Chapter 11 Gallbladder Flashcards
Extends from the point where the common hepatic duct meets meet the cystic duct; drains into the duodenum after it joins with the pain pancreatic duct
common bile duct
Storage pouch for bile
gallbladder
Small opening in the duodenum in which the pancreatic and common bile duct enter to release secreations
ampulla of Vater
Massive enlargement of the gallbladder
hydrops
Tiny valves found within the cystic duct
Heister’s valve
Refers to common bile and hepatic ducts when cystic duct is not seen
common duct
Connects the gallbladder to the common hepatic duct
cystic duct
Central area of the liver where the portal vein, common duct, and hepatic artery enter
porta hepatis
Small part of the gallbladder that lies near the cystic duct where stones may collect
Hartmann’s pouch
Travels horizontally through the pancreas to join the common bile duct at the ampulla of Vater
pancreatic duct
Small muscle that guards the ampulla of Vater
sphincter of Oddi
Yellow pigment in bile formed by the breakdown of red blood cells
bilirubin
Removal of gallbladder
cholecystectomy
Gallbladder variant in which part of the fundus is bent back on itself
phrygian cap
Bile duct system that drains the liver into the common bile duct
common hepatic duct
Gallstones in the gallbladder
cholelithiasis
Calcification of the gallbladder wall
porcelain gallbladder
Inflammation of the bile duct
cholangitis
Excessive bilirubin accumulation causes yellow pigmentation of skin; first seen in the whites of the eyes
jaundice
Small polypoid projections from the gallbladder wall
adenomyomatosis
Sonographic pattern found when the gallbladder is packed with stones
wall echo shadow (WES) sign
Cancer at the bifurcation of the hepatic ducts; may cause asymmetrical obstruction of the biliary tree
Klatskin’s tumor
Low level echos found along the posterior margin of the gallbladder; move with change in position
Sludge
Hormone secreted into the blod by the mucosa of the upper small intestine; stimulates contraction of the gallbladder and pancreatic secretion of enzymes
cholecystokinin
Variant of adenomyomatosis; cholesterol polyps
cholesterolosis
Inflammation of the gallbladder; may be acute or chronic
cholecystitis
Cystic growth on the common duct that may cause obstruction
choledochal cyst
Small septum within the gallbladder, usually arising from the posterior wall
junctional fold
Small, well-defined soft tissue projection from the gallbladder wall
polyp
Stones in the bile duct
choledocholithiasis
Positive sign implies exquisite tenderness over the area of the gallbladder upon palpation
Murphy’s sign
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 to form the ________________.
common bile duct
The main pancreatic duct joins the commone 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 know 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 functions of the extrahepatic biliary tract.
Transportation of bile from liver to intestine
Regulation of it’s flow
Describe the normal function of the gallbladder during digestion.
When gallbladder and bile ducts are functioning normally, they respond in a fairly uniform manner during various phases of digestion. Concentration of bile in the gallbladder occurs during a state of fasting. Stimulation produced by the influence of food causes the gallbladder to contract, resulting in an outpouring of bile into the duodenum.
Bile is the principal medium for excretion of bilirubin ______________.
cholesterol
The ______________ from the small intestine stimulate the liver to make more 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 _________________.
Courvoisers sign
Sonographically, the common duct lies ____________ and to the _______________ of the portal vein in the region of the porta hepatis and gastrhepatic 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.
4-6 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 an attempt to separate small stones from 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 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
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.
Micky Mouse
To obtain a cross section of the portal triad, the transducer must be directed in a slightly ___________ path from the left shoulder to right hip.
Oblique
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 is 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 food.
right upper quadrant
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, fever, leukocytosis
The ______ sign is 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 into the bilary ducts is called ___________________.
emphysematous cholecystitis
Clinically the patient falls under five “F’s”
Fat, female, forty, fertile, fair
Explain why the patient’s position should be shifted during the ultrasound examination
To see if stones move and to get a better view of stones.
Describe factors that produce a shadow in the gallbladder.
acoustic impedance of the gallstones; refraction through them or diffraction around them; their size, central or peripheral location, and position in relation to focus of beam & intensity of beam.
_________________ may be the result of pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormaility, weakness, and outpouching of ductal walls.
choledochal cysts
A hyperplastic change in gallbladder 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?
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
The job of the sonographer is to localize the level and cause of the obstruction. List the three primary areas where the obstruction occurs.
Intrapancreatic, suprapancreatic and porta hepatic
An uncommon cause for extrahepatic biliary obstruction as a result 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 duct 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
