Chapter 3: The Gallbladder Flashcards
the inflammation of the gallbladder without associated gallstones
acalculous cholecystitis
benign hyperplasia of the gallbladder wall
adenomyomatosis
the hormone produced by the duodenum that causes the gallbladder to contract
cholecystokinin
the presence of a gallstone or gallstones within the biliary tree
choledocholithiasis
the clinical detection of an enlarged, palpable gallbladder caused by a biliary obstruction in the area of the pancreatic head
Courvoisier gallbladder
the duct that connects the gallbladder to the common hepatic duct
cystic duct
an outpouching of the gallbladder neck
Hartmann pouch
gallbladder variant when the gallbladder fundus is folded onto itself
Phrygian cap
tiny pockets within the gallbladder wall
Rokitansky-Aschoff sinuses
folds located within the cystic duct that prevent it from collapsing and distending
spiral valves of Heister
what does the gallbladder do?
stores and concentrates bile
the portion of the biliary tree that lies distal to the union of the cystic duct with the hepatic duct is the:
common bile duct
blood supply to the gallbladder is via the:
cystic artery, a branch of the right hepatic artery
normal size of the gallbladder
8-10 cm in length and no more than 5 cm in diameter
the gallbladder wall should measure no more than ____ in thickness
3 mm
3 things gallstones are typically made of:
cholesterol
calcium bilirubinate
calcium carbonate
what are the 6 F’s when referring to gallstones?
fat female fertile flatulent fair forty
Clinical findings: asymptomatic biliary colic abdominal pain after fatty meals epigastric pain nausea and vomiting pain that radiates to the shoulders
cholelithiasis
Sonographic findings:
echogenic, mobile, shadowing structure(s) within the lumen of the gallbladder
stones that lodge within the cystic duct or neck of the gallbladder may not move
WES (wall-echo-shadow) sign may be present (gallbladder completely filled with stones)
cholelithiasis
sludge that is thick and may mimic an intraluminal gallbaldder mass
tumefactive sludge
Clinical findings:
asymptomatic
any reason for biliary stasis (total parenteral nutrition, fasting)
gallbladder sludge
Sonographic findings:
a collection of low-level, nonshadowing, dependent echoes within the gallbladder lumen
gallbladder sludge
a projection of tissue from the gallbladder wall that protrudes into the lumen of the gallbladder
polyp
most common type of gallbladder polyps
cholesterol polyps
Sonographic findings:
echogenic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen
polyp
Sonographic findings:
focal or diffuse thickening of the gallbladder wall
comet-tail artifact that projects from the gallbladder wall into the lumen of the gallbladder
adenomyomatosis
what causes comet-tail artifact with adenomyomatosis?
cholesterol crystals in the Rokitansky-Aschoff sinuses of the gallbladder
the most common cause of acute cholecystitis
a gallstone that has become lodged in the cystic duct or neck of the gallbladder
Clinical findings: RUQ tenderness epigastric or abdominal pain leukocytosis possible elevation in alkaline phosphatase, aminotransferase, and/or bilirubin fever pain that radiates to the shoulders nausea and vomiting
acute cholecystitis
Sonographic findings: gallstones positive sonographic Murphy's sign gallbladder wall thickening pericholecystic fluid sludge
acute cholecystitis
Clinical findings:
RUQ tenderness
epigastric or abdominal pain
leukocytosis
acalculous cholecystitis
Sonographic findings: positive sonographic Murphy's sign gallbladder wall thickening pericholecystic fluid sludge
acalculous cholecystitis
Sonographic findings:
gallbladder measures >5 cm in diameter or >8-10 cm in length
search for obstructive entities such as choledocholithiasis or pancreatic mass
gallbladder enlargement
Sonographic findings:
calcification and shadowing from the gallbladder wall
porcelain gallbladder
though rare, the most common cancer of the biliary tract
gallbladder carcinoma
what is suspected if a polyp or mass within the gallbladder measures more than 2 cm?
gallbladder carcinoma
the most common metastatic disease of the gallbladder
malignant melanoma
Clinical findings: weight loss RUQ pain jaundice nausea and vomiting hepatomegaly
gallbladder carcinoma
Sonographic findings:
nonmobile mass within the gallbladder lumen that measures >2 cm
diffuse or focal gallbladder wall thickening
irregular mass that may completely fill the gallbladder fossa
invasion of the mass into surrounding liver tissue
gallbladder carcinoma
A 71-year-old patient presents to the emergency department with painless jaundice and an enlarged, palpable gallbladder. These findings are highly suspicious for: A. acute cholecystitis B. chronic cholecystitis C. Courvoisier gallbladder D. porcelain gallbladder
Courvoisier gallbladder
The innermost layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer
mucosal layer
The cystic artery is a branch of the: A. main pancreatic artery B. celiac artery C. right hepatic artery D. left hepatic artery
right hepatic artery
The middle layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer
fibromuscular layer
The gallbladder wall should measure no more than: A. 5 mm B. 6 mm C. 4 mm D. 3 mm
3 mm
The direct blood supply to the gallbladder is the: A. cholecystic artery B. common hepatic artery C. main portal vein D. cystic artery
cystic artery
The outermost layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer
serosal layer
The gallbladder is connected to the biliary tree by the: A. common hepatic duct B. common bile duct C. cystic duct D. right hepatic duct
cystic duct
The diameter of the gallbladder should not exceed: A. 8 cm B. 5 cm C. 7 mm D. 3 cm
5 cm
All of the following are sources of diffuse gallbladder wall thickening except: A. malignant ascites B. AIDS C. hepatitis D. adenomyomatosis
malignant ascites
All of the following are sources of diffuse gallbladder wall thickening except: A. benign ascites B. hepatitis C. congestive heart failure D. gallbladder polyp
gallbladder polyp
The spiral valves of Heister are found within the: A. gallbladder neck B. cystic duct C. gallbladder fundus D. gallbladder wall
cystic duct
