URR 22 Flashcards by Billie Harney

Alkaline phosphatase is an enzyme produced by:

biliary walls

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ALP is present in the ____, ___, and ____

liver
bone
placenta

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ALP is increased with:

biliary obstruction
cholangitis
cholangiocarcinoma
GB carcinoma
pancreatic carcinoma
pregnancy

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increased with biliary obstruction

Gamma Glutamyl Transpeptidase

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increased clotting time associated with acute cholecystitis, gallbladder carcinoma, or prolonged CBD obstruction

promthrombin time

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nuclear medicine exam that evaluates gallbladder function and ejection fraction

Cholescintigraphy/HIDA scan

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In a HIDA scan, ____ is administered to cause the gallbladder to contract and relax the sphincter of Oddi

cholecystokinin

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Most accurate exam for evaluating acute cholecystitis

HIDA scan

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radiopaque oral contrast given; excreted by the liver and concentrated in the gb, which extracts water, thus concentrating the excreted substance

oral cholecystogram

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fluoroscopy procedure; demonstrates bile ducts when xray dye is injected into a T-tube in the abdomen

T-tube cholangiogram

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combines the use of endoscopy and fluoroscopy to evaluate biliary system and pancreas

ERCP

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When scanning the biliary tree __ MHz- __ MHz is used for adults

2.5-6.5

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When scanning the biliary tree a __ MHz to __ MHz pediatric probe is utilized

4
8

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NPO status for scanning of biliary tree

8-12 hours

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The biliary exam is performed with patient ___, ___, and/or ____ positions to fully evaluate gb for pathology

supine
decubitus
erect

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The gb appears as an anechoic structure ____ and ____ to the liver

posterior
inferior

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The gb appears ___ in transverse view and ____ in sagittal view

circular
pouch shaped

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The echogenic wall of the gb measures <__mm AP dimension in NPO patient

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The anterior wall thickness should be measured with incident beam ____ to the wall

perpendicular

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The porta hepatis is best visualized in _____ view with the notch side of the transducer cephalad to the non-notch side of the transducer and angulation toward the right shoulder

subcostal oblique

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The CHD is noted ____ to the portal vein inside the liver

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The CBD is located at the ____

pancreas head

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The maximum diameter of the CBD is __-__ mm depending on surgical history of the patient

6
12

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To visualize the length of the CBD and obtain a diameter measurement, demonstrate a longitudinal view of the main portal vein and the CBD will lie ____ to it

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Follow the CBD to measure the greatest diameter, which is usually

most distal segment at pancreas head

Fatty meal administration is used to assess ____, ____, and ____

biliary dynamics gallbladder contractility obstruction

Ingestion of fatty foods causes the release of _____ into the digestive tract that promotes gallbladder contraction

cholecystokinin

ducts increase in size more than 1mm due to increased bile levels with obstruction

positive exam

ducts to not change in size or decrease in size slightly

negative exam

Causes of nonvisualization of gallbladder

normal contraction after a meal prior cholecystectomy chronic cholecystitis emphysematous cholecystitis tumefactive sludge agenesis ectopic location

GB segments

neck body fundus

internal septum dividing the gb into two chambers, can be partial, complete septations may cause stone formation

bilobar/septated gallbladder

gallbladder abnormally narrowed at mid-section; no pathologic significance

hourglass gallbladder

fundus of the gb folds over on the body

phrygian cap

most common congenital anomaly of the gallbladder

phyrgian cap

fold in the gb at the neck region when it joins the body; may cause symptoms if stones involved

junctional fold

2nd most common congenital gb anomaly

junctional fold

small recessed area in neck region; may lead to stone formation due to bile stasis in that area

Hartmann pouch

rare; congenital absence of gb

gb agenesis

2 separate gallbladders; may share a single cystic duct or may have separate cystic ducts; rare

duplication of the gb

gb can be located on the left side, intrahepatic, surrounded by peritoneum, connected to liver by mesentary

ectopic gallbladder

gb surrounded by peritoneum, connected to liver by mesentary

floating gallbladder

congenital weakness of ductal walls

choledochal cyst

Choledochal cyst most commonly affects the:

CBD

Choledochal cysts are more common in ____, usually of ___ descent

women Asia

What is the classification of Choledochal cysts called?

Todani classification

fusiform dilatation of the CBD, most common

Type I choledochal cyst

diverticulum of the CBD

Type II choledochal cyst

choledochocele; found in the intraduodenal portion of the duct

Type III choledochal cyst

dilatation of the intrahepatic and extrahepatic ducts

Type IV choledochal cyst

dilatation of the intrahepatic ducts (Caroli disease)

Type V choledochal cyst

Symptoms of Choledochal cyst

jaundice pain fever

Labs for choledochal cysts

increased ALP

Choledochal cysts are associated with:

cholangitis choloangiocarcinoma pancreatitis liver abscess

Because of the proven risk of associated cholagiocarcinoma, surgical resection of _____ is advised

choledochal cysts

focal dilatation of the biliary tree; dilated area can be rounded like a cyst or fusiform like a AAA

choledochal cyst

A choledochal cyst is usually found:

near portal hepatis in CBD

Caroli disease is also known as

Communication Cavernous Ectasia of the Biliary Tree

congenital anomaly of the intrahepatic ducts

Caroli disease

Type V choledochal cysts

Caroli disease

numerous cysts form in the biliary tree; ducts interconnected/dilated; diffuse saccular or fusiform dilatation of ducts

Caroli disease

Caroli disease presents in:

childhood

Caroli disease causes ____ and impairs function

bile stasis

Symptoms of Caroli disease

pain fever intermittent jaundice

Caroli disease usually occurs with:

periportal hepatic fibrosis

Caroli disease is associated with:

renal tubular ectasia medullary sponge kidney autosomal recessive polycystic kidney disease congenital liver fibrosis

Complications of Caroli disease

cholangitis cholangiocarcinoma hepatic abscess sepsis

dilated biliary ducts; multiple intrahepatic cysts that communicate with the biliary tree; Central Dot sign

Caroli disease

echogenic dots with color flow within cystic lesion; associated with Caroli disease

Central Dot Sign

____ can cause brain damage due to exposure of brain tissue to high bilirubin

biliary atresia

brain damage due to exposure to brain tissue to high bilirubin levels

kernicterus

Biliary atresia is associated with:

polysplenia situs inversus cardiac septal defects absent IVC von Hippel Lindau Syndrome

The ____ procedure is performed to correct biliary atresia

Kasai

echogenic area above the portal vein bifurcation indicates obliterated duct

Triangular cord sign

The _____ sign is associated with biliary atresia

Triangular Cord

small or absent gallbladder in a fasting patient is indicative of

biliary atresia

two findings in a fasting infant that are widely accepted criteria for biliary atresia

triangular cord sign small or absent gallbladder

The normal gallbladder length is less than ___, while the normal transverse diameter is less than ____. a. 3cm, 2cm b. 5cm, 8 cm c. 10 cm, 5 cm d. 8cm, 4cm

The cystic artery originates from the ____ and the cystic vein empties into the ____ a. right hepatic artery, right hepatic vein b. right hepatic artery, right portal vein c. left hepatic artery, left hepatic vein d. left hepatic artery, left portal vein

What is the proper technique for caliper placement to measure the bile duct diameter? a. inner wall to inner wall b. inner wall to outer wall c. outer wall to inner wall d. outer wall to outer wall

Which biliary duct normally has bidirectional flow of bile within it? a. common hepatic duct b. common bile duct c. Ducts of Luschka d. cystic duct

Which of the following dilates first with an obstruction of the biliary tree at the pancreas head? a. distal CBD b. right and left hepatic ducts c. mid CBD d. Cystic duct

Ductal diameters normally vary with: a. patient age b. patient gender c. bile volume in the gb d. patient diet

Biliary ductal wall thickness should normally be: a. <1 cm b. < 2 mm c. <1 mm d. <2 cm

Jaundice causes all of the following except: a. yellowing of the sclera of the eyes b. dark colored urine c. pale stool d. black fingernails

Which of the following is normally found in a urine sample? a. red blood cells b. direct bilirubin c. indirect bilirubin d. bacteria

Which of the following is an enzyme produced by the biliary walls that is the first lab value to elevate with a biliary obstruction? a. alkaline phosphatase b. direct bilirubin c. indirect bilirubin d. lactate dehydrogenase

Increased prothrombin time is associated with: a. acute cholecystitis b. gallbladder carcinoma c. prolonged CBD obstruction d. all the above

Why is the gallbladder evaluated by ultrasound with the patient in multiple positions? a. to evaulate the change in gb volume b. to evaluate mobility of intraluminal abnormalities c. to evaluate the change of blood flow in the liver d. to evaluate the change in biliary flow rate with positional changes

A gallbladder wall thickness measurement should include all of the following, except: a. measurement of the posterior wall b. NPO patient c. AP measurement d. incident beam perpendicular to the wall

What blood vessel serves as the best landmark to view the length of the CBD? a. common hepatic vein b. right portal vein c. main portal vein d. IVC

What congenital gb anomaly is described as the fundus folded over the body of the organ? a. hourglass gb b. bilobed gb c. Hartmann pouch d. Phrygian cap

Which of the following GB anomalies affects the neck of the GB? a. junction fold and Hartmann pouch b. hourglass and bilobed GB c. Hartmann pouch and Phyrgian cap d. biliary atresia and septated GB

The Todani classification is used to describe: a. types of cholelithiasis b. types of choledochal cysts c. types of biliary atresia d. types of caroli disease

Why is a choledochal cyst removed? a. risk of rupture b. risk of infection c. risk of malignant transformation d. risk of thrombosis

The Central Dot Sign is associated with: a. choledochal cysts b. biliary atresia c. hourglass gb d. caroli disease

Which of the following is associated with Caroli disease? a. periportal hepatic fibrosis b. medullary sponge kidney c. renal tubular ectasia d. all the above

Which of the following is associated with biliary atresia: a. polysplenia, situs inversus b. Von Hippel Lindau syndrome c. cardiac septal defects, absent IVC d. all the above

What are the landmark findings for biliary atresia? a. triangular cord sign and absent gallbladder b. numerous cysts that connect to the biliary tree c. hypervascular biliary tree d. all the above

sudden onset of gallbladder inflammation

acute cholecystitis