Gallbladder reverse

Question 2

—Pear shaped hollow organ
—Lies on the visceral surface of the liver
—Divided into neck/body/fundus
—Neck is continuous with the cystic duct

Answer 2

Anatomy of the gallbladder

Question 3

—Size is variable,

but approx 7-10cm in length and 2.5-4cm in width

Answer 3

Gallbladder size

Question 4

An increase in GB size is termed

Answer 4

Gallbladder Hydrops

Question 5

—in the neck keeps the cystic duct from kinking

Answer 5

Heister’s valves function

Question 6

—CYSTIC ARTERY
—CYSTIC VEIN

Answer 6

gallbladder Vascular Supply

Question 7

—a branch of the right hepatic artery

Answer 7

CYSTIC ARTERY-

Question 8

—drains the blood directly into the portal vein

Answer 8

CYSTIC VEIN-

Question 9

—Lies intrahepatic and then migrates to the surface of the liver
—Covered with a peritoneal layer on most of the surface. The rest of the gallbladder is covered with an adventicia tissue layer.

There is a potential space where these meet that can be an area where infection or inflammation can occur
—If migration does not occur, the gallbladder can be termed ectopic

Answer 9

Gallbladder location

Question 10

gallbladder not developed

still has biliary duct system

Answer 10

gallbladder agenesis

Question 11

Stores bile produced by the liver can hold approx 50 ml

-Concentrates bile when the body is in a fasting state

Answer 11

gallbladder function

Question 12

Bile is forced into the gallbladder due to an increased pressure within the CBD produced by the action of the sphincter of Oddi

Answer 12

How does the bile get into the gallbladder

Question 13

As the stomach empties the food into the duodenum, the intestines secrete enzymes and bile salts that stimulate the gallbladder to contract and push the bile into the duodenum

Cholecystokinin hormone

Answer 13

How does bile get out of the gallbladder

Question 14

There are folds within the mucous membrane of the wall that has a honeycomb appearance and unite with each other

Answer 14

How does the gallbladder concentrate bile

Question 15

—Consists of the right and left hepatic duct,

common hepatic duct,

common bile duct,

pear shaped gallbladder,

and cystic duct

Answer 15

Anatomy of the Bile Ducts

Question 16

—come from the right lobe of the liver in the Porta hepatis and unite to form the CHD

Answer 16

Right and left hepatic ducts

Question 17

approx 4mm in diameter, joins the cystic duct(draining the gallbladder) and is now called the CBD

Answer 17

Common Hepatic Duct

Question 18

by piercing into the wall of the duodenum where is joins the main pancreatic duct and together, they open into the duodenum through a small opening called the ampulla of Vater

Answer 18

CBD ends

Question 19

—lies lateral to the hepatic artery and anterior to the portal vein (left ear of Mickey Mouse)

Answer 19

CBD (prox portion) location

Question 20

—Normal measurement is

Answer 20

CBD measurement

Question 21

approx 4 cm long,

connects the neck of the gallbladder to the CHD to form the CBD

normally not seen by ultrasound

Answer 21

Cystic Duct-

Question 22

—Termed cholecystectomy
—The tone of the spincter of Oddi is lost, and bile is free to move into the duodenum at a fasting or non fasting state.
—Normal size of the CBD is increased, and normal is < 10mm
—Normally cannot see surgical clips by ultrasound

Answer 22

Physiology after removal of gallbladder

Question 23

Bilobed gallbladder

Septated gallbladder

Phrygian cap

Hartmann pouch

Junctional fold

Answer 23

Normal variants of the Gallbladder

Question 24

Hourglass appearance

Answer 24

Bilobed gallbladder

Question 25

Appear as thin separations within the gallbladder

Answer 25

Septated gallbladder

Question 26

Gallbladder fundus is folded onto itself

Answer 26

Phrygian cap

Question 27

Outpouching of gallbladder neck

Answer 27

Hartmann pouch

Question 28

Prominent fold located at the junction of the gallbladder neck

Answer 28

Junctional fold

Question 29

¨Should not exceed 8-10 cm in length, and 5 cm in width ¨Transverse measurement is a better indicator of enlargement ¨Referred to as hydropic gallbladder ¨An enlarged often palpable on physical exam caused by a pancreatic head mass is termed Courvoisier gallbladder ¨Patients will have painless jaundice

Answer 29

Gallbladder enlargement

Question 30

¨Cholelithiasis ¨Gallbladder sludge ¨Gallbladder polys ¨Adenomyomatosis ¨Acute cholecystitis ¨Acalculous cholecystitis ¨Gallbladder enlargement ¨Gallbladder carcinoma

Answer 30

Gallbladder Pathology

Question 31

¨Obesity ¨Pregnancy ¨Increased parity ¨Gestational diabetes ¨Estrogen therapy ¨Oral contraceptive use ¨Rapid weight loss programs ¨Hemolytic disorder ¨Total parenteral nutrition (TPN)

Answer 31

Cholelithiasis Risk factors and predisposing conditions

Question 32

¨Asymptomatic ¨Biliary colic ¨Abdominal pain after fatty meals ¨Epigastric pain ¨Nausea and vomiting ¨Pain that radiates to shoulders

Answer 32

Clinical findings of cholelithiasis

Question 33

¨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 sign may be present (gallbladder completely filled with stones)

Answer 33

Sonographic findings of cholelithiasis

Question 34

¨Echogenic, nonshadowing, and nonmobile masses that projects from the gallbladder wall into the gallbladder lumen ¨Also called adenoma

Answer 34

Sonographic findings of polyps

Question 35

¨Asympomatic ¨Caused by a disturbance in cholesterol metabolism and accumulation of cholesterol within the wall of the gallbladder ¨May be single or multiple ¨Most measure less than 5mm ¨Benign ¨If these adenomas grow rapidly or \>2cm, worrisome for gallbladder carcinoma

Answer 35

Clinical findings of polyps

Question 36

¨Benign hyperplasia of the gallbladder ¨ ¨Epithelium and muscular layers of the wall have tiny sinuses called Rokitansky-Aschoff sinuses. These contain cholesterol crystals that produce comet tail artifacts ¨ ¨May be focal or diffuse

Answer 36

Adenomyomatosis

Question 37

¨Sudden onset of gallbladder inflammation ¨Focal tenderness, caused by inflammation is termed a positive sonograghic Murphy’s sign

Answer 37

Acute Cholecystitis

Question 38

¨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 vomitting

Answer 38

Clinical Findings of Acute Cholecystitis

Question 39

¨Gallstones ¨Positive sonographic Murphy’s sign ¨Gallbladder wall thickening ¨Pericholecystic fluid ¨Sludge

Answer 39

Sonographic findings of Acute cholecystitis

Question 40

local tenderness over the gallbladder with transducer pressure

Answer 40

Murphy’s sign

Question 41

Chronic cholecystitis Gangrenous cholecystitis Emphysematous cholecystitis (bacterial invasion within the gallbladder wall) Gallbladder perforation

Answer 41

Sequela of Acute Cholecystitis

Question 42

Nontender gallbladder/intolerance to fatty foods/belching Gallstones Possible gallbladder wall thickening

Answer 42

Chronic cholecystitis

Question 43

Elevated symptoms of acute cholecystitis Linear echogenic membranes within the lumen of the gallladder/striated gallbladder wall

Answer 43

Gangrenous cholecystitis

Question 44

Elevated symptoms of acute cholecystitis Diabetes Gas within the gallbladder wall that leads to ring down artifact/gallstones may not be present

Answer 44

Emphysematous cholecystitis (bacterial invasion within the gallbladder wall)

Question 45

Elevated symptoms of acute cholecystitis Small opening or tear in the gallbladder wall

Answer 45

Gallbladder perforation

Question 46

¨Most common form of gallbladder inflammation ¨Results from numerous attacks of acute cholecystitis which causes fibrosis of the gallbladder wall ¨Clinically, patients have transient pain RUQ, but not a positive Murphys sign ¨Sonographically, contracted gallbladder filled with stones (WES) sign

Answer 46

Chronic cholecystitis

Question 47

¨Presents with all the clinical and sonographic findings of cholecystitis except no gallstones are present ¨More commonly seen in children, recently hospitalized patitents , and those who are immunocompromised ¨Uncommon ¨Caused by decreased blood flow through the cystic artery ¨Can also be caused by extrinsic compression of the cystic duct by a mass or lymphadenopathy

Answer 47

Acalculous Cholecystitis

Question 48

¨Rare ¨Seen mostly in elderly females ¨Associated with a mobile gallbladder with a long suspensory mesentery ¨Clinical symptoms mimic acute cholecystitis ¨ ¨Sonographic findings massively inflamed and distended gallbladder, gangrene can develop ¨Treatment is surgical removal of GB

Answer 48

Torsion of the gallbladder

Question 49

¨Results from the calcification of the gallbladder wall ¨Occurs mainly in older female patients ¨May appear sonographically similar to WES sign ¨Has been associated with the potential development of gallbladder carcinoma (25%)

Answer 49

Porcelain gallbladder

Question 50

¨Rare, although most common cancer of the biliary tract ¨Caused by chronic irritation of the gallbladder wall by gallstones ¨Size \> 2cm , suspicous for carcinoma vs poloyp ¨Color doppler can reveal vessels within the malignancy ¨Most common metastatic disease of the gallbladder is malignant melanoma

Answer 50

Gallbladder carcinoma

Question 51

¨Weight loss ¨Right upper quadrant pain ¨Jaundice ¨Nausea and vomiting ¨Hepatomegaly

Answer 51

Clinical findings of gallbladder carcinoma

Question 52

¨Nonmobile mass within the gallbladder lumen that measures \>2cm ¨Gallstones seen in approx 90% ¨Diffuse or focal gallbladder wall thickening ¨Irregular mass that may completely fill the gallbladder fossa ¨Invasion of the mass into surrounding liver tissue

Answer 52

Sonographic findings of gallbladder carcinoma

Question 53

¨Choledocholithiasis ¨Cholangitis ¨Pneumobilia/hemobilia ¨Cholangiocarcinoma ¨Ascariasis

Answer 53

Bile Duct Pathology

Question 54

¨Primary – formation of stones in the bile duct resulting from a disease that leads to stasis or dilation of the ducts ¡Sclerosing cholangitis ¡Caroli’s disease ¡Parasitic infections ¡Chronic hemolytic diseases ¡Prior biliary surgery

Answer 54

Choledocholithiasis

Question 55

¨Secondary ¡Stones found in the bile duct that has migrated down from the gallbladder

Answer 55

Choledocholithiasis

Question 56

¨Inflammation of the biliary ducts ¨ 5mm Several types Acute bacterial AIDS Pyogenic Sclerosing ¡All of these have similar sonographic findings that include varying degrees of biliary dilatation, biliary sludge, and bile duct wall thickening

Answer 56

Cholangitis

Question 57

Recent biliary surgery Sequela of emphysematous cholecystitis Hemobilia-blood within biliary tree due to percutaneous intervention (liver bx) Symptoms of acute cholecystitis

Answer 57

Pneumobilia Hemobilia

Question 58

Dilated intrahepatic ducts that abruptly terminate at the level of the tumor A solid mass may be noted within the liver or ducts

Answer 58

Cholangiocarcinoma

Question 59

¨Congenital disorder ¨Found in younger adult or pediatric population ¨ ¨Characterized by segmental diliation of the intrahepatic ducts ¨May appear segmental, saccular, or berry shaped ¨ ¨Often seen in association with cystic renal disease and may precede the development of cholangiocarcinoma, a hepatic abscess, cholangitis and sepsis

Answer 59

Caroli disease

Question 60

¨Biliary atresia and Choledochal Cyst ¡Congenital disease thought to be caused by a viral infection at birth, although some think it may be an inherited disorder ¡A narrowing or obliteration of all or a portion of the biliary tree ¡This leads infants to suffer from cirrhosis and portal hypertension

Answer 60

Pediatric pathology of the bile ducts

Question 61

4 types Most common being described as the cystic dilatation of the Common bile duct Discovered in infancy or the first decade of life Jaundice Pain Fever

Answer 61

Choledochal cyst

Question 62

¨Cystic mass in the area of the porta hepatis (separate from the gallbladder) ¨Biliary dilatation

Answer 62

Sonographic findings of a choledochal cyst

Question 63

¨Jaundice ¨Pruitis ¨Unexplained weight loss ¨Abdominal pain ¨Elevated bilirubin ¨Elevated alkaline phosphatase

Answer 63

Clinical findings of cholangiocarcinoma

Question 64

¨Dilated intrahepatic ducts that abruptly terminate at the level of the tumor ¨A solid mass may be noted within the liver or ducts ¨Klatskin tumor- found at the junction of the left and right hepatic ducts

Answer 64

Sonographic findings of cholangiocarcinoma