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What two ducts join to form the CBD?
The Common Hepatic Duct and the Cystic Duct
What is the normal measurement of the CHD?
Average is 4 mm, but should not exceed 6 mm
With Cholecystectomy, 7-11 mm is within normal
What is the normal measurement of the CBD?
=< 3 mm, but starting at the age of 60, the diameter may increase by 1 mm per decade
Where is the gallbladder located in reference to the IVC and the right kidney?
The GB is lateral to the IVC and anterior and medial to the right kidney
Small posterior pouch near the GB neck
Fold of septation of the GB at the junction of the neck and body
fold in the GB fundus
What is the normal GB size in a normal fasting adult?
Approximately 8-10 cm in length and 3-5 cm in diameter
GB wall should measure =<3 mm
How long should a patient be NPO prior to an examination of the GB?
Cholangiocarcinoma located at the junction of the right and left hepatic ducts is termed a(n)
b. phrygian cap
e. Klatskin tumor
E. A malignant neoplasm located at the junction of the right and left hepatic ducts is termed a KLATSKIN TUMOR. A biloma is an extrahepatic collection of extravasated bile. A hepatoma is a parenchymal malignancy. Extension of pancreatic inflammation into the peripancreatic tissues describes a phlegmon. Folding of the GB fundus is the phrygian cap.
Which of the following patient positions may aid in visualization of the cystic duct?
d. left posterior oblique
e. left lateral decubitus
A small septation located between the neck and body of the GB BEST describes:
a. a junctional fold
b. a phrygian cap
c. Hartmann Pouch
e. Diverticulosis of the GB
A. A fold or septation located between the neck and body of the GB describes a junctional fold. Hartmann pouch is a small posterior pouch located in the neck of the GB. A phrygian cap describes a fold in the fundus. Adenomyomatosis or diverticulosis of the GB are polypoid masses protruding from the GB wall into the lumen
A 73 y.o. patient complains of vague RUQ pain. A hyperechoic focus with marked posterior acoustic shadowing is demonstrated in the anterior wall of the GB. This history is most consistent with which of the following pathologies?
a. emphysematous cholecystitis
b. porcelain GB
d. Mirizzi Syndrome
B. Demonstration of a focal hyperechoic GB WALL with MARKED posterior acoustic shadoing is characteristic of a porecelain GB. Emphysematous cholecystitis appears as an echogenic focus in the GB wall or lumen with ill-defined posterior acoustic shadowing. Adenomyomatosis demonstrates a comet tail reverberation artifact. Mirrizi syndrome is a condition caused by a lodge stone int he neck of the GB or cystic duct.
Nonshadowing, low- amplitude echoes located in the dependent portion of the GB best describes:
a. polypoid masses
d. biliary sludge
D. Non shadowing, low amplitude echoes located in the dependent portion of the GB describes biliary sludge.
All of the following are associated with cholesterolosis EXCEPT:
b. cholesterol polyp
c. serum cholesterol levels
d. local disturbance in cholesterol metabolism
e. accumulation of triglycerides and esterified sterols in the GB wall
C. cholesterolosis is an accumulation of triglycerides and esterfied sterols in the wall of the GB caused by a local disturbance in cholesterol metabolism. There are two types of cholesterolosis: cholesterolosis and cholesterol polyps. Cholesterolosis is NOT associated with serum cholesterol levels.
The spiral valves of Heister are located in which of the following structures?
b. duct of Santorini
d. cystic duct
e. duct of Wirsung
D. cystic duct
A patient presents a sudden onset of abdominal pain and extreme tenderness over the GB fossa. Localized GB wall thickening is visualized on ultrasound. This most likely represents:
a. acute cholecystitis
b. a porcelain GB
c. a hydropic GB
e. a nonfasting GB
A. acute cholecystitis
A 43 y.o. female presents to the emergency department complaining of RUQ pain and a sudden onset of jaundice. Which of the following findings is identified in this sonogram?
A patient presents with a two-day history of acute RUQ tenderness and elevated liver function tests. A sonogram of the GB demonstrates cholelithiasis and:
a. emphysematous cholecystitis
b. acute cholecystitis
c. tumefactive sludge
e. metastatic GB disease
B. Acute cholecystitis
In the portal hepatis, the CHD is located:
a. posterior to the MPV
b. lateral to the proper hepatic artery
c. medial to the proper hepatic artery
d. anterior to the common hepatic artery
e. medial to the MPV
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