URR 24 Flashcards
1
Q
Gas in the duodenum or ____ can cause dirty shadowing in the area of the GB fossa
A
pneumobilia
2
Q
The 5 âFâ of Gallstone Formation risk factors
A
female
fat
fertile
forty
fair skinned
3
Q
wall-echo-shadow
A
WES sign
4
Q
The WES sign is also called:
A
double arc shadow sign
5
Q
gallbladder wall is visualized anterior to the echogenic stone that exhibits posterior shadowing which obscures the posterior of the wall posterior to it
A
WES sign
6
Q
____ can cause loss of blood supply to the gallbladder walls/cystic duct
A
extrinsic compression
7
Q
Ischemia of the gallbladder leads to increased risk of ____ and developing ____
A
infection
gangrene
8
Q
Wall perforation can occur with _____
A
stone impaction
9
Q
Dilated ducts would be found ____ to the level of complete obstruction
A
proximal
10
Q
Dilated ducts can exhibit _____
A
posterior enhancement
11
Q
CBD >__mm abnormal
A
8
12
Q
Stone in the cystic duct causes compression of the common hepatic duct
A
Mirizzi Syndrome
13
Q
Mirizzi Syndrome can lead to:
A
pain
jaundice
elevated direct bilirubin
14
Q
In Mirizzi Syndrome, the CBD is normal in caliber because:
A
obstruction is proximal to CBD
15
Q
In Mirizzi Syndrome ___, ___, and ____ are dilated
A
GB
CHD
intrahepatic ducts
16
Q
Large gallstone passes into the duodenum causing an obstruction of the gastric outlet
A
Bouveret Syndrome
17
Q
In Bourveret Syndrome, typically a _____ is present and allows the passes of the large stone into the duodenum
A
cholecystoenteric fistula
18
Q
Rigler triad (Xray and CT) seen with Bouveret Syndrome
A
bowel obstruction
pneumobilia
ectopic gallstone
19
Q
In Bouveret Syndrome, ultrasound can demonstrate a _____, _____, and _____
A
cholecystoenteric fistula
gallstones
gastric outlet obstruction
20
Q
enlarged, non-diseased gallbladder due to mechanical obstruction of the CBD
A
Courvoisier gb
21
Q
Courvoisier gallbladder is usually caused by:
A
extrinsic compression or stone
22
Q
A Courvoiser gb has a transverse diameter >__cm
A
5
23
Q
Courvoisier gb is associated with:
A
pancreatic head mass or obstruction at the Ampulla of Vater
24
Q
Three classic characteristics of Courvoisier gb
A
painless jaundice
distended gb
obstruction at ampulla of vater
25
ductal dilatation and enlarged GB
No GB wall thickening
Courvoisier gb
26
partial or total obstruction of cystic duct; gallbladder overdistended and enlarged; filled will sterile non-pigmented mucin from the mucosal lining because bile is resorbed
mucocele of the GB
27
Mucocele of the GB transverse diameter
>5cm
28
No jaundice or abnormal serum bilirubin because the remaining biliary tree is unobstructed
mucocele of the gb
29
stone in the ductal system
choledocholithiases
30
stones form in the duct due to bile stasis
primary choledocholithiasis
31
Primary choledocholithiasis is seen with:
cholangitis
Caroli disease
infection
hemolytic disease
sickle cell anemia
32
stones from the gallbladder pass into the ductal system; most common type in the US
secondary choledocholithiasis
33
In choledocholithiasis, if the CBD dilates it can lead to the appearance of the _____ or ____; the main portal vein and CBD appear as parallel lumens of equivalent size
parallel channel sign
double barrel shotgun sign
34
An obstructed _____ will cause dilated intrahepatic ducts ini the right lobe
right hepatic duct
35
An obstructed ___ will cause dilatation of the intrahepatic ducts and a contracted GB because no bile is reaching the cystic duct to fill the gb
common hepatic duct
36
most common location for obstruction and causes dilated intrahepatic/extrahepatic ducts and GB
distal CBD
37
A stone lodged in the ____ can cause pancreatitis if the pancreatic duct is also obstructed
distal CBD
38
Jaundice occurs with ____
obstruction
39
The best way to differentiate hepatic jaundice from obstructive jaundice is to:
measure the CBD
40
Hepatic jaundice is caused by:
liver disease
41
Obstructive jaundice is caused by:
biliary obstruction
42
If the bile ducts are normal size, the cause of jaundice is:
not obstructive
43
_____ would be elevated in both hepatic and obstructive jaundice
total bilirubin
44
_____ can cause hepatic or obstructive jaundice
Liver tumor formation
45
Lab testing with choledocholithiasis
increased direct bilirubin, LFTs, ALP, GGTP
46
Increased ___ are usually the first indication of obstruction
ALP
47
Echogenic foci within ductal system; ducts proximal to obstruction will be dilated
choledocholithiasis
48
The ____ or ____ sign (dilated CBD and MPV) are associated with choledocholithiasis
Parallel channel sign
Double barrel shotgun sign
49
In choledocholithiasis, intrahepatic ducts form a ____ pattern
stellate
50
_____ can be visualized posterior to dilated ducts
acoustic enhancement
51
What is the sonographic difference between sludge and limy bile?
a. presence of posterior enhancement
b. presence of posterior shadowing
c. presence of echogenic material in GB lumen
d. presence of dilated ducts
b
52
GB sludge is associated with all of the following, except:
a. prolonged fasting
b. high fat diet
c. total parenteral nutrition (IV feeding)
d. pregnancy
b
53
How can you differentiate a wall mass from tumefactive sludge?
a. activate harmonic imaging
b. activate spatial compounding
c. activate color Doppler
d. activate multiple focal zones
c
54
Hemolytic disorders have been associated with what biliary abnormality?
a. phrygian cap
b. biliary atresia
c. cholelithiasis
d. adenomyomatosis
c
55
Whicih of the following is unaffected by an isolated obstruction caused by cholelithiasis?
a. bilirubin
b. alkaline phosphatase
c. Gamma Glutamyl Transpeptidase
d. aspartate aminotransferase
d
56
An impacted gallstone increases the risk of:
a. wall ischemia
b. gangrene
c. perforation
d. all the above
d
57
____ syndrome involves a stone in the cystic duct, while ____ syndrome involves a stone in the duodenum
a. Mirizzi, Bouveret
b. Bouveret, Courvoisier
c. Courvoisier, Mirizzi
d. Mirizza, Courvoisier
a
58
Painless jaundice, distended GB, and an obstruction at the Ampulla of Vater are the three classic characteristics of:
a. Mirizzi syndrome
b. Bouveret Syndrome
c. Murphy sign
d. Courvoisier sign
d
59
The parallel channel sign or double barrel shotgun sign refers to the:
a. Dilated CBD and main portal vein
b. Dilated CBD and main pancreatic duct
c. Dilated intrahepatic ducts and hepatic arteries
d. Dilated intrahepatic ducts and hepatic veins
a
60
The location of a ductal obstruction is determined by:
a. the size of the GB
b. the GB wall thickness
c. where the ductal dilatation starts
d. where there is hypervascularity of the ductal system
c
61
What is the best way to differentiate hepatic jaundice from obstructive jaundice?
a. measure the liver length and width
b. measure the CBD
c. Measure the GB wall thickness
d. Measure the main portal vein diameter
b
62
benign epithelial tumor; overgrowth of the gallbladder lining; usually less than 5 mm and solitary
adenoma/polyp
63
If an adenoma/polyp is >__mm diameter indicates strong suspicion for malignant mass formation, NOT a benign polyp
10
64
Clinical symptoms of adenoma/polyp
asymptomatic unless interferes with gb function
65
protrusion in the gb lumen; attached to the wall, non-mobile; usually isochoic to gb wall, non-shadowing
adenoma/polyp
66
usually solitary, >10mm, invades GB wall, demonstrates internal vascularity
malignant polyp
67
Cholesterolosis is also called:
strawberry gallbladder
68
A type of hyperplastic cholecystosis, a spectrum of degenerative and proliferative changes seen in the gb
cholesterolosis
69
Polyps are normally made from:
cholesterol
70
What causes cholesterolosis?
malfunction of cholesterol metabolism causing cholesterol to be deposited in the lamina propia of the gb wall
71
Cholesterolosis does not cause ____ or ____
gb wall thickening
comet tail artifact
72
Cholesterolosis is more common in:
women
73
multiple, non-shadowing masses, attached to gb wall with NORMAL wall thickness, NO comet tail artifacts
cholesterolosis
74
A type of hyperplastic cholecystosis, a spectrum of degenerative and proliferative changes seen in the gb; there is proliferation of mucosal tissue into the muscularis layer and the thickened muscularis increases overall wall thickness
adenomyomatosis
75
____ or _____ sinuses are caused when herniation of the wall layers forms a pocket or sinus
GB diverticula
Rokitansky-Aschoff
76
In adenomyomatosis, the sinuses may fill with ____ or ___ and can collect sludge or stones
bile
cholesterol
77
___ and ___ artifacts are seen with cholesterol deposits
comet tail
twinkle
78
Adenomyomatosis can occur with ____ which increases the changes for associated RUQ pain and other symptoms
cholelithiasis
79
diffuse or segmental thickening of the gb wall; diverticula within the wall, irregular lumen contour, stones, comet tail artifact from cholesterol deposits in Rokitanksy-Aschoff sinuses
adenomyomatosis
80
localized collection of bile
biloma
81
Biloma is a complication of ___, ___ and ___
GB perforation
surgery
trauma
82
Clinical symptoms of Biloma
pain
fever
83
Lab tests associated with biloma
increased bilirubin, LFT, white blood cell count
84
Sonolucent mass in RUQ, loculated, posterior enhancement, communicates with biliary tree
biloma
85
air in the biliary tree
pneumobilia
86
Pneumobilia is usually found at the ____
liver hilum
87
Pneumbilia is a complication of ____, ____ _____, or ____
ERCP (#1)
recent biliary or gastric/duodenal surgery
abscess
emphysematous cholecystitis
88
Clinical symptoms of pneumobilia
pain
nausea
vomiting
89
Sonographic appearance of pneumobilia
echogenic foci or linear structures in ducts with dirty shadowing
ring down artifact
90
blood within the biliary tree
hemobilia
91
Hemobilia is most often caused by _____ and ____
percuteaneous biliary procedures
liver biopsy
92
In most cases, blood accumulates in gallbladder
hemobilia
93
Sonographic appearance of hemobilia
appearance varies with age of blood
may see fluid levels
94
Gallbladder carcinoma is a form of:
adenocarcinoma
95
__-__% of cases of gb carcinoma have gallstones
65
95
96
In GB carcinoma, most tumors form in the:
fundus
97
Gallbladder carcinoma is more common in:
women over 60
98
Gallbladder carcinoma is associated with:
long standing cholecystitis
99
Clinical symptoms of gallbladder carcinoma
RUQ pain
jaundice
weight loss
100
Lab testing associated with gallbladder carcinoma
increased bilirubin, alkaline phosphatase, prothrombin time
