Chapter 3: The Gallbladder

Question 1

the inflammation of the gallbladder without associated gallstones

Answer 1

acalculous cholecystitis

Question 2

benign hyperplasia of the gallbladder wall

Answer 2

adenomyomatosis

Question 3

the hormone produced by the duodenum that causes the gallbladder to contract

Answer 3

cholecystokinin

Question 4

the presence of a gallstone or gallstones within the biliary tree

Answer 4

choledocholithiasis

Question 5

the clinical detection of an enlarged, palpable gallbladder caused by a biliary obstruction in the area of the pancreatic head

Answer 5

Courvoisier gallbladder

Question 6

the duct that connects the gallbladder to the common hepatic duct

Answer 6

cystic duct

Question 7

an outpouching of the gallbladder neck

Answer 7

Hartmann pouch

Question 8

gallbladder variant when the gallbladder fundus is folded onto itself

Answer 8

Phrygian cap

Question 9

tiny pockets within the gallbladder wall

Answer 9

Rokitansky-Aschoff sinuses

Question 10

folds located within the cystic duct that prevent it from collapsing and distending

Answer 10

spiral valves of Heister

Question 11

what does the gallbladder do?

Answer 11

stores and concentrates bile

Question 12

the portion of the biliary tree that lies distal to the union of the cystic duct with the hepatic duct is the:

Answer 12

common bile duct

Question 13

blood supply to the gallbladder is via the:

Answer 13

cystic artery, a branch of the right hepatic artery

Question 14

normal size of the gallbladder

Answer 14

8-10 cm in length and no more than 5 cm in diameter

Question 15

the gallbladder wall should measure no more than ____ in thickness

Answer 15

3 mm

Question 16

3 things gallstones are typically made of:

Answer 16

cholesterol
calcium bilirubinate
calcium carbonate

Question 17

what are the 6 F’s when referring to gallstones?

Answer 17

fat
female
fertile
flatulent
fair
forty

Question 18

Clinical findings:
asymptomatic
biliary colic
abdominal pain after fatty meals
epigastric pain
nausea and vomiting
pain that radiates to the shoulders

Answer 18

cholelithiasis

Question 19

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)

Answer 19

cholelithiasis

Question 20

sludge that is thick and may mimic an intraluminal gallbaldder mass

Answer 20

tumefactive sludge

Question 21

Clinical findings:
asymptomatic
any reason for biliary stasis (total parenteral nutrition, fasting)

Answer 21

gallbladder sludge

Question 22

Sonographic findings:

a collection of low-level, nonshadowing, dependent echoes within the gallbladder lumen

Answer 22

gallbladder sludge

Question 23

a projection of tissue from the gallbladder wall that protrudes into the lumen of the gallbladder

Answer 23

polyp

Question 24

most common type of gallbladder polyps

Answer 24

cholesterol polyps

Question 25

Sonographic findings: | echogenic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen

Answer 25

polyp

Question 26

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

Answer 26

adenomyomatosis

Question 27

what causes comet-tail artifact with adenomyomatosis?

Answer 27

cholesterol crystals in the Rokitansky-Aschoff sinuses of the gallbladder

Question 28

the most common cause of acute cholecystitis

Answer 28

a gallstone that has become lodged in the cystic duct or neck of the gallbladder

Question 29

``` 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 ```

Answer 29

acute cholecystitis

Question 30

``` Sonographic findings: gallstones positive sonographic Murphy's sign gallbladder wall thickening pericholecystic fluid sludge ```

Answer 30

acute cholecystitis

Question 31

Clinical findings: RUQ tenderness epigastric or abdominal pain leukocytosis

Answer 31

acalculous cholecystitis

Question 32

``` Sonographic findings: positive sonographic Murphy's sign gallbladder wall thickening pericholecystic fluid sludge ```

Answer 32

acalculous cholecystitis

Question 33

Sonographic findings: gallbladder measures >5 cm in diameter or >8-10 cm in length search for obstructive entities such as choledocholithiasis or pancreatic mass

Answer 33

gallbladder enlargement

Question 34

Sonographic findings: | calcification and shadowing from the gallbladder wall

Answer 34

porcelain gallbladder

Question 35

though rare, the most common cancer of the biliary tract

Answer 35

gallbladder carcinoma

Question 36

what is suspected if a polyp or mass within the gallbladder measures more than 2 cm?

Answer 36

gallbladder carcinoma

Question 37

the most common metastatic disease of the gallbladder

Answer 37

malignant melanoma

Question 38

``` Clinical findings: weight loss RUQ pain jaundice nausea and vomiting hepatomegaly ```

Answer 38

gallbladder carcinoma

Question 39

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

Answer 39

gallbladder carcinoma

Question 40

``` 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 ```

Answer 40

Courvoisier gallbladder

Question 41

``` The innermost layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer ```

Answer 41

mucosal layer

Question 42

``` The cystic artery is a branch of the: A. main pancreatic artery B. celiac artery C. right hepatic artery D. left hepatic artery ```

Answer 42

right hepatic artery

Question 43

``` The middle layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer ```

Answer 43

fibromuscular layer

Question 44

``` The gallbladder wall should measure no more than: A. 5 mm B. 6 mm C. 4 mm D. 3 mm ```

Answer 44

3 mm

Question 45

``` The direct blood supply to the gallbladder is the: A. cholecystic artery B. common hepatic artery C. main portal vein D. cystic artery ```

Answer 45

cystic artery

Question 46

``` The outermost layer of the gallbladder wall is the: A. fibromuscular layer B. mucosal layer C. serosal layer D. muscularis layer ```

Answer 46

serosal layer

Question 47

``` 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 ```

Answer 47

cystic duct

Question 48

``` The diameter of the gallbladder should not exceed: A. 8 cm B. 5 cm C. 7 mm D. 3 cm ```

Answer 48

5 cm

Question 49

``` All of the following are sources of diffuse gallbladder wall thickening except: A. malignant ascites B. AIDS C. hepatitis D. adenomyomatosis ```

Answer 49

malignant ascites

Question 50

``` All of the following are sources of diffuse gallbladder wall thickening except: A. benign ascites B. hepatitis C. congestive heart failure D. gallbladder polyp ```

Answer 50

gallbladder polyp

Question 51

``` The spiral valves of Heister are found within the: A. gallbladder neck B. cystic duct C. gallbladder fundus D. gallbladder wall ```

Answer 51

cystic duct