Ch 11 Gallbladder and the Biliary System Flashcards
ampulla of Vater
Small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions
bilirubin
Yellow pigment in bile formed by the breakdown of red blood cells
cholecystectomy
Removal of the gallbladder
common bile duct
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
common hepatic duct
Bile duct system that drains the liver into the common bile duct
cystic duct
Connects the gallbladder to the common hepatic duct
gallbladder
Storage pouch for bile
Hartmann’s pouch
Small part of the gallbladder that lies near the cystic duct where stones may collect
Heister’s valve
Tiny valves found within the cystic duct
hydrops
Massive Enlargement of the gallbladder
pancreatic duct
Travel horizontally through the pancreas to join the common bile duct at the ampulla of Vater
phrygian cap
Gallbladder variant in which part of the fundus is bent back on itself
porta hepatis
Central area of the liver where the portal vein, common duct, and hepatic artery enter
sphincter of Oddi
Small muscle that guards the ampulla of Vater
common duct
Refers to common bile and hepatic duct when cystic duct is not seen
adenomyomatosis
Small polypoid projection from the gallbladder wall
cholangitis
Inflammation of the bile duct
cholecystitis
Inflammation of the gallbladder; maybe acute or chronic
cholecystokinin
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
choledocholithiasis
Stones in the bile duct
cholelithiasis
Gallstones in the gallbladder
cholesterolosis
Variant of adenomyomatosis; cholesterol polyps
jaundice
Excessive bilirubin accumulation causes yellow pigmentation of the skin; first seen in the whites of the eyes
junctional fold
Small septum within the gallbladder, usually arising from the posterior wall
Klatskin’s tumor
Cancer at the bifurcation of the hepatic ducts; may cause asymmetrical; obstruction of the biliary tree
Murphy’s sign
Positive sign implies exquisite tenderness over the area of the gallbladder upon palpation
polyp
Small, well defined soft tissue projection from the gallbladder wall
porcelain gallbladder
Calcification of the gallbladder wall
sludge
Low-level echoes found along the posterior margin of the gallbladder; move with change in position
wall echo shadow (WES) sign
Sonographic pattern found when the gallbladder is packed with stones
The gallbladder serves as 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 from the ____ duct.
common bile duct
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.
Ampulla ofVater
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 from the _____ artery, which is a branch of the right hepatic artery
cystic
List two primary function of the extrahepatic biliary tract.
Transportation of bile from the liver to the intestine and regulation of its flow
Describe the normal function of the gallbladder during digestion
think
Bile is the principal medium for excretion of bilirubin _____.
cholesterol
The ____ from the small intestine stimulate the liver to make bile. This activates intestinal and pancreatic enzymes.
bile salts
The sign that indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder, is called ____.
Courvoisier’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
The most classic symptoms of gallbladder disease is _____ pain, usually occurring after ingestion of greasy foods.
right upper abdominal quadrant
A gallbladder attack may cause pain in the ____ shoulder.
right
The normal wall thickness of the gallbladder is less than ____mm.
3
List 6 biliary causes of gallbladder wall thickening
cholecystitis, adenomyomatosis, cancer, acquired immunodeficiency syndrome, cholangiopathy, and sclerosing cholangitis
Clinically the patient with acute cholecystitis presents with these symptoms:
Acute right upper quadrant pain, Murphy’s sign, fever, and leukocytosis
The ____ signis described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.
WES
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 ____.
emphysematous cholecystitis
Clinically the patient falls under five F’s:_____, _____, ____, ____, and _____.
fat, female, forty, fertile, fair
To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for at least ____ hours before the ultrasound examination
8 to 12 hours
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 within the gallbladder) in attempt to separate small stones form the gallbladder wall or cystic duct
decubitus
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(n) ______ on the medial aspect of the liver.
fossa
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
fat or 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
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.
oblique
On sagittal scan, the right branch of the hepatic artery usually passes ___ to the common duct.
posterior
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
hepatic
The common duct is seen just ____ to the portal vein before it dips posteriorly to enter the head of the pancreas
anterior
What position should the patient be shifted during ultrasound examination
Patient should be scanned in the left ducubitus, right lateral, or up right position
_____ 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.
choledochal
A hyperplastic change in the gallbladders wall is _______
adenomyomatosis
The differential for a porcelain gallbladder would include a packed bag or ____ sign.
WES
What is the most notable sonographic finding with carcinoma of the gallbladder?
The gallbladder wall is markedly abnormal and thickened
The most common cause of biliary ductal system obstruction is the presence of a(n) _____ or _____ within the ductal system.
tumor, thrombus
Job of the sonographer is to localize the level and cause of the obstruction. List 3 primary area of obstruction
intrapancreatic obstruction, suprapancreatic obstruction, and porta hepatic obstruction
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.
Mirizzi
_______ causes increasing pressure in the biliary tree with pus accumulation
cholangitis
The majority of stones in the common bile have migrated from the gallbladder. Common duct stones are usually associated with _________.
calculous cholecystitis
____ within the 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
