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Chapter 9 Vascular > Ch 11 Gallbladder and the Biliary System > Flashcards

Ch 11 Gallbladder and the Biliary System Flashcards

1
Q

ampulla of Vater

A

Small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions

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2
Q

bilirubin

A

Yellow pigment in bile formed by the breakdown of red blood cells

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3
Q

cholecystectomy

A

Removal of the gallbladder

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4
Q

common bile duct

A

Extends from the point where the common hepatic duct meets the cystic duct; drains into the duodenum after it joins with the main pancreatic duct

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5
Q

common hepatic duct

A

Bile duct system that drains the liver into the common bile duct

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6
Q

cystic duct

A

Connects the gallbladder to the common hepatic duct

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7
Q

gallbladder

A

Storage pouch for bile

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8
Q

Hartmann’s pouch

A

Small part of the gallbladder that lies near the cystic duct where stones may collect

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9
Q

Heister’s valve

A

Tiny valves found within the cystic duct

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10
Q

hydrops

A

Massive Enlargement of the gallbladder

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11
Q

pancreatic duct

A

Travel horizontally through the pancreas to join the common bile duct at the ampulla of Vater

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12
Q

phrygian cap

A

Gallbladder variant in which part of the fundus is bent back on itself

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13
Q

porta hepatis

A

Central area of the liver where the portal vein, common duct, and hepatic artery enter

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14
Q

sphincter of Oddi

A

Small muscle that guards the ampulla of Vater

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15
Q

common duct

A

Refers to common bile and hepatic duct when cystic duct is not seen

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16
Q

adenomyomatosis

A

Small polypoid projection from the gallbladder wall

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17
Q

cholangitis

A

Inflammation of the bile duct

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18
Q

cholecystitis

A

Inflammation of the gallbladder; maybe acute or chronic

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19
Q

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

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20
Q

choledochal cyst

A

Cystic growth on the common duct that may cause obstruction

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21
Q

choledocholithiasis

A

Stones in the bile duct

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22
Q

cholelithiasis

A

Gallstones in the gallbladder

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23
Q

cholesterolosis

A

Variant of adenomyomatosis; cholesterol polyps

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24
Q

jaundice

A

Excessive bilirubin accumulation causes yellow pigmentation of the skin; first seen in the whites of the eyes

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25
Q

junctional fold

A

Small septum within the gallbladder, usually arising from the posterior wall

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26
Q

Klatskin’s tumor

A

Cancer at the bifurcation of the hepatic ducts; may cause asymmetrical; obstruction of the biliary tree

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27
Q

Murphy’s sign

A

Positive sign implies exquisite tenderness over the area of the gallbladder upon palpation

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28
Q

polyp

A

Small, well defined soft tissue projection from the gallbladder wall

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29
Q

porcelain gallbladder

A

Calcification of the gallbladder wall

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30
Q

sludge

A

Low-level echoes found along the posterior margin of the gallbladder; move with change in position

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31
Q

wall echo shadow (WES) sign

A

Sonographic pattern found when the gallbladder is packed with stones

32
Q

The gallbladder serves as a reservoir for _____ that is drained from the hepatic ducts in the liver.

A

bile

33
Q

The common hepatic duct is joined by the cystic duct to from the ____ duct.

A

common bile duct

34
Q

The main pancreatic duct joins the common bile duct, and together they open through a small ampulla ( the ampulla of ____) in to the duodenal wall.

A

Ampulla ofVater

35
Q

The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the _____.

A

sphincter of Oddi

36
Q

The arterial supply of the gallbladder is from the _____ artery, which is a branch of the right hepatic artery

A

cystic

37
Q

List two primary function of the extrahepatic biliary tract.

A

Transportation of bile from the liver to the intestine and regulation of its flow

38
Q

Describe the normal function of the gallbladder during digestion

A

think

39
Q

Bile is the principal medium for excretion of bilirubin _____.

A

cholesterol

40
Q

The ____ from the small intestine stimulate the liver to make bile. This activates intestinal and pancreatic enzymes.

A

bile salts

41
Q

The sign that indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder, is called ____.

A

Courvoisier’s sign

42
Q

Sonographically, the common duct lies _____ and to the ____ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.

A

anterior, right

43
Q

The hepatic artery lies ____ and to the ____of the portal vein

A

anterior, left

44
Q

The most classic symptoms of gallbladder disease is _____ pain, usually occurring after ingestion of greasy foods.

A

right upper abdominal quadrant

45
Q

A gallbladder attack may cause pain in the ____ shoulder.

A

right

46
Q

The normal wall thickness of the gallbladder is less than ____mm.

A

3

47
Q

List 6 biliary causes of gallbladder wall thickening

A

cholecystitis, adenomyomatosis, cancer, acquired immunodeficiency syndrome, cholangiopathy, and sclerosing cholangitis

48
Q

Clinically the patient with acute cholecystitis presents with these symptoms:

A

Acute right upper quadrant pain, Murphy’s sign, fever, and leukocytosis

49
Q

The ____ signis described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.

A

WES

50
Q

A fairly rare complication of acute cholecystitis associated with the presence of gas- forming bacteria in the gallbladder wall and lumen with extension onto he biliary ducts is called ____.

A

emphysematous cholecystitis

51
Q

Clinically the patient falls under five F’s:_____, _____, ____, ____, and _____.

A

fat, female, forty, fertile, fair

52
Q

To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for at least ____ hours before the ultrasound examination

A

8 to 12 hours

53
Q

The patient is initially examined with ultrasound in full____.

A

inspiration

54
Q

The patient should also be rolled into a steep ____ or upright position (to ensure there are no stones within the gallbladder) in attempt to separate small stones form the gallbladder wall or cystic duct

A

decubitus

55
Q

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.

A

sonolucent

56
Q

The gallbladder commonly resides in a(n) ______ on the medial aspect of the liver.

A

fossa

57
Q

Because of _____ tissue withing 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

A

fat or fibrous

58
Q

A small ____ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum

A

echogenic

59
Q

On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the ___ sign

A

Mickey Mouse

60
Q

To obtain a cross section of the portal triad, the transducer must be directed in a slightly ____ path from the left shoulder to the right hip.

A

oblique

61
Q

On sagittal scan, the right branch of the hepatic artery usually passes ___ to the common duct.

A

posterior

62
Q

When the right subcostal approach is used, the common hepatic is seen as a tubular structure anterior to the portal vein. The right bunch of the _____ artery can be seen between the duct and the portal vein as a small circular structure

A

hepatic

63
Q

The common duct is seen just ____ to the portal vein before it dips posteriorly to enter the head of the pancreas

A

anterior

64
Q

What position should the patient be shifted during ultrasound examination

A

Patient should be scanned in the left ducubitus, right lateral, or up right position

65
Q

_____ may be the result of pancreatic juices refluxing into the bile because of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and out pouching of the ductal walls.

A

choledochal

66
Q

A hyperplastic change in the gallbladders wall is _______

A

adenomyomatosis

67
Q

The differential for a porcelain gallbladder would include a packed bag or ____ sign.

A

WES

68
Q

What is the most notable sonographic finding with carcinoma of the gallbladder?

A

The gallbladder wall is markedly abnormal and thickened

69
Q

The most common cause of biliary ductal system obstruction is the presence of a(n) _____ or _____ within the ductal system.

A

tumor, thrombus

70
Q

Job of the sonographer is to localize the level and cause of the obstruction. List 3 primary area of obstruction

A

intrapancreatic obstruction, suprapancreatic obstruction, and porta hepatic obstruction

71
Q

An uncommon cause for extrahepatic biliary obstruction of an impacted stone in the cystic duct creating extrinsic mechanical compression of the common hepatic duct is _____ syndrome.

A

Mirizzi

72
Q

_______ causes increasing pressure in the biliary tree with pus accumulation

A

cholangitis

73
Q

The majority of stones in the common bile have migrated from the gallbladder. Common duct stones are usually associated with _________.

A

calculous cholecystitis

74
Q

____ within the duodenum may also give rise to a dirty shadow in the right upper quadrant

A

air or gas

75
Q

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ____ disease.

A

Caroli’s

Chapter 9 Vascular (16 decks)

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