Penny Gallbladder

Front 1

Enlarged, palpable gallbladder caused by biliary obstruction in the area of the pancreatic head. Typically pancreatic head mass.

Back 1

Courvoisier Gallbladder

Front 2

Emphysematous means?

Back 2

Abnormal distention of an organ with air or gas. Outpouching of the gallbladde

Front 3

Outpouching of the gallbladder neck?

Back 3

Hartmann pouch

Front 4

Mucocele of the gallbladder is also known as?

Back 4

Hydropic gallbladder (Enlarged Gallbladder)

Front 5

Fold in the neck of the gallbladder.

Back 5

Junctional fold

Front 6

Porcelain Gallbladder is?

Back 6

Calcification of all or part of the Gb wall

Front 7

What is Rokitansky-Aschoff sinus?

Back 7

Tiny pockets within the gallbladder wall.

Front 8

This is found in African American; form of anemia.

Back 8

Sickle cell disease

Front 9

Thick sludge is also referred to as?

Back 9

Tumefactive sludge

Front 10

Name the normal variants of the gallbladder?

Back 10

Phrygian cap, junctional fold, Hartman pouch, Bilobed GB (hourglass) Septated GB (thin septations within the Gb)

Front 11

This structure is posterior to the right lobe liver?

Back 11

Gallbladder

Front 12

Gallbladders function?

Back 12

Store and concentrate bile.

Front 13

Gallbladder has how many layers?

Back 13

3;

Inner layer: mucosal layer

Middle layer: fibromuscular layer

Outer: Serosal layer

Front 14

What connects the neck of the gallbladder to the rest of the biliary system?

Back 14

Cystic duct; at the level of the common hepatic duct.

Front 15

What connects the neck of the gallbladder to the rest of the biliary system?

Back 15

Cystic duct; at the level of the common hepatic duct.

Front 16

What lies distal to the union of the cystic duct to the hepatic duct?

Back 16

Common bile duct

Front 17

What’s the most dependent portion of the gallbladder?

What is the most common location for gallstones to collect?

Back 17

Fundus.

Fundus.

Front 18

Which structure provides the blood supply to the gallbladder?

Back 18

Cystic artery; typically rises from small branch of right hepatic artery.

Front 19

What releases the cholecystokinin?

Back 19

The duodenum releases the hormone once the chyme leave me the stomach. This release of hormones causes the Gb to contract.

Front 20

What is the most common variant in the gallbladder shape?

Back 20

Phrygian cap

Front 21

What are other anomalies of the gallbladder?

Back 21

Agenesis, duplicated, floating Gb, hypoplasia.

Front 22

How can Gallbladder torsion occur?

Back 22

Free floating Gb, has potential to twisting off the blood supply.

Front 23

How can Gallbladder torsion occur?

Back 23

Free floating Gb, has potential to twisting off the blood supply.

Front 24

Gallbladder normal length and normal AP diameter?

Back 24

Length 8-10 cm

AP no more than 4-5 cm

Front 25

Gallbladder wall should measure?

Back 25

<3 mm

Front 26

What labs should be evaluated to Eval for gallbladder disease?

Back 26

ALT, GGT, ALP, WBC

Front 27

What are sources of diffused gallbladder wall thickening?

Back 27

Postprandial, acute cholecystitis, chronic cholecystitis, Adenomyomatosis, Hypoalbuminemia, GB carcinoma, hepatitis, cirrhosis

Front 28

Sources with focal gallbladder wall thickening?

Back 28

GB Polyp, Adenomyomatosis, GB carcinoma, Adhered gallstone.

Front 29

Sources with focal gallbladder wall thickening?

Back 29

GB Polyp, Adenomyomatosis, GB carcinoma, Adhered gallstone.

Front 30

Causes for non visual of Gb?

Back 30

Cholecystectomy, WES sign, post prandial, ectopic location, agenesis, emphysematous, Hepatization of the GB (tumefactive sludge)

Front 31

cholelithiasis consist of?

Back 31

Cholesterol, calcium bilirubinate, calcium carbonate.

Front 32

This dx is seen with having a higher incidence with females, flatulent, fair, forty, fertile, fat.

Back 32

Gallstones

Front 33

Which type of patients have an increased chance to developing gallstones?

Back 33

Pediatric patients with sickle cell disease (hemolytic anemia), patients with chrohn disease.

Front 34

Spiral valves of heisted are located where?

Back 34

In the cystic duct

Front 35

Risk factors and predisposing condition for cholelithiasis?

Back 35

Parity, total parenteral nutrition.

Front 36

What artifact can be used to identify small gallstones?

Back 36

Twinkle artifact

Front 37

Pt presents with biliary colic, pain that radiates to the shoulder, vomiting. Sono finding includes mobile shadowing echogenic structure in lumen of Gb.

Back 37

Cholelithiasis

Front 38

Patients with hyperalimentation / total parenteral nutrition or extended period of fasting are prone to this dx. Low level non shadowing defender echoes seen in the gallbladder.

Back 38

Gallbladder Sludge

Front 39

What are the most common types of polyps?

Back 39

Cholesterol; measure less than 10 mm.

Front 40

What are the most common types of polyps?

Back 40

Cholesterol; measure less than 10 mm.

Front 41

This is known as a strawberry gallbladder?

Group of proliferative and degenerative GB disorders includes both?

Back 41

Hyperplastic cholecystosis

(includes Adenomyomatosis and cholesterolosis)

Front 42

Asymptomatic patient, sono finding: muscular layer of Gb becomes thickened producing diverticuli, comet tail artifact, seen protruding into the GB lumen from anterior wall.

Back 42

Adenomyomatosis

(Form of Hyperplastic Cholecystosis of the Gb)

Front 43

What’s the most common cause when a gallstone is lodged in the cystic duct or neck of the Gb?

Back 43

Acute Cholecystitis

Front 44

What is associated with acute cholecystitis?

Back 44

Leukocytosis

Front 45

RUQ pain, fever, pain radiating to shoulder, ALT, ALP, GGT, bilirubin elevated, vomiting. Sono finding: gallstone in neck and cystic duct, positive Murphy sign. GB wall thickening, Pericholecystic fluid, sludge. Suspect?

Back 45

Acute Cholecystitis

Front 46

Pt presents with RUQ pain, elevated ALP, ALT, GGT, bilirubin, Fever, pain radiates to shoulder. Positive Murphy sign. Sono finding: GB wall thickened, wall tear noted. Focal wall necrosis, bulge. GB loss it’s typical shape, pericholecystic fluid, sludge. Suspect?

Back 46

Gangrenous cholecystitis and GB perforation.

Front 47

Differential to gangrenous cholecystitis is?

Back 47

Suppurative cholecystitis (Empyema), Xanthogranulomatous cholecystitis

Front 48

This finding is based on diabetic patient. Pt present with RUQ pain, negative Murphy sign. Fever. Sono finding: champagne sign-dirty shadowing, reverberation seen at Gb. Potential to becoming septic. Suspect?

Back 48

Emphysematous cholecystitis

Front 49

Pt mentions when eating fast food, stomach hurts. Eval GB. Wall thickened, WES sign. Contracts Gb, gallstones. Finding?

Back 49

Chronic cholecystitis

Front 50

This finding can be in children, or those immunocompromised. Pt presents with RUQ pain, leukocytosis, positive Murphy sign, pericholecystic fluid, sludge, GB wall thickening.

Back 50

Acalculous Cholecystitis

Front 51

Gallbladder Hydrops in older infants and children may be associated with?

Back 51

Kawasaki disease - condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes.

Front 52

Gallbladder Hydrops in older infants and children may be associated with?

Back 52

Kawasaki disease - condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes.

Front 53

Pt asymptomatic. Calcification on Gb wall with posterior shadowing. Appears as WES sign. Signs of Chronic cholecystitis, gallstones seen.

Back 53

Porcelain gallbladder.

(Posterior wall will be seen with porcelain Gb, whereas WES sign the posterior wall is obscured by the shadowing of gallstone.)

Front 54

Gallbladder Hydrops in older infants and children may be associated with?

Back 54

Kawasaki disease - condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes.

Front 55

Pt asymptomatic. Calcification on Gb wall with posterior shadowing. Appears as WES sign. Signs of Chronic cholecystitis, gallstones seen.

Back 55

Porcelain gallbladder.

(Posterior wall will be seen with porcelain Gb, whereas WES sign the posterior wall is obscured by the shadowing of gallstone.)

Front 56

Those who have had porcelain gallbladder, have an increased risk for?

Back 56

Gallbladder carcinoma

Front 57

Pt present with RUQ pain, jaundice, nausea / vomiting. Elevated ALP, ALT, GGT, bilirubin. Weight loss. Sono finding- hepatomegaly. Non mobile mass > 1 cm in Gb lumen. Diffuse Gb wall thickening. Invasion of mass into surrounding liver tissue. Suspect?

Back 57

Gallbladder carcinoma

Front 58

Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes?

Back 58

Gangrenous cholecystitis

Front 59

Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes?

Back 59

Gangrenous cholecystitis

Front 60

Which of the following is not a risk factor for the development of gallstones?

A. Oral contraceptive

B. Total parenteral nutrition

C. Pregnancy

D. Phrygian cap

Back 60

D. Phrygian cap

Front 61

What is the merging point of the pancreatic duct and common bile duct just before the sphincter of oddi?

Back 61

Ampulla of vater.

Also referred to has hepatopancreatic ampulla.

Front 62

Biliverdin means?

Back 62

Green pigment found in the bile.

Front 63

What is Caroli disease?

Back 63

Segmental dilatation of the Intrahepatic ducts

Front 64

Fever, RUQ pain, and jaundice is associated with?

Back 64

Cholangitis.

[CHARCOT TRIAD]

Front 65

What is the primary bile duct cancer?

Back 65

Cholangiocarcinoma

Front 66

This muscle controls the emptying of the bile and pancreatic juices into the duodenum?

Back 66

Hepatopancreatic sphincter.

Also referred to as sphincter of Oddi.

Front 67

Malignant biliary tumor that is located at the junction of the right and left hepatic ducts.

Back 67

Klatskin tumor

Front 68

Pt presents with jaundice, pain, fever, lodged stone in cystic duct causing a compression of the common duct.

Back 68

Mirizzi syndrome

Front 69

Pt presents with jaundice, pain, fever, lodged stone in cystic duct causing a compression of the common duct.

Back 69

Mirizzi syndrome

Front 70

Enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis

Back 70

Parallel tube sign

Shotgun sign

Front 71

Explain the bile flow in the gallbladder?

Back 71

Bile flow - liver - biliary radicles - rt & lt hepatic ducts - common hepatic duct- cystic duct - GB - CBD - ampulla of vater - Sphincter of Oddi - Duodenum

Front 72

This structure is posterior to the head of pancreas?

Back 72

CBD.

Front 73

Structure is inferior to the gallbladder neck??

Back 73

CBD

Front 74

Complete biliary tree includes which organs?

Back 74

Liver, gallbladder, pancreas

Front 75

Intrahepatic ducts are considering dilated if they measure?

Back 75

> 2 mm

Front 76

CBD is considered normal if measuring 7mm, when?

Back 76

If patient is over 60 years old or had a cholecystectomy

Front 77

CBD is considered normal if measuring 7mm, when?

Back 77

If patient is over 60 years old or had a cholecystectomy

Front 78

Biliary abnormalities, what labs should be evaluated?

Back 78

ALT, ALP, GGT, urobilirubin, amylase, Lipase.

Front 79

What is it referred to when the bile duct and pancreatic duct are dilated?

Back 79

Double duct sign

Front 80

What is considered the proximal portion of the biliary tree?

Back 80

Liver (origin of the bile)

Front 81

What is the most distal segment of the biliary tree??

Back 81

CBD closest to the pancreatic head.

Front 82

What is the most common level for an obstruction to occur at in the biliary system?

Back 82

Distal common bile duct

Front 83

What is the most common cause of a common bile duct obstruction?

Back 83

Choledocholithiasis, chronic pancreatitis, acute pancreatitis and pancreatic carcinoma.

Front 84

With biliary stasis what is usually probable to occurring?

Back 84

Choledocholithiasis (gallstones in the bile duct)

Front 85

ERCP can diagnose which biliary diagnosis?

Back 85

Mirizzi syndrome

Front 86

If the bile duct wall is thickened, what is this called?

Back 86

Cholangitis

Front 87

Most common cause of Cholangitis is?

Back 87

Choledocholithiasis

Front 88

What are the types of cholangitis?

Back 88

Acute bacterial cholangitis, AIDS cholangitis, oriental cholangitis, sclerosing Cholangitis

Front 89

What are the types of cholangitis?

Back 89

Acute bacterial cholangitis, AIDS cholangitis, oriental cholangitis, sclerosing Cholangitis

Front 90

This type of cholangitis, patient has a fever, RUQ pain, jaundice. low level echoes seen in the bile ducts. This type is?

Back 90

Acute bacterial cholangitis

Front 91

This type of cholangitis is endemic in Asia.

Back 91

Oriental Cholangitis

Front 92

This type of cholangitis affect young men. Thickening if the bile ducts, associated with inflammatory bowel disease or ulcerative colitis.

Back 92

Sclerosing cholangitis

Front 93

Cholangitis can lead to?

Back 93

Portal HTN or cirrhosis

Front 94

How to differ pneumobilia from Intrahepatic stones?

Back 94

Pneumobilia- echogenic linear structure with ringdown artifact and dirty shadowing.

Intrahepatic stones - produce acoustic shadowing if large enough.

Front 95

Pt presents with biliary colic. Sono finding: echogenic linear structure in biliary duct in sagittal plane. This finding made its way through biliary tree via ampulla of vater.

Back 95

Ascariasis (parasitic roundworm)

Front 96

What is the primary biliary tree cancer?

Back 96

Cholangiocarcinoma

Front 97

Which cholangitis is the most common risk factor for cholangiocarcinoma?

Back 97

Sclerosing cholangitis

Front 98

What is the most common manifestation of cholangiocarcinoma?

A. Sclerosi cholangitis

B. Klatskin tumor

C. Cholangiocarcinoma

D. Biliary atresia

Back 98

Klatskin tumor

Front 99

Pt has pruritus, jaundice, unexplained weight loss, and pain, elevated bilirubin, elevated ALP. Dilated intrahepatic ducts.

Back 99

Cholangiocarcinoma

Front 100

Pt presents as a Neonate with jaundice. Elevated AST, ALT, bilirubin. Sono finding: triangular cord sign- avascular, echogenic, triangular or tubular structure anterior to portal vein. Absent biliary ducts.

Back 100

Biliary atresia

Front 101

Pt presents as a Neonate with jaundice. Elevated AST, ALT, bilirubin. Sono finding: triangular cord sign- avascular, echogenic, triangular or tubular structure anterior to portal vein. Absent biliary ducts.

Back 101

Biliary atresia

Front 102

This finding is in the first decade of life of infancy. Clinical finding: pain, fever, jaundice. Pt has abdominal mass. Sono finding- cystic mass near porta hepatis. Biliary dilatation.

Back 102

Choledochal cyst

Front 103

Pt presents as a Neonate with jaundice. Elevated AST, ALT, bilirubin. Sono finding: triangular cord sign- avascular, echogenic, triangular or tubular structure anterior to portal vein. Absent biliary ducts.

Back 103

Biliary atresia

Front 104

This finding is in the first decade of life of infancy. Clinical finding: pain, fever, jaundice. Pt has abdominal mass. Sono finding- cystic mass near porta hepatis. Biliary dilatation.

Back 104

Choledochal cyst

Front 105

How many types of choledochal cyst and which one is most common?

Back 105

4 types; most common is the cystic dilatation of the common bile duct

Front 106

Pt presents with pain, fever, jaundice, signs of portal HTN, this is seen with cystic renal disease.

Sono finding- dilatation of the intrahepatic ducts. Central dot appearance.

Back 106

Caroli disease (Caroli syndrome)

Front 107

Which of the following is associated with charcot triad?

A. Cholesterolosis

B. Klatskin tumor

C. Cholangitis

D. Choledochal cyst

Back 107

Cholangitis

Front 108

Which of the following is associated with charcot triad?

A. Cholesterolosis

B. Klatskin tumor

C. Cholangitis

D. Choledochal cyst

Back 108

Cholangitis

Front 109

All of the following are clinical findings consistent with cholangiocarcinoma except?

A. Pruritis

B. Weight loss

C. Elevated bilirubin

D. Dilation of intrahepatic ducts

Back 109

D. Dilation of intrahepatic ducts

Front 110

The biliary duct wall should never measure more than:

A. 9mm

B. 2mm

C. 4 mm

D. 5mm

Back 110

B. 2 mm