GB Flashcards
1
Q
The 4/5-week embryo develops a bud from the foregut that grows _____ (direction); the cranial portion becomes the _____ and the _____.
A
Cephalad
Liver
Hepatic bile ducts
2
Q
In the _____ portion of the growing bud, a second bud develops, also called the _____, and this becomes the gall bladder and cystic duct.
A
caudal
diverticulum
3
Q
This is a rare condition that results from the failure of the cystic bud to develop in the 4th week of intrauterine life.
A
agenesis of the GB
4
Q
This condition often occurs with duplication of the cystic duct and may be diagnosed prenatally.
A
duplication of the GB
5
Q
The GB’s main function is to
A
store bile
6
Q
T or F? When stored in the GB, bile becomes less concentrated and therefore more powerful in its ability to do its work.
Why?
A
False
MORE concentrated = MORE powerful
7
Q
This organ is often also removed automatically with gastric bypass surgery.
A
GB
8
Q
What hormone is released with the ingestion of food (especially fats), that signals the relaxtion of the valve at the end of the CBD (the sphincter of _____) which lets the bile enter the small intestine.
A
cholecystokinin
Oddi
9
Q
What does the release of cholecystokinin signal (2)
A
the relaxation of the sphincter of Oddi
the contraction of the GB
10
Q
When the GB contracts, what happens?
A
It squirts the concentrated bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal.
11
Q
This is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the Ampulla of Vater into the second part of the duodenum.
A
Sphincter of Oddi
12
Q
This is relaxed by the release of cholecystokinin (CCK).
A
Sphincter of Oddi
13
Q
What 2 vessels merge at the Ampula of Vater?
A
CBD and Pancreatic Duct
14
Q
This consists of cholesterol, lecithin, calcium, bile salts, acids and waste materials among other things.
A
Bile
15
Q
What happens within bile that is a cause of gallstones?
A
the bile salts and cholesterol become umbalanced
16
Q
T or F? Bile is continually being made and secreted by the liver in varying amounts into bile ducts.
A
true
17
Q
Some of the bile that is made and secreted go directly into the _____ and some into the _____.
A
small intestines
GB
18
Q
This also acts as a reservoir that uptakes excess bile when there is pressure in the bile ducts.
A
GB
19
Q
The 2 major functions of bile are
A
1) emulsifies fats so that the body can use them
2) acts as an antioxident to help remove toxins from the liver
20
Q
The GB lies in the _____ margin of the liver, between the RLL and LLL.
A
inferior
21
Q
This vessel may be used to help find the GB fossa, which is in the same anatomic plane.
A
MHV
22
Q
Most hepatic ultrasounds will see and use this as a landmark for the GB fossa.
A
MLF
23
Q
The GB derives its blood supply from the _____.
A
cystic artery
24
Q
The cystic artery arrises from the _____ and supplies the GB with blood.
A
RHA
25
T or F? You can't see the cystic artery or cystic vein on U/S.
True
26
Sometimes the proper hepatic artery skips the RHA and connects directly to the _____.
cystic artery
27
The GB is divided into _____ (#) parts, which are
3
neck
body
fundus
28
The GB neck terminates in the _____.
narrow infundibulum
29
This area of the GB is a common location for impaction of gallstones.
infundibulum (Hartmann's Pouch)
30
This is a region of the GB neck that may be angulated in some people.
infundibulum
| Hartmann's Pouch
31
Failure to identify the GB on an exam is most often due to
a previous cholecystectomy
32
Occasionally it is hard to find the GB in an exam because of this condition, which leads to a collapsed and fibrosed GB.
chronic cholecystitis
33
The GB may lie in _____ positions and be difficult to locate.
ectopic
34
The GB may fold onto itself, the body onto the _____ or the _____ onto the body.
neck
| fundus
35
When the GB fundus folds onto the body, this is known as a _____ and has no clicial significance.
phrygian cap
36
This is a GB composed of 2 or more intercommunicating compartments divided by a THIN septa.
Septate GB
37
This is an GB composed of 2 or more intercommunicating compartments divided by a THICK septa.
Hourglass GB
38
The GB is located at the _____ end of the MLF in the area we call the GB _____.
inferior
| fossa
39
The _____ (vessels) converge to form the RHD and LHD.
intrahepatic bile ducts
40
The _____ (vessels) converge to form the CHD.
RHD and LHD
41
The GB neck tapers to form the _____ which joins with the CHD to form the CBD.
cystic duct
42
The _____ and _____ join to form the Ampulla of Vater.
CBD
| Main Pancreatic Duct
43
Within the cystic duct and sometimes the GB neck, small mucosal folds exist called
Spiral Valves of Heister
44
T or F? Sometimes you will see the Spiral Valves of Heister on U/S.
True
45
The Spiral Valves of Heister control the bile flow in the _____ (vessel).
cystic duct
46
Spiral Valves of Heister are problematic at times because _____ can get stuck in them.
gallstones
47
The GB appears as a _____ (echogenicity) oblong structure _____ (relationship/location) to the right kidney, _____ (relationship/location) to the head of the pancreas and duodenum, indenting the _____ to medial aspect of the RLL.
sonolucent
anterior
lateral
inferior
48
The GB size should be less than _____ transversely and less than _____ sagitally.
4cm
| 10cm
49
The wall thickness of the GB should be less than _____ and measured at the _____ portion.
3mm
| fundus
50
The GB is located in the _____ (quadrant), between the _____ and _____.
RUQ
RLL
LLL
51
The bright linear reflector within the liver that connects the GB and the RPV or MPV is the
MLF
52
T or F? A prominent GB may be normal in some people because of their fasting state.
True
53
If the GB appears too large, administration of a _____ _____ and further evaluation may differentiate between normal and abnormal. If contraction does not occur, the _____ area should be studied for suspicious masses.
fatty meal
| pancreatic
54
The contracted GB wall appears thick and may obscure _____ or _____ abnormalities.
luminal
| wall
55
The exam of a GB should be performed after a minimum of _____ hours of fasting.
6
56
A well contracted GB changes in the following ways (3):
1) strong, reflective outer contour
2) poorly reflective inner contour
3) sonolucent area between both reflecting structures
57
T or F? A GB ultrasound MUST be performed in at least 2 different patient positions.
True
58
If the GB is not visualized, what should be done?
Maneuvers to evaluate the GB fossa are essential to avoid missing GB pathology
59
The rule of thumb for measuring the GB is to compare it to the _____ in the _____ plane. The width of the GB should always less than _____.
right kidney
transverse
5cm
60
Within the liver parenchyma, the bile ducts follow the same course as the _____ and the _____. All of these vessels are contained in a _____ _____ _____ that forms the _____ _____.
portal veins
hepatic artery
common collagenous sheath
portal triad
61
The proximal portion of the CBD is _____ to the PHA and _____ to the MPV.
lateral
| anterior
62
The CBD becomes more posterior after it descends behind the _____ bulb and enters the _____.
duodenal
| pancreas
63
The distal CBD lies _____ to the anterior wall of the IVC .
parallel
64
The 5 common risk factors for gallstone disease are
1) Forty something
2) Female
3) Fat
4) Fertile
5) Fair skinned
65
Although most patients are asymptomatic of gallstone disease, some develop a complication that is most often
biliary colic
66
Biliary colic is
recurrent episodes of abdominal pain
67
Sonography is considered highly sensitive in the detection of gallstones because
the variable size and number of stones within the GB give them different appearances on ultrasound
68
The reason gallstones are highly reflective is because of the
large difference in the acoustic impedance of stones and adjacent bile
69
The high reflective gallstones appear _____ (echogenicity) with strong _____ _____ _____ .
echogenic
| posterior acoustic shadowing
70
Stones smaller than _____ may not shadow but will still appear _____.
5mm
| echogenic
71
This is the key feature of stones that allows differentiation from polyps or other entities.
mobility
72
Do small stones or large stones cause more complications and pain usually? Why?
small
| because they can travel out of the GB and get lodged in the ducts
73
List 4 possible positions to demonstrate mobility of stones during scanning.
1) RLD
2) LLD
3) upright
4) standing
74
This appears as the GB wall in the near field, followed by a sliver of anechoic bile, then bright echo of a stone, followed by acoustic shadowing.
WES sign
75
WES stands for
wall echo shadowing
76
WES is also known as
double arc
77
Cholelithiasis is
gallstones
78
Choledocholithiasis is
gallstones in the CBD
79
T or F? Blockage and infection caused by stones in the biliary tract can be life threatening. However, with prompt diagnosis and treatment, the outcome is usually very good.
true
80
This is a rare condition in which the GB becomes filled with a pasty semi-solid substance made mostly of calcium carbonate.
Milk of Calcium Bile
81
Milk of Calcium Bile is also called
Limey Bile
82
Milk of Calcium bile involves a semi-solid substance made mostly of
calcium carbonate
83
Milk of Calcium Bile or Limey Bile is often associated with (caused by) _____.
GB stasis
84
T or F? Milk of Calcium Bile or Limey Bile often causes acute cholecystitis.
False (it rarely does)
85
The appearance of Milk of Calcium Bile/Limey Bile is
high echogenic material with posterior acoustic enhancement
86
This is made up of residual particles that remain in the GB after it sends bile from the liver to the intestines to further break down food. If the GB doesn't empty correctly, proteins can be left behind resulting in this.
sludge
87
This can solidify in the GB, causing gallstones.
sludge
88
3 other terms for GB sludge are
biliary sludge
biliary sand
microlithiasis
89
Why do people that have been fasting or are critically ill have problems with GB sludge?
Because since they aren't eating, cholecystichinin isn't being released, so the GB isn't contracting to release the stored bile from the GB.
90
The kinds of people with a higher risk for sludge are/have experienced (7)
```
Pregnant
Rapid weight loss
Prolonged fasting/critically ill
Bone marrow transplant
Biliary stasis
Cystic duct obstruction
Cholecystitis
```
91
Why is the GB often removed automatically during gastric bypass surgery?
Because the rapid weight loss can result in sludge filling the entire GB
92
Complications of sludge are (4)
1) gallstones
2) biliary colic (pain)
3) acalculous cholecystitis ("no stone inflammation")
4) pancreatitis
93
Amorphous, low level echoes within the GB in the dependent position with no shadowing is probably
sludge
94
If sludge mimics polypoid tumors, it is called either _____ or _____.
```
tumefactive sludge
sludge balls (organization of the sludge)
```
95
Occasionally, the sludge in the GB has the same echotexture as the liver, leading to camouflage of the GB, this is called
hepatization of the GB
96
Camouflage of the GB =
hepatization of the GB
97
What are GB polyps?
Tumor or tumor-like projections arising from the GB mucosa.
98
T or F? Although most polyps are benign, some early GB carcinomas present as polypoid lesions.
True
99
Polyps need to be followed up for a(n) _____ in size and changes which may suggest _____ _____.
increase
| malignant transformation
100
The most common kind of polyp is a _____ polyp.
cholesterol
101
What size polyp requires follow-up?
5-10mm
102
Inflammation of the GB is called
cholecystitis
103
A relatively common disease accounting for some patients in the ER with abdominal pain is
acute cholecystitis
104
Acute cholecystitis is caused by _____ in more than 90% of cases.
gallstones
105
With cholecystitis, impaction of stones in the cystic duct or the GB neck results in obstruction with _____ distention, _____, superinfection, and eventually _____ of the GB.
luminal
ischemia
necrosis
106
This is associated with RUQ pain, fever, and leukocytosis
acute cholecystitis
107
Can you tell the difference between acute and chronic cholecystitis on an ultrasound?
No
108
Sonographic findings of cholecystitis are (7)
1) Thickened GB wall
2) distention of the GB lumen
3) gallstones
4) impacted stone in cystic duct or gb neck
5) pericholecystic fluid collections
6) positive Murphy's sign
7) hypermic GB wall with doppler
109
_____ (hormone) elevation suggests obstruction at the level of the Ampula of Vater (with cholecystitis).
amylase
110
7 complications of acute cholecystitis are
1) gangrenous cholecystitis
2) emphysematous cholecystitis
3) empyema
4) GB perforation
5) acalculous cholecystitis
6) torsion of the GB
7) pericholecystic abscess
111
This is loss of tissue due to decreased blood supply (with cholecystitis).
gangrenous cholecystitis
112
3 signs of gangrenous cholecystitis are
1) wall striations
2) intraluminal membranes
3) pericholecystic fluid
113
This condition means the GB wall is necrosing
gangrenous cholecystitis
114
This is acute cholecystitis due to GB wall ischemia and infection. This condition occurs most often in _____ men.
emphysematous cholecystitis
| diabetic
115
This complication of cholecystitis may result in a fever because of infection involved with this condition.
emphysematous cholecystitis
116
Pus from bacteria-containing bile within the GB is
empyema
117
Purulent =
pus
118
This complication of cholecystitis is initiated with obstruction of the cystic duct.
empyema
119
Localized fluid collection in the GB fossa is
GB perforation
120
If the fluid leaks from GB perforation, these complications can occur (3)
1) peritonitis
2) pericholecystic abcess
3) biliary fistula
121
This is acute cholecystitis without gallstones.
acalculous cholecystitis
122
Acalculous cholecystitis is associated with existing conditions such as (6)
1) prolonged use of TPN
2) abdominal surgery
3) trauma
4) severe burns
5) sepsis
6) AIDS
123
This is rare but patients may present with symptoms of acute cholecystitis. This is seen most often in females and sonographically looks like a massively distended and inflamed GB lying in an unusual horizontal position.
torsion of the GB
124
GB in unusual HORIZONTAL postion =
torsion of the GB
125
Another word for torsion is
volvulus
126
If torsion of the GB is >180 degrees, _____ sets in.
gangrene
127
With torsion of the GB, a twist of the _____ (vessel) and _____ (vessel) may be visible.
cystic artery
| cystic duct
128
T or F? GB torsion is rarely diagnosed preoperatively.
True
129
This is characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis.
chronic cholecystitis
130
Do acute and chronic cholecystitis appear different sonographically?
No
131
Findings with chronic cholecystitis may include (3)
1) thick fibrotic GB wall
2) sludge
3) obstruction of the cystic duct by a stone
132
An unusual variant of chronic cholecystitis is
xanthogranulomatous cholecystitis
133
Xanthogranulomatous cholecystitis causes spreading to _____.
adjacent organs
134
The GB is thickened and irregular with extension of yellow inflammation to adjacent organs. This condition is extremely difficult to suspect preoperatively as it macroscopically resembles carcinoma of the GB. This is
Xanthogranulomatous cholecystitis
135
CBD should be less than _____, unless over the age of _____, in which it will often increase an extra mm a year.
6mm
| 60
136
Although the CBD should be less than 6mm below the age of 60, if the GB is removed it can be up to _____.
1 cm
137
When is GB removal usually necessary?
when gallstones begin causing problems
138
GB wall thickness should be less than _____ and the most common cause of GB wall thickening is _____.
3mm
| cholecystitis
139
Other causes, besides cholecystitis, of GB wall thickening are
```
hypoalbuminemia
ascites
hepatitis
CHF
pancreatitis
```
140
There are many causes of GB wall thickening, but with acute cholecystitis, a difference can sometimes be that
marked thickening of the wall with visible stratification, as seen in general edmatous states, is not present
141
The origin of the RPV to the GB fossa is the
MLF
142
Normal GB wall thickness can be up to _____ thick after eating.
5mm
143
Postprandial means
after eating
144
What is hyperplastic cholecystitis?
polyps
145
Will benign ascites thicken the GB wall?
Yes
146
Will malignant ascites thicken GB wall?
No
147
The most common anatomic variants of the GB are
junctional folds
148
The term for after you eat is
Postprandial
