Gallbladder/Biliary System Flashcards
The gallbladder is divided into what 3 parts
neck
body
fundus
What is the name of the valve that controls the bile flow in the cystic duct
Heister’s Valve
When performing a gallbladder ultrasound you must evaluate what 4 areas of anatomy
gallbladder
common bile duct
liver
pancreas
The portal vein and hepatic artery flow is ____ the liver
toward
The flow in the bile ducts is _____ from the liver
away
connection from the gallbladder to the bile ducts
Cystic duct
What two things converge to form the CBD, which carries bile from the liver to the duodenum
Cystic Duct
Common Hepatic Duct
What is known as the Wirsung’s duct and joins to enter the duodenum at the Ampulla of Vater
CBD
main pancreatic duct
Muscular “gatekeeper” that relaxes to allow bile/pancreatic enzymes from the ampulla of vater to the duodenum
Sphincter of Oddi
Name 3 types of folds of the gallbladder and where they occur
Hartmann’s- neck
Phrygian Cap- fundus
Junctional Fold- between body and infundibuim
What is the term for removal of the Gallbladder
cholecystectomy
Is there any expected change in size of the CBD after the gallbladder is removed? How?
Yes
dilation
What is the appearance of the Gallbladder if the patient is not NPO
small and thick walled due to its contracted state
The purpose of changing the patient’s position during the exam is to demonstrate what
The mobility of gallstones and to make sure that no stones are lodged in the neck of cystic duct
The gallbladder should be less that ___cm in the anterior/posterior dimension from the transverse plane
5
The gallbladder wall should measure less than
3 mm
Where is the CBD routinely measured
At the point where right hepatic artery courses between the main portal vein and the bile duct
Typically, the CBD should be
5-6 mm or less
The CBD diameter increases with age. After 60 the normal CBD diameter increases
1mm per decade
What is round and distended, non-inflamed GB due to obstruction of the cystic duct
Hydrops/Mucocele
What is demonstrated when a pt. indicates exquisite tenderness of the rt costal margin over the area of the gallbladder. Is this an indication of disease?
Murphy’s sign
Yes
Name 4 appearances signs associated with dilated intrahepatic ducts
Parallel channel sign
double barrel shot gun
stellate confluence
too many tubes
“fatty” hormone that may be administered which causes the gallbladder to contract
cholecystokinin
If a patient was positive for obstruction the gallbladder would appear
distended (fat)
What are the 5 Fs of gallbladder disease
female fertile forty fair fat
Name 4 primary causes of Gallbladder wall thickening
Cholecystitis
AIDS
Cancer
Adenomyomatosis
gravity dependent, non-shadowing, echogenic material, made up of calcium bilirubinate granules and cholesterol crystals
GB sludge
Term for inflammation of the gallbaldder
cholecystitis
The symptoms of Cholecystitis include
RUQ pain Murphys sign possible fever gallstones elevated WBC diffuse GB wall thickening
An elevation of what suggests obstruction at the ampulla of vater
amylase
What of the gallbladder involves purulent material (pus) within the gallbladder due to bacteria-containing bile
Empyema
What is the technical term for gallstones
Choleithiasis
What are the 3 diagnostic criteria for gallstones
echogenic
posterior shadow
mobility
What is the WES sign short for
Wall Echo Shadow
What is another name for the WES sign that could be used for that sonographic appearance
double arc
What pathology is the term WES referring to
gallbladder full of stones
What is the technical term for gas in the biliary tree
pneumobilia
What condition is also known as strawberry gallbladder
cholesterolosis
The mortality rate for Gallbladder Carcinoma is near
100%
What % of patients with GB Carcinoma will also have cholelithiasis (gallstones)
80-90
Name 3 sonographic appearances of GB carcinoma
focal thickening of GB wall
intraluminnal GB mass
GB replaced by mass
Absence of the extrahepatic biliary tree and is suspected in infants and jaundice
Biliary Atresia
inflammation of the bile ducts, usually due to infection secondary to intestinal infection
cholangitis
What are the symptoms of Cholangitis
fever
jaundice
RUQ pain
extraheptic biliary obstruction due to an impacted stone in the cystic duct, causing mechanical compression of the common hepatic duct
Mirizz Syndrome
cholangiocarcinoma is also known as
Klatskin tumor
Tumor that occurs at the bifurcation of the common hepatic duct into right and left. It results in intra-hepatic but not extra-hepatic duct dilation
cholangiocarcinoma
The 2 most common lessions causing biliary obstruction are
gallstones
carcinoma of the head of the pancreas
What labs are typically elevated with biliary obstruction
serum alkaline phosphatase
conjugated bilirubin
GGT (gamma-glutamyl)
An obstruction in the distal portion of the CBD will result in dilation of
extra & intra-hepatic duct
What does the term choledocholithiasis mean
stones in the bile duct
What is the most common cause of choledocholithiasis
extra-hepatic obstructive jaundice
What diagnostic tests may be performed if choledocholithiasis is suspected
ERCP
PTC
CT
ultrasound
rare condition caused by weakness in the bile duct wall, causing cystic dilation of the intra and extra-hepatic bile ducts
choledochal cyst
What is the sonographic appearance of the choledochal cyst
2 cystic structures in RUQ:
- Gallbladder
- the dilated ducts
In what part of the world are choledochal cyst prevalent
asia
Most common cause of malignant neoplasm obstructing the biliary tree
pancreatic adenocarcinoma
