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Penny abdomen > Ch. 3 The Gallbladder > Flashcards

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

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2
Q

True of false: Is gallbladder a intraperitoneal organ?

A

True

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3
Q

What does the gallbladder store?

A

bile that is produced in the liver

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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)

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5
Q

What are the 3 parts of the gallbladder (anatomy)?

A

Neck, body, and fundus

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6
Q

the neck of the gallbladder is continuous with

A

cystic duct

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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

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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

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9
Q

Where in the gallbladder is the most common location for gallstones?

A

Fundus

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10
Q

What is the post dependent part of the gallbladder?

A

Fundus

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11
Q

What is the hormone that causes the bladder to contract?

A

Cholecystokinin

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12
Q

What is the name of the most common variant of the gallbladder shape?

A

Phrygian cap (folding of the fundus)

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13
Q

The right and left hepatic ducts eventually unite to form the

A

common hepatic duct

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14
Q

The point of attachment of the cystic duct to the gallbladder marks the ___ of the CBD.

A

proximal margin

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15
Q

Spiral valves of Heister are found where?

A

cystic duct

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16
Q

What is the purpose of the spiral valves of Heister?

A

prevent the cystic duct from collapsing or distending

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17
Q

What is choleycystokinin produced by?

A

duodenum

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18
Q

What is the opening that allows bile and pancreatic juices to flow into the duodenum?

A

sphincter of Oddi

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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

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20
Q

The CBD should not exceed ___ and is typically abnormal.

A

6mm

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21
Q

For patients older than 60 years who have had a cholecystectomy a max diameter of _____ may be normal.

A

10mm

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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)

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23
Q

Intrahepatic ducts are considered dilated if they exceed

A

2mm

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24
Q

A gallbladder sonogram should be performed after the patient has had nothing to eat for at least ________ hours.

A

Four to eight

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25
Q

What is the normal shape of the gallbladder in sagittal?

A

Anechoic, pear-shaped structure

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26
Q

What is the normal shape of the gallbladder in transverse?

A

Anechoic circle

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27
Q

What is typically the normal size of the gallbladder in length?

A

8 to 10cm

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28
Q

What is typically the normal size of the gallbladder in diameter?

A

4 to 5 cm

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29
Q

What is the proper position of the patient to check for gallbladder motility (most likely for gallstones and how stones move in the gallbladder)?

A

Supine, left lateral decubitus, prone, upright, and any position needed to demonstrate mobility

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30
Q

The gallbladder wall should measure no more than ___ mm.

A

3 mm

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31
Q

The enlargement of the common duct to the size of the adjacent portal vein within the porta hepatis is referred to as

A

double barrel “shotgun sign” or “parallel tube sign”

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32
Q

Coexisting dilation of the common duct and pancreatic duct is referred to as

A

“double-duct sign”

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33
Q

The CBD segment closest to the pancreatic head is considered

A

most distal segment of the biliary tree

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34
Q

Biliary dilation will occur where to the level of obstruction?

A

proximal

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35
Q

Most common level of obstruction to occur is

A

the distal CBD

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36
Q

Most common causes of CBD obstruction are

A

choledocholithiasis, chronic pancreatitis, acute pancreatitis,
pancreatic carcinoma

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37
Q

Obstruction within the bilary tree the patient will eventually suffer from

A

posthepatic (obstructive) jaundice

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38
Q

What is the yellow pigment found in bile?

A

bilirubin

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39
Q

Excessive bilirubin leads to elevated

A

serum bilirubin

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40
Q

What is infant jaundice usually caused by?

A

inability of the newborn liver to eliminate bilirubin from the bloodstream

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41
Q

Gallstones within the bile duct is called

A

choledocolithiasis

42
Q

What is the most common cause of obstructive jaundice?

A

gallstones within CBD (most near ampulla of Vater)

43
Q

are some sources of gallbladder wall ____
1. Postprandial
2. Acute cholecystitis
3. Chronic cholecystitis
4. Adenomyomatosis
5. Hypoalbuminemia

A

diffuse thickening

44
Q

are the sources of ____ gallbladder wall thickening
1. Gallbladder polyp
2. Adenomyomatosis
3. Gallbladder carcinoma
4. Adhered gallstones

A

focal

45
Q

the main causes of _____of the gallbladder
Cholecystectomy, gallbladder filled with stones (WES sign), postprandial, ectopic location, hepatization of the gallbladder

A

nonvisualization

46
Q

ALT, ALP, and bilirubin may be most beneficial for determining evidence of _____ and ____.

A

gallbladder and bile duct disease.

47
Q

the main causes of ____ of the gallbladder
Cholecystectomy, gallbladder filled with stones (WES sign), postprandial, ectopic location, hepatization of the gallbladder

A

nonvisualization

48
Q

What is the medical term for gallstones?

A

cholelithiasis

49
Q

What are gallstones typically consists of?

A
  1. Cholesterol
  2. Calcium bilirubinate
  3. Calcium carbonate
50
Q

True of False: gallstones are more common in male than females.

A

False. Gallstones are more common in females.

51
Q

What are the six “F’s” of cholecystitis?

A

Female, Fat, Forty, Fertile, Fair, Flatulent

52
Q

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

A

cholelithiasis

53
Q

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

A

cholelithiasis

54
Q

The ________ artifact can be used to identify gallstones

A

Twinkle artifact

55
Q

Sludge in the gallbladder is most often associated with?

A

Biliary stasis

56
Q

What are the clinical symptoms of gallbladder sludge?

A
  1. Asymptomatic
  2. Any reason for biliary stasis (ex: total parenteral nutrition, extended period of fasting)
57
Q

What are the sonographic findings of gallbladder sludge?

A

A collection of low-level, nonshadowing, dependent echoes within the gallbladder lumen

58
Q

When sludge is visualized, the sonographer should closely evaluate the gallbladder for signs of _______ _________ and other possible sonographic markers of cholecystitis.

A

Small gallstones

59
Q

A condition in the gallbladder where it shows a projection of tissue of its wall that protrudes into the lumen of the gallbladder

A

Gallbladder polyp

60
Q

They tend to be small, measures less than 10mm and are the result of an accumulation of cholesterol and triglycerides within the gallbladder.

A

Cholesterol polyps

61
Q

sonographic findings of ____
Hyperechoic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen

A

gallbladder polyps

62
Q

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

A

Cholesterolosis

63
Q

A group of proliferative and degenerative disorders which includes both Adenomyomatosis and cholesterolosis

A

Hyperplastic cholecystosis

64
Q

The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with

A

Cholesterolosis

65
Q

What is the “condition of glands within a muscle” of the gallbladder called?

A

Adenomyomatosis

66
Q

Tiny pockets within the gallbladder wall

A

Rokitansky-Aschoff sinuses

67
Q

Rokitansky-Aschoff is associated with?

A

Adenomyomatosis

68
Q

What type of artifact is associated with Adenomyomatosis?

A

Comet tail artifact

69
Q

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

A

adenomyomatosis

70
Q

The sudden onset of gallbladder inflammation is referred to as

A

acute cholecystitis

71
Q

What is the most common cause of acute cholecystitis?

A

A gallstone that has become lodged in the cystic duct or neck of the gallbladder

72
Q

An elevated white blood cell count

A

leukocytosis

73
Q

True of False: Leukocytosis often associated with acute cholecystitis

A

True

74
Q

pain directly over the gallbladder with applied probe pressure is termed…

A

Murphy sign

75
Q

When acute cholecystitis is suspected, what should the sonographer do?

A

When acute cholecystitis is suspected, what should the sonographer do?

76
Q

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

A

acute cholecystitis

77
Q

sonographic findings of _____
1. Gallstones
2. Positive sonographic Murphy sign
3. Gallbladder wall thickening
4. Gallbladder enlargement
5. Pericholecystic fluid
6. Sludge

A

acute cholecystitis

78
Q

__________ ___________ can be a direct evolution of acute cholecystitis.

A

Gangrenous cholecystitis

79
Q

Complication of acute cholecystitis characterized by pus accumulation within the gallbladder

A

suppurative cholecystitis

80
Q

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

A

gangrenous cholecystitis of gallbladder perforation

81
Q

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

A

gangrenous cholecystitis and gallbladder perforation

82
Q

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.

A

Emphysematous cholecystitis

83
Q

The effect of dirty shadowing, reverberation, or ring down artifact caused by gas or gas bubbles produced by bacteria within the nondependent gallbladder wall

A

champagne sign

84
Q

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)

A

emphysematous cholecystitis

85
Q

the clinical findings of _____
1. Diabetic patient
2. Right upper quadrant pain, possibly without Murphy sign
3. Fever
4. Can progress to sepsis

A

emphysematous cholecystitis

86
Q

This condition results from the intermittent obstruction of the cystic duct by gallstones, resulting in multiple bouts of acute cholecystitis

A

Chronic cholecystitis

87
Q

the clinical findings of _____
1. Intolerabce to fatty foods because of subsequent abdominal pain
2. Nontender gallbladder

A

chronic cholecystitis

88
Q

the sonographic findings of_____
1. Contracted gallbladder
3. WES sign
3. Gallstones
4. Wall thickening

A

chronic cholecystitis

89
Q

Thus condition presents with all the symptoms of sonographic finings of cholecystitis except no gallstones are present.

A

Acalculous cholecystitis

90
Q

This form of acute cholecystitis is more commonly found in children, recent hospitalized patients, or those who are immunocompromised

A

Acalculous cholecystitis

91
Q

the sonographic findings of _____
1. Positive sonographic Murphy sign
2. Gallbladder wall thickening
3. Pericholecystic fluid
4. Sludge

A

acalculous cholecystitis

92
Q

An enlarged gallbladder;also referred to as mucocele of the gallbladder

A

Hydropic gallbladder

93
Q

The clinical detection of an enlarged palpable gallbladder caused by a biliary obstruction in the area of the pancreatic head

A

Courvoisier gallbladder

94
Q

the clinical findings of _____
1. Palpable gallbladder
2. Could suffer from painless jaundice (Courvoisier gallbladder)
3. Possible elevation in ALP, ALT, GGT, and bilirubin

A

gallbladder enlargement

95
Q

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

A

gallbladder enlargement

96
Q

Calcification of the gallbladder wall is termed

A

Porcelain gallbladder

97
Q

What is the difference between a porcelain gallbladder and WES sign?

A

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
Q

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

A

porcelain gallbladder

99
Q

This pathology is thought to be caused by chronic irritation of the gallbladder wall by gallstones

A

Gallbladder carcinoma

100
Q

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

A

gallbladder carcinoma

101
Q

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

A

gallbladder carcinoma

102
Q

the clinical findings of ______
1. Right upper quadrant tenderness
2. Epigastric or abdominal pain
3. Leukocytosis

A

acalculous cholecystitis

Penny abdomen (4 decks)

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