Biliary Workbook Key Terms Flashcards
Small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions
Ampulla of Vater
Yellow pigment in bile formed by the breakdown of red blood cells
Bilirubin
Cholecystectomy
Removal of the GB.
Extends from the point where the common hepatic duct meets the cystic duct; drains into the duodenum after it joins within the main pancreatic duct.
Common Bile Duct
Common Duct
Refers to common bile and hepatic ducts when the cystic duct is not seen.
Bile duct system that drains the liver into the common bile duct.
Common Hepatic Duct
Connect the GB to the common Hepatic Duct
Cystic Duct
Storage Pouch for Bile
Gallbladder
A small part of the GB that lies near the cystic duct where stones may collect.
Hartmann’s Pouch
Tiny valves found within the cystic duct.
Heister’s Valve
Massive enlargement of the GB.
Hydrops
Travels horizontally through the pancreas to join the common bile duct at the ampulla of Vater.
Pancreatic Duct
Phrygian Cap
GB variant in which part of the fundus is bent back on itself.
The Central area of the liver where the portal vein, common duct, and hepatic artery enter.
Porta Hepatis
A small muscle that guards the ampulla of Vater.
Sphincter of Oddi
small polypoid projections from the gallbladder wall
adenomyomatosis
inflammation of the gallbladder may be acute or chronic
cholecystitis
cholangitis
Inflammation of the bile duct
cholecystokinin
a hormone secreted into the blood by the mucosa of the upper small intestine; stimulates contraction of the gallbladder and pancreatic secretion of enzymes
Choledochal cyst
cystic growth on the common duct that may cause obstruction
stones in the bile duct
choledocholithiasis
Gallstones in the gallbladder
cholelithiasis
Cholesterolosis
variant of adenomyomatosis; cholesterol polyps
jaundice
excessive bilirubin accumulation causes yellow pigmentation of the skin; 1st seen in the whites of the eyes
junctional fold
small septum within the gallbladder, usually arising from the posterior wall
cancer at the bifurcation of the hepatic ducts; may cause asymmetrical obstruction of the biliary tree
Klatskin’s tumor
positive sign implies exquisite tenderness over the area of the gallbladder upon palpation
Murphy’s sign
small, well-defined soft tissue projection from the gallbladder wall
polyp
calcification of the gallbladder wall is termed
porcelain gallbladder
Low-level echoes found along the posterior margin of the gallbladder; move with a change in position
sludge
wall echo shadow (WES) sign
sonographic pattern found when the gallbladder is packed with stones
The gallbladder serves a reservoir for ___ that is drained from the hepatic ducts in the liver.
bile
The common hepatic duct is joined by the cystic duct to form the __ duct.
common bile
The main pancreatic duct joins the common bile duct, and together they open through a small ampulla (the ampulla of _ ) into the duodenal wall.
Vater
The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the
sphincter of oddi
The arterial supply of the gallbladder is the _ artery, which is a branch of the right hepatic artery.
cystic
List the 2 primary functions of the extrahepatic biliary duct.
The transportation of bile from the liver to the intestine and regulation of its flow
Bile is the principal medium for excretion of bilirubin and
cholesterol
The __ from the small intestine stimulates the liver to make more bile. This activates intestinal and pancreatic enzymes.
bile salts
The sign that indicates an extrahepatic mass compressing the CBD, which can produce an enlarged gallbladder, is called ___
Courvoiser’s sign
Sonographically, the common duct lies ___ and to the ___ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.
anterior/right
The hepatic artery lies ___ and to the ___ of the portal vein.
anterior/left
To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for at least _ hours before the ultrasound exam.
8-12
The patient is initially examined with ultrasound in full
Inspiration
The patient should also be rolled into a steep ___ or upright position (to ensure there are no stones in the gallbladder) in an attempt to separate small stones from the gallbladder wall or cystic duct.
decubitis
The gallbladder may be identified as a(n) ___ oblong structure located anterior to the right kidney, lateral to the head of the pancreas and duodenum.
sonolucent
The gallbladder commonly resides in a ___ on the medial aspect of the liver.
fossa
Because ___ tissue within the main lobar fissure of the liver (which lies between the gallbladder and the right portal vein), this bright linear reflector is a reliable indicator of the location of the gallbladder.
fat/fibrous
A small ___ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum.
Echogenic
On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _ _ sign.
mickey mouse
On sagittal scans, the right branch of the hepatic artery usually passes ___ to the common duct.
Posterior
The common duct is seen just _ to the portal vein before it dips posteriorly to enter the head of the pancreas.
Anterior
When the right subcostal approach used, the common hepatic duct is seen as a tubular structure anterior to the portal vein. The right branch of the ___ artery can be seen between the duct and the portal vein as a small circular structure.
Hepatic
The most classic symptom of gallbladder disease is ___ pain, usually occurring after ingestion of greasy foods.
RUQ
A gallbladder attack may cause pain in the _ shoulder.
Right
The normal wall thickness of the gallbladder is less than _ mm.
3
Clinically the patient with acute cholecystitis presents with these symptoms:
Acute RUQ pain.
The _ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.
WES (wall echo shadow)
A fairly rare complication of acute cholecystitis associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts is called ___.
emphysematous cholecystitis
Clinically the patient falls under the five F’s:
fat, forty, fertile, female, and fair
The ___ may be the result of pancreatic juices refluxing into the bile duct bc of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and an outpouching of the ductal walls.
Choledochal cyst
A hyperplastic change in the gallbladder wall is _
adenomyomatosis
The differential for a porcelain gallbladder would include a packaged bag or ___ sign.
WES
What is the most notable sonographic finding with carcinoma of the gallbladder?
GB wall is markedly abnormal and thickened
The most common cause of biliary ductal system obstruction is the presence of a ___ or ___ within the ductal system.
tumor/thrombus
3 primary areas where obstruction occurs:
intrapancreatic obstruction, suprapancreatic obstruction, and porta hepatic obstruction
An uncommon cause of extrahepatic biliary obstruction as a result of impacted stone in the cystic duct creating extrinsic mechanical compression of the common hepatic duct is ___ syndrome. ___ causes increased pressure in the biliary tree with pus accumulation.
Mirizzi/cholangitis
The majority of stones in the CBD have migrated from the gallbladder. Common duct stones are usually associated with _ _.
calculous cholecystitis
_ or _ within duodenum may also give rise to a dirty shadow in the right upper quadrant.
air or gas
On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ___ disease.
Caroli’s
