Biliary System - Part 2 Flashcards
What are 3 anatomical variants of the GB?
- Hartmann pouch
- Junctional fold
- Phrygian cap
Hartmann pouch
Small posterior pouch near the GB neck
Junctional fold
Fold or septation of the GB at the junction of the neck and body
Phrygian cap
Fold in the gallbladder fundus
What are 5 congenital anomalies of the GB?
- Agenesis
- rare - Duplication
- Hypoplasia
- Intrahepatic or ectopic
- Multiseptated
What is hypoplasia of the GB associated with?
Cystic fibrosis
What is the normal length and diameter of the GB in fasting adult?
- Length = 8=10cm
2. Diameter = 3-5cm
What is the normal length and width of the GB in a fasting in a pediactric patient?
- Length = 1.5-3cm
2. Width = 1.2cm
What is the normal length and diameter of the GB in a fasting in a patient between the ages of 2-16 years old?
- Length = 3-7cm
2. Diameter = 1-3cm
What is the US appearance of a fasting GB? (2)
- An ellipsoid anechoic structure located in the GB fossa demonstrating posterior acoustic enhancement
- Smooth hyper echoic walls
- measuring 3mm or less in thickness
Where is the GB located compared to the liver?
Inferior medial aspect of the liver
What are 6 reasons on why you wouldn’t see a GB?
- Non-fasting patient
- Surgically absent
- Obliteration of the GB lumen by intestinal air or gallstones
- Patient body habitus
- Ectopic location
- Agenesis
What are 6 non-inflammatory causes of GB wall thickening?
- Non-fasting patient
- Ascites
- Cirrhosis
- Congestive heart failure
- Hypoalbuminemia
- Acute hepatitis
What can be used to decrease artifactual echoes in the GB? (2)
- Harmonics
- Dynamic range
- compression
How can spatial compounding help?
It can help to visualize structures posterior to a highly attenuating structure
If the patient is in a jaundice state, what part of the biliary system should be evaulated?
Intrahepatic ducts
What are 7 indications for scanning the biliary system?
- RUQ pain
- may radiate to the upper back and chest - Increase in LFTs
- Nausea/vomiting
- Intolerance to fatty foods
- Postprandial pain
- Positive Murphy sign
- Jaundice.
Alkaline phosphatase
An enzyme produced primarily by the liver, bone and placenta and excreted
through the bile ducts
What is the normal range of alkaline phosphatase?
35-150 U/L
What does an increase in alkaline phosphatase indicate?
Obstructive jaundice
ALT
Alanine aminotransferase
Alanine aminotransferase
An enzyme found in high concentration in the liver and in lower concentrations in the heart, muscle, and kidney
What is the normal range of ALT?
1-45U/L
Does ALT or AST remain elevated longer?
ALT
What does an elevation of ALT associated with? (3)
- Cirrhosis
- Hepatitis
- Biliary obstruction
What does a mild elevation of ALT associated with?
Liver metastasis
AST
Aspartate Aminotransferase
Aspartate Aminotransferase
An enzyme present in many types of tissue that is released when cells are injured or damaged
- levels will be proportional to amount of damage and the time between cell injury and testing
What is the normal range for AST?
1-36U/L
What does an elevation of AST associated with? (3)
- Cirrhosis
- Hepatitis
- Mononucleosis
Bilirubin
A product from the break down of Hb in old RBCs
- a disruption in the process may cause abnormal levels
- leakage into tissues gives the skin a yellow appearance
What is the normal range of total bilirubin?
0.3-1.1mg/dL
What is the normal range of direct bilirubin?
0.1-0.4mg/dL
What does bilirubin reflect on?
The balance between production and excretion of bile
What is an elevation of direct on conjugated bilirubin associated with? (4)
- Obstruction
- Hepatitis
- Cirrhosis
- Liver metastasis
What is an elevation of indirect on unconjugated bilirubin associated with?
Non-obstructive conditions
