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ABDOMINAL I21 > Gallbladder & Biliary > Flashcards

Gallbladder & Biliary Flashcards

1
Q

small polypoid projections from the gallbladder wall

A

adenomyomatosis

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2
Q

small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions

A

ampulla of Vater

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3
Q

yellow pigment in bile formed by the breakdown of red blood cells

A

bilirubin

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4
Q

inflammation of the bile duct

A

cholangitis

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5
Q

removal of the gallbladder

A

cholecystectomy

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6
Q

inflammation of the gallbladder; may be acute or chronic

A

cholecystitis

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7
Q

hormone secreted into the blood by the mucosa of the upper small intestine; stimulates contraction of the gallbladder and pancreatic secretion of enzymes

A

cholecystokinin

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8
Q

cystic growth of the common duct that may cause obstruction

A

choledochal cyst

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9
Q

stones in the bile duct

A

choledocholithiasis

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10
Q

gallstones in the gallbladder

A

cholelithiasis

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11
Q

variant of adenomyomatosis; cholesterol polyps;

A

cholesterolosis

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12
Q

extends from the point where the common hepatic duct meets the cystic duct; drains into the duodenum after it joins with the main pancreatic duct

A

common bile duct

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13
Q

refers to common bile or hepatic ducts when the cystic duct is not seen

A

common duct

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14
Q

bile duct system that drains the liver into the common bile duct

A

common hepatic duct

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15
Q

connects the gallbladder to the common hepatic duct

A

cystic duct

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16
Q

storage pouch for bile

A

gallbladder (GB)

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17
Q

small part of the gallbladder that lies near the cystic duct where stones may collect

A

Hartmann’s pouch

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18
Q

tiny valves found within the cystic duct

A

Heister’s valves

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19
Q

massive enlargement of the gallbladder

A

hydrops

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20
Q

excessive bilirubin accumulation that causes yellow pigmentation of the skin; first seen in the whites of the eyes

A

jaundice

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21
Q

small septum within the gallbladder, usually arising from the posterior wall

A

junctional fold

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22
Q

cancer at the bifurcation of the hepatic ducts; may cause asymmetric obstruction of the biliary tree

A

Klatskin’s tumor

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23
Q

positive sign implies exquisite tenderness over the area of the gallbladder upon palpation

A

Murphy’s sign

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24
Q

travels horizontally through the pancreas to join the common bile duct at the ampulla of Vater

A

pancreatic duct

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25
Q

gallbladder variant in which part of the fundus is bent back on itself

A

Phrygian cap

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26
Q

small, well-defined soft tissue projection from the gallbladder wall

A

polyps of the gallbladder

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27
Q

calcification of the gallbladder wall

A

porcelain gallbladder

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28
Q

central area of the liver where the portal vein, common duct, and hepatic artery enter

A

porta hepatis

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29
Q

low-level echoes found along the posterior margin of the gallbladder; move with change in position

A

sludge

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30
Q

small muscle that guards the ampulla of Vater

A

sphincter of Oddi

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31
Q

sonographic pattern found when the gallbladder is packed with stones

A

wall echo shadow (WES) sign

32
Q

The gallbladder serves as a reservoir for _______________ that is drained from the hepatic ducts in the liver.

A

bile

33
Q

The common hepatic duct is joined by the cystic duct to form the ______________ duct.

A

common bile duct

34
Q

The main pancreatic duct joins the common bile duct, and together they open through a small ampulla (the ampulla of _______________) into the duodenal wall.

A

Vater

35
Q

The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the _______________

A

Sphincter of Oddi

36
Q

The arterial supply of the gallbladder is from the _______________ artery, which is a branch of the right hepatic artery.

A

cystic

37
Q

List the two primary functions of the extrahepatic biliary tract.

A
  1. transportation of bile from the liver to the intestines 2. regulation of its flow
38
Q

Bile is the principal medium for excretion of bilirubin _______________.

A

cholesterol

39
Q

The _______________ from the small intestine stimulate the liver to make more bile. This activates intestinal and pancreatic enzymes.

A

bile salts

40
Q

The sign that indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder, is called _______________.

A

Courvoisier’s sign

41
Q

The hepatic artery lies _______________ and to the _______________ of the portal vein.

A

anterior; left

42
Q

To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for a least _______________ hours before the ultrasound examination.

A

8 to 12

43
Q

The patient is initially examined with ultrasound in full _______________.

A

inspiration

44
Q

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.

A

decubitus

45
Q

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.

A

sonolucent

46
Q

The gallbladder commonly resides in a(n) _______________ on the medial aspect of the liver.

A

fossa

47
Q

A small ________________ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum.

A

echogenic

48
Q

On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _______________ sign.

A

Mickey Mouse

49
Q

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.

A

oblique

50
Q

On sagittal scans, the right branch of the hepatic artery usually passes _______________ to the common duct.

A

posterior

51
Q

The common duct is seen just _______________ to the portal vein before it dips posteriorly to enter the head of the pancreas.

A

anterior

52
Q

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.

A

hepatic

53
Q

The most classic symptom of gallbladder disease is _______________ pain, usually occurring after ingestion of greasy foods.

A

RUQ

54
Q

A gallbladder attack may cause pain in the _______________ shoulder.

A

right

55
Q

The normal wall thickness of the gallbladder is less than _______________ mm.

A

3

56
Q

List the six biliary causes of gallbladder wall thickening.

A
  1. cholecystitis2. adenomyomatosis3. cancer4. acquired immunodeficiency syndrome5. cholangiopathy6. sclerosing cholangitis
57
Q

Clinically the patient with acute cholecystitis presents with these symptoms.

A

acute RUQ pain, positive Murphy’s sign, fever, and leukocytosis (increased white blood cell count)

58
Q

The ________________ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.

A

WES (wall echo shadow) sign

59
Q

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 ________________.

A

emphysematous cholecystitis

60
Q

Clinically the patient falls under the five “F”s.

A

fat, forty, female, fertile, fair

61
Q

Explain why the patient’s position should be shifted during ultrasound examination.

A

To demonstrate the movement of stones

62
Q

Describe the factors that produce a shadow in the gallbladder.

A

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

63
Q

_______________ 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 out pouching of the ductal walls.

A

choledochal cysts

64
Q

A hyperplastic change in the gallbladder wall is _______________.

A

adenomyomatosis

65
Q

The differential for a porcelain gallbladder would include a packed bag or _______________ sign.

A

WES (wall echo shadow)

66
Q

What is the most notable sonographic finding with carcinoma of the gallbladder?

A

gallbladder wall is markedly abnormal and thickened

67
Q

The most common cause of biliary ductal system obstruction is the presence of a(n) ________________ or ________________ within the ductal system.

A

tumor or thrombus

68
Q

The job of the sonographer is to localize the level and cause of the obstruction. List the three primary areas where obstruction occurs.

A
  1. intrapancreatic obstruction 2. suprapancreatic obstruction 3. porta hepatis obstruction
69
Q

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.

A

Mirizzi

70
Q

_______________ causes increasing pressure in the biliary tree with pus accumulation.

A

cholangitis

71
Q

The majority of stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______________.

A

Calculous cholecystitis

72
Q

______________ within the duodenum may also give rise to a dirty shadow in the right upper quadrant.

A

Air or gas

73
Q

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in _______________ disease.

A

Caroli’s

74
Q

What maneuvers may be performed to be sure the sludge in the gallbladder is not a tumor?

A

Change the patient’s position to see if the sludge moves.

75
Q

The majority of the stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______________.

A

calculous cholecystitis

76
Q

_______________ within the duodenum may also give rise to a dirty shadow in the right upper quadrant.

A

Air or gas

77
Q

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ______________ disease.

A

Caroli’s

ABDOMINAL I21 (11 decks)

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