Chapter 11 - The Gallbladder and the BIliary System Fill In The Blanks Flashcards
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 form 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 _______________) 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 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 the two primary functions of the extrahepatic biliary tract.
- transportation of bile from the liver to the intestines
2. regulation of its flow
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 _______________.
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
To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for a least _______________ hours before the ultrasound examination.
8 to 12
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 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 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 occuring after ingestion of greasy foods.
RUQ
A gallbladder attack may cause pain in the _______________ shoulder.
right
The normal wall thickness of the gallbladder is less than _______________ mm.
3
List the six biliary causes of gallbladder wall thickening.
- cholecystitis
- adenomyomatosis
- cancer
- acquired immunodeficiency syndrome
- cholangiopathy
- sclerosing cholangitis
Clinically the patient with acute cholecystitis presents with these symptoms.
acute RUQ pain, positive Murphy’s sign, fever, and leukocytosis (increased white blood cell count)
The ________________ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.
WES (wall echo shadow) sign
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 biliary ducts is called ________________.
emphysematous cholecystitis
Clinically the patient falls under the five “F”s.
fat, forty, female, fertile, fair
Explain why the patient’s position should be shifted during ultrasound examination.
To demonstrate the movement of stones
Describe the factors that produce a shadow in the gallbladder.
acoustic impedance of gallstones; refraction through them or around them; their size, centra, or peripheral location, and position in relation to the focus of the beam; intensity of the beam
_______________ may be the result of the 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 abnormality, weakness, and outpouching of the ductal walls.
choledochal cycts
A hyperplastic change in the gallbladder wall is _______________.
adenomyomatosis
The differential for a porcelain gallbladder would include a packed bag or _______________ sign.
WES (wall echo shadow)
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 or thrombus
The job of the sonographer is to localize the level and cause of the obstruction. List the three primary areas where obstruction occurs.
- intrapancreatic obstruction
- suprapancreatic obstruction
- porta hepatis obstruction
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
What maneuvers may be performed to be sure the sludge in the gallbladder is not a tumor?
Change the patient’s position to see if the sludge moves.
The majority of the stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______________.
calculous cholecysitis
_______________ 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
