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Abdomen > gallbladder and biliary > Flashcards

gallbladder and biliary Flashcards

1
Q

the gallbladder is located on the fossa on _____ ________ portion of the liver

A

posterior inferior

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2
Q

the gallbladder can have a ____ of positions and the ___ ____ fissure is used as an identifying landmark

A

variety
main lobar

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3
Q

the gallbladder is used as a storage sac for ____

A

bile

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4
Q

the gallbladder shape can be ___, conical, ____ gourd-like, pear shaped

A

round
teardrop

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5
Q

the gallbladder is a musculo-______ sac

A

membranous

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6
Q

the gallbladder is located ____ to the right liver lobe. ___ to the right kidney and ____ to the pancreas head and duodenum

A

posterior
anterior
lateral

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7
Q

normal gallbladder size in SAG is __-__ cm and in TRANS is ___ cm

A

7-10cm
3cm

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8
Q

typical bile capacity is __ to __ ML

A

30 to 60

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9
Q

the normal gallbladder wall thickness is <___mm

A

3mm

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10
Q

the three segments of the gallbladder are the ____, ___ and the ____

A

Fundus
Body
neck

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11
Q

in the gallbladder the _____ is a hemispheric blind end, normally the most inferolateral portion that extends caudal and anterior below the inferior margin of the right hepatic love at the level of the 9th costal cartilage

A

fundus

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12
Q

in the gallbladder the ____ is the part between the funds and the neck, central main portion

A

body

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13
Q

in the gallbladder the _____ a narrow tube-like part that tapers its also known as infundibulum

A

neck

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14
Q

the neck of the gallbladder is in a fixed position at ____ ____ fissure

A

main lobar

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15
Q

the gallbladder body and fundus are ___ in postion

A

variable

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16
Q

a saggital or transverse imaging plane will not always produce a sagittal or transverse _____ image

A

Gallbladder

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17
Q

the gallbladder wall consists of 3 tissue layers the inner most layer is the epithelial (_____)

A

mucosa

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18
Q

the gallbladder wall consists of 3 tissue layers the middle is the muscular (_______)

A

smooth muscle

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19
Q

the gallbladder consists of 3 tissue of layers the outer most layer is called _____

A

serosa

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20
Q

the gallbladders blood supply is from the ___ artery ( branch of the right hepatic artery )

A

Cystic

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21
Q

the gallbladder blood drainage is from the ___ vein into the ___ venous system

A

cystic
portal

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22
Q

the ____ duct connects the neck of the GB to the common hepatic duct

A

cystic duct

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23
Q

the ____ duct contains spiral valves of Hester which prevent the GB from _____

A

cystic
collapsing

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24
Q

the cystic duct is ____ to Gb neck and not normally seen on ultrasound

A

superior

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25
Q

the cystic duct merges with the CHD to form the ____

A

CBD

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26
Q

spiral valves of heister is found within the ___ duct. it controls inward and outward flow of bile and keeps duct from kinking

A

cystic duct

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27
Q

the intrahepatic bile ducts is located within the liver anterior lateral to the ____ veins

A

Portal

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28
Q

the intrahepatic bile ducts are the most ___ bile ducts

A

proximal

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29
Q

the right and left intrahepatic ducts emerge to form the common hepatic duct at the level of the porta____

A

hepatic

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30
Q

the common bile duct is formed by the union of the ___ ___ ___ and ____ ___

A

CHD
cystic duct

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31
Q

the common bile duct is divided into __ parts

A

4

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32
Q

the 4 parts of the common bile duct are the ___ duodenum, ____ duodenum , ______ duodenum and _____ duodenum

A

supra
retro
infra
intra

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33
Q

the duodenal ____ is the opening into the duodenum

A

papilla

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34
Q

_____ of ODDI controls flow of bile and pancreatic juices into duodenum

A

sphincter

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35
Q

the vessels and structures from most posterior to most anterior is the ____ the ____ vein the ____ artery and the ___ ____

A

IVC
portal V
hepatic A
bile duct

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36
Q

the _____ is used to store bile

A

gallbladder

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37
Q

bile is a surfactant, emulsifier that breaks down ____ its made up of bile ___, ____ and a small amount of _____

A

fats
salts
cholesterol
bilirubin

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38
Q

in the gallbladder contractions are controlled by ______

A

cholecystokinin

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39
Q

_____ is the main pigment found in bile

A

bilirubin

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40
Q

bile is produced by the breakdown of ____

A

hemoglobin

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41
Q

____ is responsible for color in feces

A

Bilirubin

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42
Q

bilirubin pigment is associated with ____

A

jaundice

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43
Q

the CBD ____ and concentrate bile

A

store

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44
Q

the CBD deliver bile to the ______

A

duodenum

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45
Q

the normal size of the CBD is __-___mm

A

1-4mm

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46
Q

increase in _____ bilirubin indicates mechanical obstruction to flow

A

DIRECT

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47
Q

increase in ____ bilirubin indicates hepatic damage or pre-hepatic problem

A

INDIRECT

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48
Q

an increase of serum alkaline phosphate indicates mechanical obstruction to flow of _____

A

bilirubin

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49
Q

______ cap Is a fold between the funds and body of gallbladder

A

Phrygian cap

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50
Q

junctional fold also called _____ pouch is a fold between the body abdomen infundibulum of gallbladder its the most frequent variation

A

hartmann’s

51
Q

Duplication, agenesis and separations are ____

A

rare

52
Q

normal gallbladder on ultrasound

lumen is ____, wall is pencil ___ and echogenic the wall measurement taken in transverse of ____ wall and the normal length is no greater than ____mm

A

anechoic
thin
anterior
3mm

53
Q

to prepare for a gallbladder exam the patient must be NPO ___-___ hours prior to the exam

A

8-12

54
Q

biliary ___ is concentrated bile-thickened

A

sludge

55
Q

_____ ____ is sometimes a precursor to a stone formation

A

billiard sludge

56
Q

cholelithiasis is also known as _____

A

Gallstones

57
Q

cholelithiasis (gallstones) is more common in ____ (4;1) and ___% of the population will develop stones

A

women
10%

58
Q

the 5 F’s of gallbladder disease is _____, ____, ____, ___ and ____

A

Female
Fat
Feritle
Forty
Fair

59
Q

some signs and symptoms of cholelithiasis ( gallstones) the patient may be ____ up to 60-80%. the patients generally present with RUQ pain that occurs after ___ or radiates to the upper ____, ____ or ___ area as well as nausea vomiting or intolerance to fatty foods

A

asymptomatic
meals
back
shoulder
epigastric

60
Q

with gallstones ___ and ___ are more costly

A

MRI
CT

61
Q

____ sign is also known as double - arc shadow sign

A

WES sign

62
Q

with west sign the first arc or curved echogenic line represents the ____ ___ wall

A

thickened GB

63
Q

with WES sign the second arc is from surface or ___ followed by posterior acoustic shadowing

A

stone

64
Q

The ___ ___ shows the contracted gallbladder containing stones

A

WES sign

65
Q

acute _____ ( inflammation of GB wall) up to 95% of cases result from impacted stones with GB neck or cystic duct

A

cholecystitis

66
Q

with acute cholecystitis patients present with RUQ pain that radiates to shoulder, the positive ____ sign ( rebound tenderness over the GB area ) , nausea , vomiting and fever

A

murphy

67
Q

acute cholecystitis may require ____ ___ ( life threatening )

A

emergency surgery

68
Q

empyema is ___ in the GB

A

pus

69
Q

_____ cholecystitis is caused by repeated attacks of ___ cholecystitis with subsequent ___ of the GB wall

A

chronic
acute
fibrosis

70
Q

chronic cholecystitis is a long term ____ of the GB due to infection , ____ or metabolic ____

A

inflammation
obstruction
disorders

71
Q

______ syndrome (gallstone ileus) is a complication that occurs when biliary enteric fistula forms between the Gb and duodenum, stones migrate to the duodenum and cause obstruction

A

Bouveret

72
Q

_____ cholecystitis is a rare inflammatory disease of the GB characterized by inflation of round lipid- laden histiocytes and multiple nucleated giant cells and proliferation of fibroblasts in the muscle layer

A

Xanathogranulomatous

73
Q

_____ gallbladder is a rare, calcium incrustation of the GB wall and a form of chronic cholecystitis

A

porcelain

74
Q

____ of the gallbladder AKA mucocele is a distended, non inflamed gallbladder due to total prolonged obstruction of the cystic duct

A

Hydrops

75
Q

Gallbladder _____ is benign and appears as a small non shadowing masses attached to wall

A

polyps

76
Q

gallbladder polyps do not change _____ in relation to patient position change

A

position

77
Q

Cholesterol polyps is also called ____ gallbladder

A

strawberry

78
Q

cholesterol polyps (strawberry gallbladder ) is an accumulation of ____ and sterols in the GB wall

A

triglycerides

79
Q

strawberry gallbladder is associated with cholesterol stones 50-70% of patients and appear as small non_____ masses that project into he lumen of the GB

A

non SHADOWING

80
Q

_____ is a benign proliferation of gallbladder wall tissue, it may be focal or diffuse and comet tail artifact may be seen due to trapped cholesterol stones in the RA sinuses and is usually asymptomatic

A

Adenomyomatosis

81
Q

GB _____ is progressive , rapidly spreading to other structures . Its also rare .Poor prognosis- mortality 100%

A

carcinoma

82
Q

GB carcinoma is usually seen in elderly and most commonly in ____ >60

A

woman

83
Q

GB carcinoma is highly associated with ___

A

cholelithiasis

84
Q

a bile duct ____ can be intrahepatic or extra hepatic location and is caused by stones, tumors within the bile ducts, or by a primary sclerosis cholangitis liver mass and pancreas disease

A

obstruction

85
Q

with a bile obstruction bile duct are dilated ____ to the obstruction level

A

proximal

86
Q

intrinsic is ____ the duct such as stones,cholangiocarcinoma and inflammatory occlusions due to cholangitis

A

WITHIN

87
Q

extrinsic is ____ the duct such as the pancteatic mass , pancreatitis , pancreatic pseudocyst, periductal lymphadenopathy and hepatic mass

A

OUTSIDE

88
Q

a biliary obstruction is suspected when patients present with _____

A

jaundice

89
Q

with biliary obstruction jaundice is caused by elevated _____

A

bilirubin

90
Q

_____ bilirubin is obstruction outside the liver , direct bilirubin is blocked from flow out of the liver and overflows into bloodstream; also known as surgical jaundice

A

DIRECT

91
Q

_____ bilirubin indicated hepatic damage; liver cells unable to conjugate bilirubin, or pre-hepatic problem ( hemolytic anemia)

A

INDIRECT

92
Q

the antler branching pattern or stellate branching pattern, the parallel channel sign, shotgun sign or too many tubes sign is seen with a biliary _____

A

obstruction

93
Q

choledocholithiasis is biliary obstruction caused by ____ in the bile ducts

A

stone

94
Q

_____ syndrome is when a stone is impacted in cystic duct of neck of GB

A

Mirizzi

95
Q

with ____ syndrome cholecystectomy is the preferred treatment

A

Mirizzi

96
Q

______ are enlarged lymph nodes in the areas of the porta hepatis and they can put pressure on the bile ducts and cause dilation in the proximal and intrahepatic ducts .

A

Lymphadenopathy

97
Q

Enlarged lymph nodes in this area may be sign of ____ or some other infection

A

hepatitis

98
Q

Carcinoma in the head of the _____ may obstruct the distal CBD

A

pancreas

99
Q

with pancreatic head carcinoma all proximal ducts could become ____

A

dilated

100
Q

______ is a malignant neoplasm of bile ducts, most common are adenocarcinomas, followed by squamous

A

cholangiocarcinoma

101
Q

there are ____ types of cholangiocarcinoma

A

3

102
Q

The 3 types of cholangiocarcinoma are
_____ ( peripheral)
______ ( most common ; develops outside the CBD)
____ - klatskin’s tumor ( located between left and right hepatic ducts causes intrahepatic dilation)

A

Intrahepatic
Distal
Hilar

103
Q

the subtypes of cholangiocarcinoma are
_____ - most common
____ - most common
_____- found in distal CBD

A

sclerosing
nodullar
papillary

104
Q

the most common subtypes of cholangiocarcinoma are ____ ____

A

nodular sclerosing

105
Q

_____ tumor is cholangiocarcinoma at the right and left hepatic bifurcation, dilation is only of the intrahepatic ducts, Lack of joining of left and right hepatic ducts

A

Klatskin’s

106
Q

metastases can affect the ___hepatic and _____ hepatic ductal system

A

INTRAhepatic
EXTRAhepatic

107
Q

_____ cyst is a congenital cyst like dilation of common bile duct there are different types and the most common is cyst like dilation in porta hepatis

A

Choledochal

108
Q

choledochal cysts are classified by _____

A

anatomy

109
Q

choledochal cyst type 1 is a localized cystic dilation of the ____ ____ ____

A

Common Bile duct

110
Q

choledochal cyst type 2 is a diverticulum from the _____ _____ _____

A

Common Bile Duct

111
Q

choledochal cyst type 3 is an invagination of the ___ ____ ___ into the _____

A

Common Bile Duct
Duodenum

112
Q

choledochal cyst type 4 is a dilation of the entire common bile duct and the common ____ duct

A

hepatic

113
Q

choledochal cyst type 5 is ____ disease which is multiple cysts

A

Caroli’s

114
Q

____ disease is a congenital anomaly its usually asymptomatic first 5-20 years its a segmental saccular cystic dilation of major intrahepatic ducts

A

Caroli’s

115
Q

Caroli’s disease can appear as a ___ of ___

A

string of beads

116
Q

the central dot sign is associated with ___ ___-

A

Caroli’s disease

117
Q

____ is inflammation of the bile ducts

A

cholangitis

118
Q

there are 4 types of cholongitis
- ____ cholangitis
- primary _____ cholangitis
- ___ related cholangitis
- recurring ____ cholangitis

A

bacterial
sclerosing
AID’s
pyogenic

119
Q

main cause of ___ is biliary failure secondary to percutaneous biliary procedures or other biopsies

A

Hemobilia

120
Q

_____ is air within the biliary tree secondary to biliary intervention, Biliary-enteric anastomoses, or common bile duct stents

A

Pneumobilia

121
Q

_____ is a disease that is caused by the parasitic roundworm, Ascaris Lumbricoides, which uses a fecal-oral route of transmission

A

ascariasis

122
Q

age related billiary dilation ___mm may be added to the normal measurement for each decade past ____ years old

A

1mm
60

123
Q

after a cholecystectomy the normal measurement of the CBD may increase up to ____ cm

A

1cm

Abdomen (7 decks)

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