Chapter 11 GB and Biliary System Flashcards
1
Q
Small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions
A
Ampulla of Vater
2
Q
Yellow pigment in bile formed by the breakdown of RBC’s
A
bilirubin
3
Q
Removal of the GB
A
cholecystectomy
4
Q
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
A
CBD- common bile duct
5
Q
Refers to the common bile and hepatic ducts when the cystic duct is not seen
A
common duct
6
Q
Bile duct system that drains the liver into the common bile duct
A
common hepatic duct
7
Q
Connects the GB to the common hepatic duct
A
cystic duct
8
Q
Storage pouch for bile
A
gallbladder
9
Q
Small part of the GB that lies near the cystic duct where stones may collect
A
Hartmann’s pouch
10
Q
Tiny valves found within the cystic duct
A
Heister’s valve
11
Q
Massive enlargement of the GB
A
hydrops
12
Q
Travels horizontally through the pancreas to join the CBD at the ampulla of Vater
A
pancreatic duct
13
Q
GB variant in which part of the fundus is bent back on itself
A
phrygian cap
14
Q
Central area of the liver where the portal vein, common duct, and hepatic artery enter.
A
porta hepatis
15
Q
Small muscle that guards the ampulla of Vater
A
sphincter of Oddi
16
Q
Small polypoid projections from the GB wall
A
adenomyomatosis
17
Q
Inflammation of the bile duct
A
cholangitis
18
Q
Inflammation of the GB; may be acute or chronic
A
cholecystitis
19
Q
Hormone secreted into the blood by the mucosa of the upper small intestine; stimulates contraction of the GB and pancreatic secretion of enzymes
A
cholecystokinin
20
Q
Cystic growth on the common duct that may cause obstruction
A
choledochal cyst
21
Q
Stones in the bile duct
A
choledocholithiasis
22
Q
Gallstones in the GB
A
cholelithiasis
23
Q
Variant of adenomyomatosis; cholesterol polyps
A
cholesterolosis
24
Q
Excessive bilirubin accumulation causing yellow pigmentation of the skin; first seen in the whites of the eyes
A
jaundice
25
Small septum within the GB, usually arising from the posterior wall
junctional fold
26
Cancer at the bifurcation of the hepatic ducts; may cause asymmetrical obstruction of the biliary tree
Klatskin's tumor
27
Positive sign implies exquisite tenderness over the area of the GB upon palpitation
Murphy's sign
28
Small, well defined soft tissue projection from the GB wall
polyp
29
Calcification of the GB wall
porcelain GB
30
Low level echoes found along the posterior margin of the GB; moves with change in position
sludge
31
Sonographic pattern found when the GB is packed with stones
wall echo shadow (WES sign)
32
The GB serves as a reservoir for ___ that is drained form the hepatic ducts in the liver.
bile
33
The common hepatic duct is joined by the cystic duct to form the ___.
CBD- common bile duct
34
The main pancreatic duct joins the CBD, and together they open through a small ampulla call the ___ into the duodenal wall.
ampulla of Vater
35
The end parts of the CBD and main pancreatic duct and the ampulla of Vater are surrounded by circular muscle fibers known as ___.
sphincter of Oddi
36
The arterial supply of the GB is from the ___ artery, which is a branch of the right hepatic artery.
cystic
37
List the 2 primary functions of the extrahepatic biliary tract.
To take bile from the liver to intestine and regulates flow.
38
Describe the normal function of the GB during digestion.
Bile concentrates during fasting. Very little is sent to duodenum when fasting. Food stimulates the sphincter of Oddi to open and the GB to contract, releasing bile to the duodenum for digestion.
39
Bile is the principal medium for excretion of bilirubin ___.
cholesterol
40
The ___ from the small intestine stimulate the liver to make more bile. This activates intestinal and pancreatic enzymes.
bile salts
41
The sign that indicates an extrahepatic mass compressing the CBD, which can produce an enlarged GB, is called _____.
Courvoisier's sign
42
Sonographically, the CBD lies ___ and to the ___ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.
anterior; right
43
The hepatic artery lies ___ and to the ___ of the portal vein.
anterior; left
44
To ensure maximn dilation of the GB, the patient should not be given anything to eat for at least ___ hours before a sono.
8-12
45
The patient is initially in full ___ with ultrasound.
respiration
46
The patient should also be rolled into a deep ____ or upright position (to ensure there are no stones in the GB) in an attempt to separate small stones from the GB wall or cystic duct.
decubitus
47
The GB may be described as a ___ oblong structure located anterior to the right kidney, lateral to the head of the pancreas and duodenum.
sonolucent
48
The GB commonly resides in a ___ on the medial aspect of the liver.
fossa
49
Because of ____ tissue within the main lobar fissure of the liver (which lies between the GB and the right portal vein), this bright linear reflector is a reliable indicator of the location of the GB.
fat or fibrous tissue
50
A small ____ fold has been reported to occur along the posterior wall of the GB at the junction of the body and infundibulum.
echogenic
51
On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _____ sign.
Mickey Mouse
52
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
53
On sagittal scans, the the right branch of the hepatic artery usually passes ___ to the common duct.
posterior
54
The common duct is seen just ___ to the portal vein before it dips posteriorly to enter the head of the pancreas.
anterior
55
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
56
The most classic symptom of GB disease is ___ pain, usually occurring after ingestion of greasy foods.
RUQ
57
A GB attack may cause pain in the ___ shoulder.
right
58
The normal wall thickness of the GB is less than ____cm.
3
59
List the 6 biliary causes of GB wall thickening.
cholecystitis, adenomyomatosis, cancer, AIDS, cholangiopathy, sclerosing cholangitis
60
Clinically the patient with acute cholecystitis presents with what symptoms?
acute RUQ pain, positive Murphy's sign, inspiritory arrest upon palpitation of GB (which may be false positive in a small percentage) fever, leukocytosis
61
The ____ sign is described as a contracted bright GB with posterior shadowing caused by a packed bag of stones.
WES- wall echo shadow
62
A fairly rare complication of acute cholecystitis associated with the presence of gas forming bacteria in the GB wall and lumen with extension into the biliary ducts is called ____.
emphysematous cholecystitis
63
For gallstones, clinically the patient falls under the five F's which are:
fat, forty, fertile, fair, female
64
Explain why the patient's position should be altered during an ultrasound.
To demonstrate movement of stones. Patients can be scanned LLD, right lateral, or upright. Stones should shift to the most dependent areas of the GB. If bile is thick and stones float, the density of the stones and posterior shadow will provide evidence.
65
Describe the factors that can produce a shadow in the GB.
acoustic impedence of gall stones, refraction through them and diffraction around them, their size, central or peripheral location, position in relation to the beam or intensity of the beam.
66
_____ may be the result of pancreatic juices refluxing into the bile duct because of an anomolous junction of the pancreatic duct into the distal common bile duct,causing duct wall abnormality, weakness, and outpouching of the ductal walls.
Choledochal cysts
67
A hyperplastic change in the GB wall is ___.
adenomyomatosis
68
The differential for a porcelain GB would include a packed bag or _____.
WES sign- wall echo shadow
69
What is the most notable finding in GB carcinoma?
GB wall is markedly abnormal and thickened
70
The most common cause of biliary obstruction is the presence of a ____ or ___ within the ductal system.
tumor; thrombus
71
List three primary areas where obstruction occurs.
intrahepatic, suprapancreatic, or porta hepatic obstructions
72
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 ______.
Mirrizzi syndrome
73
____ causes increasing pressure in the biliary tree with pus accumulation.
Cholangitis
74
The majority of stones in the CBD have migrated from the GB. Common duct stones are ususally associated with ____.
calculous cholecystitis
75
____ within the duodenum may also give rise to a dirty shadow in the RUQ.
Air or gas
76
On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in _____.
Caroli's disease
77
What maneuvers can be performed to differentiate a tumor of the GB from sludge?
change patient position
78
Describe clinical signs and sono findings of the patient with acute cholecystitis? Complications?
Symptoms- RUQ pain, fever. Findings include- enlarged GB, positive Murphy sign, thick and irregular GB, stones, pericholecystic fluid. Complications- GB rupture, empyema, emphasematous or gangrenous cholecystitis, perforation
79
What anechoic structure surrounds the GB that may lead to confusion during the exam?
duodenum filled with fluid
