Chapter 13- Gallbladder Flashcards
What structures are part of the Biliary System
Gallbladder and bile ducts.
The gallbladder is located in the gallbladder fossa. Where in the liver is this located?
The posterior inferior portion of the Right Lobe of the Liver
The neck of the gallbladder does not change position. What is the name for this?
Fixed Position.
What is the function of the Gallbladder?
It is a reservoir for storing bile.
The gallbladder has a fixed anatomic relationship to what 2 structures?
Main Lobar Fissure and Portal Vein
What is the function of the liver?
Hepatocytes in the liver produce bile
What is the function of the bile ducts?
They drain the liver of bile and empties into the duodenum
List 3 of the compounds that make up bile
Bile Salts, Water,, Billirubin
Bile Salts are the most important component of bile. What do they do?
They break down fats during digestion.
Does the gallbladder look the same in every patient?
No, size and shape vary greatly.
What is the normal sonographic appearance of the gallbladder
anechoic with echogenic walls
What is the inner layer of the gallbladder called?
Mucosa
What is the middle layer of the gallbladder called?
Fibromuscular
What is the outer layer of the gallbladder called?
Serous
Inside the gallbladder, there are many small, inward folds. What are these folds called?
Rugae
What is the purpose of Rugae?
they increase the surface area to aid in concentrating bile through the absorption of water and secretion of mucous
What ducts converge to form the common hepatic duct
The R and L hepatic ducts
The gallbladder neck tapers at one end to form what structure?
The cystic duct
The cystic duct joins with the common hepatic duct. what does this union form?
The Common Bile Duct
The common bile duct and main pancreatic duct join to form the…?
Ampulla of Vater
The ampulla of vater empties through the duodenal papilla. What structure controls this?
The Sphincter of Oddi
What is the muscle that controls the flow of pancreatic juices and bile into the duodenum?
The sphincter of Oddi
What do the Valves of Heister do?
They are spiral folds that control bile flow in the cystic duct. They prevent the cystic duct from over distending or collapsing.
Do the Valves of Heister actually contain valves?
No.
Which 3 structures produce, transport, and then store the bile?
The liver produces bile, it is carried by the biliary ducts to the gallbladder where it is stored.
When bile is released, it is transported through the Ampulla of Vater. Where does it go?
The duodenum.
What happens when the sphincter of Oddi is closed?
The gallbladder is forced to fill with bile.
When we eat, what peptic hormone is released by the duodenum?
Cholecystokinin (CCK)
What does Cholecystokinin (CCK) do?
CCK stimulates the gallbladder to contract and tells the sphincter to relax. This allows bile into the duodenum.
How thick should the gallbladder wall be?
3 mm or less.
What should the diameter of the Right, Left, and Common Hepatic Ducts be?
0.1-0.2 cm
What should the diameter of the Common Bile Duct be?
0.1-0.7 cm
What should the diameter of the Cystic Duct be?
0.1-0.4
How long should the normal gallbladder be?
8-12 cm long
When is a gallbladder considered Hydropic?
When it is enlarged: measuring more than 5 cm in a transverse plane.
Describe a Phrygian Cap. What percent of patients have one?
A normal variant of the gallbladder
when the fundus is folded onto the body. It is found in 1-6% of patients.
Describe a Junctional Fold and what it may be confused with on ultrasound.
A fold anywhere in the gallbladder wall. It could be confused with polyps or calculi and cause high-amplitude echos.
What is Hartmanns Pouch
A small sac that may be seen in the area of the gallbladder neck
Describe a floating gallbladder
a gallbladder positioned low in the abdomen
Describe agenisis of the gallbladder
no gallbladder due to failure to develop
Describe a bilobed gallbladder
“hourglass” or V- shaped
Describe a septated gallbladder
One or more internal divisions
Describe a duplicated gallbladder
2 complete gallbladders
Describe a gallbladder with hypoplasia
an underdeveloped gallbladder.
In the portal triad’s “mickey mouse” symbol, which vessel is the right side of the patient or “left ear”
The common bile duct
Where do we obtain the most accurate sonographic measurement of the Common Bile Duct?
In Porta Hepatis
What is the general rule for the measurement of the Common Bile Duct? Give an example.
About 1mm for every decade of life. for a 20 year old patient, their CBD should measure around 2mm.
What is the most common location for a stone in the biliary tract?
The gallbladder
What could happen if a stone passes to the joining of the bile and pancreatic duct?
It could cause pancreatitis
What is Billiruben?
a compound made from the breakdown of Red Blood Cells.
Which wall of the gallbladder should you measure, how do you measure it, and what scan plane should you use?
The anterior wall, outer edge to outer edge, and in Transverse
How many patient positions should you use when scanning the gallbladder? Why?
2 positions because the gallbladder fundus is not in a fixed position so it moves around. It’s important to move the patient in case pathology is hidden in a supine position.
What patient positions are accepatable when measuring the gallbladder?
Supine and LLD or Semi-Erect
What MUST you do when you are scanning a patient in a non-supine position? Why?
Label the patient’s position on the images so the radiologist knows how the patient was laying.
What two questions should you ask specifically to a gallbladder patient?
How long since last time eating? What did you eat?
Why would you ask when a patient last ate?
In non-emergency situations we NEVER scan a patient who ate less than 4 hours previously, since the gallbladder would not be distended.
When and Why would you ask a patient what they last ate?
During a biliary/gallbladder exam. The radiologist may want to know if they’ve recetnly had fatty foods.
What scan plane is used to measure the Common Bile Duct? How do you meausre it?
In a sagittal scan plane. It is measured from inner wall to inner wall.
What is the width of the gallbladder
3-5 cm diameter
Where are the spiral valves of heister found specifically?
In the lumen of the cystic duct.
What is Murphy’s sign
Right Upper Quadrant pain. It is used in a physical exam to diagnose cholecystitis
