Ch. 3 The Gallbladder Flashcards
1
Q
Where is the gallbladder located in the body?
A
Posterior to the right lobe of the liver within the gallbladder fossa
Useful landmark to locate the gallbladder fossa is the main lobar fissure
2
Q
True of false: Is gallbladder a intraperitoneal organ?
A
True
3
Q
What does the gallbladder store?
A
bile that is produced in the liver
4
Q
What are the 3 layers of the gallbladder?
A
mucosal (innermost layer-consists of multiple folds and rugae)
musculosa (fibromuscular layer)
serosal (outer)
5
Q
What are the 3 parts of the gallbladder (anatomy)?
A
Neck, body, and fundus
6
Q
the neck of the gallbladder is continuous with
A
cystic duct
7
Q
What is the role of the cystic duct of the gallbladder?
A
It connects the gallbladder to the rest of the biliary system
8
Q
What is the function of the biliary tree?
A
provide a conduit for bile to drain from the liver into the small intestine
9
Q
Where in the gallbladder is the most common location for gallstones?
A
Fundus
10
Q
What is the post dependent part of the gallbladder?
A
Fundus
11
Q
What is the hormone that causes the gallbladder to contract?
A
Cholecystokinin
12
Q
What is the name of the most common variant of the gallbladder shape?
A
Phrygian cap (folding of the fundus)
13
Q
The right and left hepatic ducts eventually unite to form the
A
common hepatic duct
14
Q
The point of attachment of the cystic duct to the gallbladder marks the ___ of the CBD.
A
proximal margin
15
Q
Spiral valves of Heister are found where?
A
cystic duct
16
Q
What is the purpose of the spiral valves of Heister?
A
prevent the cystic duct from collapsing or distending
17
Q
What is choleycystokinin produced by?
A
duodenum
18
Q
What is the opening that allows bile and pancreatic juices to flow into the duodenum?
A
sphincter of Oddi
19
Q
liver –> biliary radicles –> right or left hepatic duct –> common hepatic duct –> cystic duct –> gallbladder –> common bile duct –> ampulla of vater –> sphincter of oddi –> duodenum
A
Bile flow
20
Q
The CBD should not exceed ___ and is typically abnormal.
A
6mm
21
Q
For patients older than 60 years who have had a cholecystectomy a max diameter of _____ may be normal.
A
10mm
22
Q
When biliary tree obstruction or disease is suspected, look for an elevation in
A
ALP, ALT, serum bilirubin, GGT, urobilirubin (in additon to amylase and lipase)
23
Q
Intrahepatic ducts are considered dilated if they exceed
A
2mm
24
Q
A gallbladder sonogram should be performed after the patient has had nothing to eat for at least ________ hours.
A
Four to eight
25
What is the normal shape of the gallbladder in sagittal?
Anechoic, pear-shaped structure
26
What is the normal shape of the gallbladder in transverse?
Anechoic circle
27
What is typically the normal size of the gallbladder in length?
8 to 10cm
28
What is typically the normal size of the gallbladder in diameter?
4 to 5 cm
29
What is the proper position of the patient to check for gallbladder motility (most likely for gallstones and how stones move in the gallbladder)?
Supine, left lateral decubitus, prone, upright, and any position needed to demonstrate mobility
30
The gallbladder wall should measure no more than ___ mm.
3 mm
31
The enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis is referred to as
double barrel "shotgun sign" or "parallel tube sign"
32
Coexisting dilation of the common duct and pancreatic duct is referred to as
"double-duct sign"
33
The CBD segment closest to the pancreatic head is considered
most distal segment of the biliary tree
34
Biliary dilation will occur where to the level of obstruction?
proximal
35
Most common level of obstruction to occur is
the distal CBD
36
Most common causes of CBD obstruction are
choledocholithiasis, chronic pancreatitis, acute pancreatitis,
pancreatic carcinoma
37
Obstruction within the bilary tree the patient will eventually suffer from
posthepatic (obstructive) jaundice
38
What is the yellow pigment found in bile?
bilirubin
39
Excessive bilirubin leads to elevated
serum bilirubin
40
What is infant jaundice usually caused by?
inability of the newborn liver to eliminate bilirubin from the bloodstream
41
Gallstones within the bile duct is called
choledocolithiasis
42
What is the most common cause of obstructive jaundice?
gallstones within CBD (most near ampulla of Vater)
43
are some sources of gallbladder wall ____
1. Postprandial
2. Acute cholecystitis
3. Chronic cholecystitis
4. Adenomyomatosis
5. Hypoalbuminemia
diffuse thickening
44
are the sources of ____ gallbladder wall thickening
1. Gallbladder polyp
2. Adenomyomatosis
3. Gallbladder carcinoma
4. Adhered gallstones
focal
45
the main causes of _____of the gallbladder
Cholecystectomy, gallbladder filled with stones (WES sign), postprandial, ectopic location, hepatization of the gallbladder
nonvisualization
46
ALT, ALP, and bilirubin may be most beneficial for determining evidence of _____ and ____.
gallbladder and bile duct disease.
47
the main causes of ____ of the gallbladder
Cholecystectomy, gallbladder filled with stones (WES sign), postprandial, ectopic location, hepatization of the gallbladder
nonvisualization
48
What is the medical term for gallstones?
cholelithiasis
49
What are gallstones typically consists of?
1. Cholesterol
2. Calcium bilirubinate
3. Calcium carbonate
50
True of False: gallstones are more common in male than females.
False. Gallstones are more common in females.
51
What are the six "F's" of cholelithiasis?
Female, Fat, Forty, Fertile, Fair, Flatulent
52
clinical findings of ____
1. Asymptomatic
2. Biliary colic
3. Abdominal pain after fatty meals
4. Epigastric pain
5. Nausea and vomiting
6. Pain that radiates to the shoulders
cholelithiasis
53
sonographic findings of _____
1. Echogenic, mobile, shadowing structure within the lumen of the gallbladder
2. Stones that lodge within the cystic duct or neck of the gallbladder may not move
3. WES sign may be present
cholelithiasis
54
The ________ artifact can be used to identify gallstones
Twinkle artifact
55
Sludge in the gallbladder is most often associated with?
Biliary stasis
56
What are the clinical symptoms of gallbladder sludge?
1. Asymptomatic
2. Any reason for biliary stasis (ex: total parenteral nutrition, extended period of fasting)
57
What are the sonographic findings of gallbladder sludge?
A collection of low-level, nonshadowing, dependent echoes within the gallbladder lumen
58
When sludge is visualized, the sonographer should closely evaluate the gallbladder for signs of _______ _________ and other possible sonographic markers of cholecystitis.
Small gallstones
59
A condition in the gallbladder where it shows a projection of tissue of its wall that protrudes into the lumen of the gallbladder
Gallbladder polyp
60
They tend to be small, measures less than 10mm and are the result of an accumulation of cholesterol and triglycerides within the gallbladder.
Cholesterol polyps
61
sonographic findings of ____
Hyperechoic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen
gallbladder polyps
62
A condition that results from the disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the gallbladder wall: may be diffused and referred to as a strawberry gallbladder
Cholesterolosis
63
A group of proliferative and degenerative disorders which includes both Adenomyomatosis and cholesterolosis
Hyperplastic cholecystosis
64
The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with
Cholesterolosis
65
What is the "the dissemination of glands within a muscle" of the gallbladder called?
Adenomyomatosis
66
Tiny pockets within the gallbladder wall
Rokitansky-Aschoff sinuses
67
Rokitansky-Aschoff is associated with?
Adenomyomatosis
68
What type of artifact is associated with Adenomyomatosis?
Comet tail artifact
69
the sonographic findings of ____
1. focal or diffuse thickening of the GB wall
2. comet tail artifact that projects from the GB wall into the lumen of the GB
adenomyomatosis
70
The sudden onset of gallbladder inflammation is referred to as
acute cholecystitis
71
What is the most common cause of acute cholecystitis?
A gallstone that has become lodged in the cystic duct or neck of the gallbladder
72
An elevated white blood cell count
leukocytosis
73
True of False: Leukocytosis often associated with acute cholecystitis
True
74
pain directly over the gallbladder with applied probe pressure is termed...
Murphy sign
75
When acute cholecystitis is suspected, what should the sonographer do?
closely evaluate the GB for the progression of the disease to gangrenous cholecystitis, GB perforation, and other sequela.
76
clinical findings of _____
1. Right upper quadrant tenderness
2. Epigastric or abdominal pain
3. Leukocytosis
4. Possible elevation in ALP, ALT, GGT, and bilirubin
5. Fever
6. Pain that radiates to the shoulders
7. Nausea and vomiting
8. Jaundice may be present if there is obstruction of the bile ducts
acute cholecystitis
77
sonographic findings of _____
1. Gallstones
2. Positive sonographic Murphy sign
3. Gallbladder wall thickening
4. Gallbladder enlargement
5. Pericholecystic fluid
6. Sludge
acute cholecystitis
78
__________ ___________ can be a direct evolution of acute cholecystitis.
Gangrenous cholecystitis
79
Complication of acute cholecystitis characterized by pus accumulation within the gallbladder
suppurative cholecystitis
80
the clinical findings of _______
1. Right upper quadrant pain
2. Epigastric or abdominal pain
3. Leukocytosis
4. Possible elavation in ALP, ALT, GGT, and bilirubin
5. Fever
6. Pain that radiates to the shoulder
7. Nausea and vomiting
gangrenous cholecystitis of gallbladder perforation
81
the sonographic findings of ______
1. Gallstones
2. Loss of the sonographic Murphy sign
3. Gallbladder wall thickening with a possible perceptible wall tear
4. Focal wall necrosis, bulges of the gallbladder wall, sloughed membranes, and ulcerative craters
5. Gallbladder loses its typically shape
6. Pericholecystic fluid
7. Sludge
gangrenous cholecystitis and gallbladder perforation
82
This condition is most often discovered in diabetic patients. It is a form of acute cholecystitis that is caused by gas-forming infection invading the gallbladder lumen, wall, or both.
Emphysematous cholecystitis
83
The effect of dirty shadowing, reverberation, or ring down artifact caused by gas or gas bubbles produced by bacteria within the nondependent gallbladder wall
champagne sign
84
the sonographic findings of ____
1. Dirty shadowing reverberation or ring down artifact coming from the gallbladder wall or lumen
2. Champagne sign (gas bubbles within the gb wall)
emphysematous cholecystitis
85
the clinical findings of _____
1. Diabetic patient
2. Right upper quadrant pain, possibly without Murphy sign
3. Fever
4. Can progress to sepsis
emphysematous cholecystitis
86
This condition results from the intermittent obstruction of the cystic duct by gallstones, resulting in multiple bouts of acute cholecystitis
Chronic cholecystitis
87
the clinical findings of _____
1. Intolerabce to fatty foods because of subsequent abdominal pain
2. Nontender gallbladder
chronic cholecystitis
88
the sonographic findings of_____
1. Contracted gallbladder
3. WES sign
3. Gallstones
4. Wall thickening
chronic cholecystitis
89
This condition presents with all the symptoms and sonographic finings of cholecystitis except no gallstones are present.
Acalculous cholecystitis
90
This form of acute cholecystitis is more commonly found in children, recent hospitalized patients, or those who are immunocompromised
Acalculous cholecystitis
91
the sonographic findings of _____
1. Positive sonographic Murphy sign
2. Gallbladder wall thickening
3. Pericholecystic fluid
4. Sludge
acalculous cholecystitis
92
An enlarged gallbladder;also referred to as mucocele of the gallbladder
Hydropic gallbladder
93
The clinical detection of an enlarged palpable gallbladder caused by a biliary obstruction in the area of the pancreatic head
Courvoisier gallbladder
94
the clinical findings of _____
1. Palpable gallbladder
2. Could suffer from painless jaundice (Courvoisier gallbladder)
3. Possible elevation in ALP, ALT, GGT, and bilirubin
gallbladder enlargement
95
the sonographic findings of _____
1. Gallbladder measures >4 to 5cm in diameter or >8-10cm in length
2. Search for obstructive entities such as choledocholithiasis or pancreatic mass
gallbladder enlargement
96
Calcification of the gallbladder wall is termed
Porcelain gallbladder
97
What is the difference between a porcelain gallbladder and WES sign?
With WES sign, the posterior wall is typically obscured by the shadowing gallstones within the gallbladder.
Many times the posterior wall will be seen with porcelain gallbladder
98
the sonographic findings of _____
1. Calcification of the gallbladder
2. The identification of the calcified posterior wall of the gallbladder is helpful to differentiate porcelain gallbladder from WES sign
3. Signs of chronic cholecystitis and gallstones may be present
porcelain gallbladder
99
This pathology is thought to be caused by chronic irritation of the gallbladder wall by gallstones
Gallbladder carcinoma
100
the clinical findings of _____
1. Weight loss
2. Right upper quadrant pain
3. Jaundice
4. Nausea and vomiting
5. Hepatomegaly
6. Possible elevation in ALP, ALT, GGT, and bilirubin
gallbladder carcinoma
101
the sonographic findings of _____
1. Nonmobile mass within the gallbladder lumen that measures >1cm
2. Diffuse or focal gallbladder wall thickening
3. Irregular mass that may completely fill the gallbladder fossa
4. Invasion of the mass into surrounding liver tissue
5. color doppler can reveal vessels in malignancy
gallbladder carcinoma
102
the clinical findings of ______
1. Right upper quadrant tenderness
2. Epigastric or abdominal pain
3. Leukocytosis
acalculous cholecystitis
103
Direct Blood supply to the GB is the:
cystic artery
104
The cystic artery is most often a direct branch of the:
right hepatic artery
105
Which of the following is associated with cholelithiasis and is characteristically found in African or people of African descent?
a. sickle cell disease
b. gallbladder torsion
c. cholesterolosis
d. arland-berlin syndrome
a. sickle cell disease
106
Which of the following is a condition associated with vasculitis and gallbladder hydrops?
a. Kawasaki disease
b. beckwith-wiedemann syndrome
c. sickle cell disease
d. multiple hepatic hemangiomas
a. kawasaki disease
107
unconjugated bilirubin may also be referred to as _____
indirect bilirubin
108
Which of the following would be most likely associated with gallstones or biliary tree obstruction?
a.elevated direct bilirubin
b. elevated indirect bilirubin
c. decreased conjugated bilirubin
d. decreased unconjugated bilirubin
a. elevated direct bilirubin (conjugated bilirubin)
109
Which of the following is a rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells?
a. GB perferoration
b. adenomyomatosis
c. xanthogranulomatous cholecystitis
d. emphysematous cholecystitis
c. xanthogranulomatous cholecystitis
