choledocholithiasis
D. Cholesterolosis
A
The presence of an echogenic dot in the nondependent part of a dilated
duct representing small fibrovascular bundles is seen with:
A. Caroli disease
B. Choledochal cysts
C. Biliary atresia
D. Mirizzi syndrome
A
The spiral valves of Heister are located within the:
A. common bile duct
B. pancreatic duct
C. common hepatic duct
D. cystic duct
D
Which of the following is characterized by fibrotic thickening of the bile
ducts, found most often in young males, and is associated with
inflammatory bowel disease or ulcerative colitis?
A. Ulcerative biliary atresia
B. Oriental cholangitis
C. Sclerosing cholangitis
D. AIDS biliary atresia
C
If a gallstone, causing obstruction, is located within the distal common
hepatic duct, which of the following would become dilated?
A. Main pancreatic duct
B. Gallbladder only
C. ntrahepatic ducts
D. Distal common bile duct
C
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
A
Pneumobilia will produce
A. through transmission
B. ring down artifact
C. acoustic shadowing
D. edge artifact
B
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
A
Which of the following could accidentally introduce bacteria into the
biliary tree and thus cause cholangitis?
A. Computed tomography
B. Endoscopic retrograde cholangiopancreatography
C. Magnetic resonance imaging
D. Radiography
B
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
D
The muscle that controls the emptying of bile and pancreatic juices into
the duodenum is the:
A. cystic duct
B. ampulla of vater
C. sphincter of oddi
D. common bile duct
C
The most common level for biliary obstruction to occur is the:
A. unction of the right and left hepatic ducts
B. Proximal common hepatic duct
C. Distal common bile duct
D. Cystic duct
C
A 32-year-old female patient presents to the sonography department with
a history of fever, leukocytosis, and right upper quadrant pain.
Sonographically, you visualize dilated bile ducts that have thickened
walls and contain sludge. What is the most likely diagnosis?
A. Choledocholithiasis
B. Cholangitis
C. Mirizzi syndrome
D. Biliary atresia
B
Sonographically, you visualize scattered echogenic linear structures
within the liver parenchyma that produce ring-down artifact. What is the
most likely diagnosis?
A. Pneumobilia
B. Choledocholithiasis
C. Sludge balls
D. Cholesterolosis
A
A 64-year-old man presents to the sonography department for a right
upper quadrant 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
D
An abdominal sonogram is ordered for an infant in the intensive care unit
who is suffering from jaundice and fever. Sonographically, you visualize
a cystic mass within the common bile duct that is causing a focal
enlargement. This is most suggestive of:
A. Cholangiocarcinoma
B. Mirizzi syndrome
C. Choledochal cyst
D. Biliary atresia
C
All of the following are clinical findings consistent with
cholangiocarcinoma except:
A. pruritus
B. weight loss
C. elevated bilirubin
D. dilatation of the intrahepatic ducts
D
Which of the following is not associated with the development of
pneumobilia?
A. Cholangiopneumonia
B. Gastric surgery
C. Acute cholecystitis
D. Fistula formation
A
A Klatskin tumor is a form of:
A. Lymphocytic carcinoma
B. Cholangiocarcinoma
C. Pancreatic carcinoma
D. Gallbladder carcinoma
B
The biliary duct wall should never measure more than:
A. 2mm
B. 9mm
C. 4mm
D. 5mm
A
Clinical findings of choledocholithiasis include all of the following
except:
A. jaundice
B. elevated bilirubin
C. elevated blood urea nitrogen
D. elevated ALP
C
Which segment of the biliary tree tends to dilate first with obstruction?
A. intrahepatic
B. extrahepatic
B
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
C
All of the following are forms of cholangitis except:
A. acute bacterial
B. AIDS
C. oriental
D. parabolic
D
The yellowish pigment found in bile that is produced by the breakdown
of old red blood cells by the liver is:
A. biliverdin
B. bilirubin
C. cholesterol
D. chyme
B
Which of the following is typically found in pediatric patients and is
described as the cystic dilation of the common bile duct?
A. Biliary atresia
B. Mirizzi syndrome
C. Caroli disease
D. Choledochal cyst
D
For patients older than age 60, or those who have had a cholecystectomy,
a maximum diameter of _____ may be considered normal.
A. 1 cm
B. 12mm
C. 14 mm
D. 1.5cm
A
Which of the following would be the most common cause of obstructive jaundice
A. klatskin tumor
B. cholangiocarcinoma
C. biliary atresia
D. choledocholithiasis
D
