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Abdomen Section 2 > Gallbladder reverse > Flashcards

Gallbladder reverse Flashcards

1
Q
A
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2
Q

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

A

Anatomy of the gallbladder

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3
Q

—Size is variable,

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

A

Gallbladder size

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4
Q

An increase in GB size is termed

A

Gallbladder Hydrops

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5
Q

—in the neck keeps the cystic duct from kinking

A

Heister’s valves function

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6
Q

—CYSTIC ARTERY
—CYSTIC VEIN

A

gallbladder Vascular Supply

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7
Q

—a branch of the right hepatic artery

A

CYSTIC ARTERY-

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8
Q

—drains the blood directly into the portal vein

A

CYSTIC VEIN-

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9
Q

—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

A

Gallbladder location

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10
Q

gallbladder not developed

still has biliary duct system

A

gallbladder agenesis

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11
Q

Stores bile produced by the liver can hold approx 50 ml

-Concentrates bile when the body is in a fasting state

A

gallbladder function

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12
Q

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

A

How does the bile get into the gallbladder

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13
Q

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

A

How does bile get out of the gallbladder

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14
Q

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

A

How does the gallbladder concentrate bile

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15
Q

—Consists of the right and left hepatic duct,

common hepatic duct,

common bile duct,

pear shaped gallbladder,

and cystic duct

A

Anatomy of the Bile Ducts

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16
Q

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

A

Right and left hepatic ducts

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17
Q

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

A

Common Hepatic Duct

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18
Q

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

A

CBD ends

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19
Q

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

A

CBD (prox portion) location

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20
Q

—Normal measurement is

A

CBD measurement

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21
Q

approx 4 cm long,

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

normally not seen by ultrasound

A

Cystic Duct-

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22
Q

—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

A

Physiology after removal of gallbladder

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23
Q

Bilobed gallbladder

Septated gallbladder

Phrygian cap

Hartmann pouch

Junctional fold

A

Normal variants of the Gallbladder

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24
Q

Hourglass appearance

A

Bilobed gallbladder

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25
Q

Appear as thin separations within the gallbladder

A

Septated gallbladder

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26
Q

Gallbladder fundus is folded onto itself

A

Phrygian cap

27
Q

Outpouching of gallbladder neck

A

Hartmann pouch

28
Q

Prominent fold located at the junction of the gallbladder neck

A

Junctional fold

29
Q

¨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

A

Gallbladder enlargement

30
Q

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

A

Gallbladder Pathology

31
Q

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

A

Cholelithiasis Risk factors and predisposing conditions

32
Q

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

A

Clinical findings of cholelithiasis

33
Q

¨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)

A

Sonographic findings of cholelithiasis

34
Q

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

A

Sonographic findings of polyps

35
Q

¨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

A

Clinical findings of polyps

36
Q

¨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

A

Adenomyomatosis

37
Q

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

A

Acute Cholecystitis

38
Q

¨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

A

Clinical Findings of Acute Cholecystitis

39
Q

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

A

Sonographic findings of Acute cholecystitis

40
Q

local tenderness over the gallbladder with transducer pressure

A

Murphy’s sign

41
Q

Chronic cholecystitis

Gangrenous cholecystitis

Emphysematous cholecystitis

(bacterial invasion within the gallbladder wall)

Gallbladder perforation

A

Sequela of Acute Cholecystitis

42
Q

Nontender gallbladder/intolerance to fatty foods/belching

Gallstones

Possible gallbladder wall thickening

A

Chronic cholecystitis

43
Q

Elevated symptoms of acute cholecystitis

Linear echogenic membranes within the lumen of the gallladder/striated gallbladder wall

A

Gangrenous cholecystitis

44
Q

Elevated symptoms of acute cholecystitis

Diabetes

Gas within the gallbladder wall that leads to ring down artifact/gallstones may not be present

A

Emphysematous cholecystitis

(bacterial invasion within the gallbladder wall)

45
Q

Elevated symptoms of acute cholecystitis

Small opening or tear in the gallbladder wall

A

Gallbladder perforation

46
Q

¨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

A

Chronic cholecystitis

47
Q

¨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

A

Acalculous Cholecystitis

48
Q

¨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

A

Torsion of the gallbladder

49
Q

¨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%)

A

Porcelain gallbladder

50
Q

¨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

A

Gallbladder carcinoma

51
Q

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

A

Clinical findings of gallbladder carcinoma

52
Q

¨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

A

Sonographic findings of gallbladder carcinoma

53
Q

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

A

Bile Duct Pathology

54
Q

¨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

A

Choledocholithiasis

55
Q

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

A

Choledocholithiasis

56
Q

¨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

A

Cholangitis

57
Q

Recent biliary surgery

Sequela of emphysematous cholecystitis

Hemobilia-blood within biliary tree due to percutaneous intervention (liver bx)

Symptoms of acute cholecystitis

A

Pneumobilia
Hemobilia

58
Q

Dilated intrahepatic ducts that abruptly terminate at the level of the tumor

A solid mass may be noted within the liver or ducts

A

Cholangiocarcinoma

59
Q

¨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

A

Caroli disease

60
Q

¨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

A

Pediatric pathology of the bile ducts

61
Q

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

A

Choledochal cyst

62
Q

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

A

Sonographic findings of a choledochal cyst

63
Q

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

A

Clinical findings of cholangiocarcinoma

64
Q

¨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

A

Sonographic findings of cholangiocarcinoma

Abdomen Section 2 (8 decks)

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