ARRT abdomen 4 Flashcards
most common sources of metastasis in the liver are:
lung, colon, breast
most common place for metastasis
liver
clinical symptoms of metastasis
possible abnormal LFTs
pain
jaundice
sonographic appearance of metastasis
multiple masses with variable appearance
ascites
hypoechoic metastatic masses in the liver are usually from:
breast
lung
lymphoma
Hyperechoic metastatic masses in the liver are usually from:
colorectal cancer
Sonographic target appearing masses in the liver are usually from:
lung
colon
pediatric version of HCC
hepatoblastoma
Hepatoblastoma has an elevated:
AFP
Patients with ______ are at an increased risk for developing hepatoblastoma.
Beckwidth-Weidemann syndrome
Most common reason for liver transplant
hepatitis C
In a liver transplant the donor ____ is connected to recipient ____
portal vein
hepatic artery
Portal vein flow in a transplanted liver
hepatopetal
minimally phasic
Hepatic artery flow in transplanted liver
hepatopetal
low resistance
Hepatic vein flow in transplanted liver
hepatofugal
pulsatile
signs of rejection of transplanted liver
abnormal doppler patterns
elevated resistance in hepatic artery
thrombosed or hepatofugal flow in portal vein
Most common vascular complication of a liver transplant
hepatic artery thrombosis
hypoechoic wedge shaped regions throughout the liver
infarction
Infarction may be caused by ____ or _____
embolism
thrombosed artery
Core biopsy gauge range for liver
14-20
In order to have liver biopsy a patient must have normal labs, these include:
PT
PTT
INR
platelets
no abnormal clotting factors
What is the best scanning technique for ultrasound guided needle biopsy
perpendicular incidence or 90 degrees
The gallbladder and biliary system is ____peritoneal
intra
What is the function of the gallbladder
store and concentrate bile
____ transport bile
ducts
Cholecystokinin does what?
makes gallbladder contract releasing bile into system
Where does cholecystokinin come from?
duodenum
Intrahepatic biliary radicles (part of portal triads) drain into:
right and left hepatic ducts
Right and left hepatic ducts drain into:
common hepatic duct
Common hepatic duct connects to _____ as it becomes extrahepatic
cystic duct
The cystic duct contains:
spiral valves of Heister
allow bile to flow into gallbladder but not leak out until gallbladder is contracted
spiral valves of Heister
From the cystic duct, connects to ____
common bile duct
The common bile duct joins the _____ at the Ampulla of Vater
main pancreatic duct
The common bile duct joins the main pancreatic duct at the:
Ampulla of Vater
controls the flow of enzymes into the duodenum
Sphincter of Oddi
The Sphincter of Oddi controls the flow of enzymes into the:
duodenum
3 parts of gallbladder
neck, body, fundus
most dependent part of the gallbladder is
fundus
The ____ connects neck of gallbladder to the rest of the biliary tree
cystic duct
Vascular supply to the gallbladder
cystic artery
The cystic artery is a branch of the:
right hepatic artery
wall layers of gallbladder inner to outer
mucosa, fibromuscular, serosa
Most common variant of the gallbladder
phrygian cap
fold of fundus over body in gallbladder
phrygian cap
outpouching of neck of gallbladder
Hartmann pouch
fold at neck of gallbladder
junctional fold
Normal gallbladder wall thickness
up to 3mm
Normal gallbladder width in transverse plane
up to 4 cm
Normal CBD measurement
up to 6mm at porta hepatis
If a patient has a cholecystectomy the normal measurement of the CBD can be up to:
10 mm
The ____ may be seen posterior to the CBD
cystic duct
While dilated ducts or gallbladder are observed, evaluate ____ to locate obstruction
distal
Infection in the gallbladder is most commonly caused by:
obstruction
projection of tissue from gallbladder wall
polyps
Most common gallbladder polyps
cholesterol
Polyps are related to ____, _____, and ____
cholesterolosis or hyperplastic cholecystosis
strawberry gallbladder
diffuse wall polyps
Sonographic appearance of gallbladder polyp
echogenic non-mobile mass projecting from inner lumen
muscular layer of gallbladder forms pockets called Rokitanksy- Aschoff sinuses
Adenomyomatosis
Sonographic appearance of adenomyomatosis
focal or diffuse wall thickening with comet tail artifact
calcification the gallbladder wall
porcelain gallbladder
hyperechoic gallbladder with shadowing
porcelain gallbladder
gallbladder sludge is also known as
viscid bile
Gallbladder sludge is caused by:
biliary stasis (bile not flowing)
low-level dependent echoes within gallbladder with a fluid level line
gallbladder sludge
thicker sludge forming sludge balls, will be mobile
tumefactive sludge
gallbladder full of tumefactive sludge, gallbladder appears isoechoic to liver texture
hepatization of gallbladder
biliary stones or gallstones within gallbladder
cholelithiasis
6 F’s most common for cholelithiasis
fat
female
fertile
flatulent
fair
forty
Most common location of stones in gallbladder
fundus
Obstructing symptoms of gallstones
RUQ pain
biliary colic
nausea and vomiting
radiating pain to shoulders
Sonographic appearance of cholelithiasis
hyperechoic with posterior shadowing, WES sign,
WES sign
wall echo shadow
gallstones in bile ducts
choledocholithiasis
Obstructive labs include:
ALP
bilirubin
Most common cause of biliary obstruction and obstructive jaundice
choledocholithiasis
Stones within ducts are most commonly found where?
distal CBD, near Ampulla of Vater
The ____ are most likely to dilate first in choledocholithiasis
extrahepatic ducts
Symptoms of Pirrizzi syndrome
jaundice, pain, fever, stone lodged in cystic duct, compression of CBD
parallel tube or channel seen on sonographic image with choledocholithiases
shotgun sign
Double duct sign
dilated CBD and pancreatic duct
> 4cm gallbladder
hydropic gallbladder
The cause of biliary obstruction will ALWAYS be seen ____ to the dilatation
distal
enlarged gallbladder due to pancreatic head mass with painless jaundice
courvoisier gallbladder
Key symptoms of infection
fever
leuko
pain
most common cause of acute cholecystitis:
obstructive gallstone in cystic duct
clinical signs of acute cholecystitis
+ Murphy’s sign
fever
leuko
elevated ALP, bilirubin
nausea/vomiting
Sonographic appearance of acute cholecystitis
thickened gallbladder wall, pericholecystic fluid
stones
sludge
bulging of wall, craters, sloughed membrances, wall of gallbladder starts eroding, high risk for perforation
gangrenous cholecystitis/perforation
Gangrenous cholecystitis may lead to _____
peritonitis
pus filling and distending galbladder
suppurative cholecystitis
air or gas bubbles produced by bacteria in the wall of the gallbladder
emphysematous cholecystitis
emphysema =
air
Increased risk for emphysematous cholecystitis
diabetics
immunocompromised
Emphysematous cholecystitis is associated with what sonographic sign
champagne sign
No stone within gallbladder, RUQ pain, fever, leuko, no obstructive labs
acalculus cholecystitis
Who is most likely seen with acalculous cholecystitis
children
hospitalized
immunocompromised patients
Sonographic appearance of acalculus cholecystitis
thickened wall, pericholecystic fluid, no sludge or stone
stone in the bile ducts
acute cholangitis
Acute cholangitis is most commonly caused by:
obstructed stone
