GB Flashcards
What shape is a normal gallbladder?
pear-shaped hollow organ
What are the parts of the GB?
neck, body, fundus
What is the size of the GB?
7-10 cm in length 2.5-4 cm in width
An increase in size of a GB is called what?
hydrops
What keeps the cystic duct of the neck of the GB from kinking?
Heister’s valves
What is the vascular supply of the GB?
cystic artery and cystic vein
Where does the GB lie?
intrahepatic, migrating to the surface of the liver
What is the GB covered by?
a peritonal layer on most of it and an adventicia layer on the covering the rest
What does the GB store
approx. 50 mL of bile
How does bile get into the GB?
Bile is forced into the GB due to an increased pressure within the CBD produced by the action of the Sphincter of Oddi
How does bile get out of the GB?
As the stomach empties the food into the duodenum, the intestines secrete enzymes and bile salts that stimulate the GB to contract and push bile into the duodenum
How does the GB concentrate bile?
folds within the mucous membrane of the wall (with honeycomb appearance) unite with each other
What ducts are in the biliary system?
right and left hepatic duct, common hepatic duct, common bile duct, cystic duct and GB
The right and left hepatic ducts come from the right lobe of the liver in the porta hepatis and unite to form what?
Common Hepatic Duct
The common hepatic duct joins the ____ duct to form the ____ ____ ____ .
cystic; common bile duct
The common bile duct ends by piercing into the wall of the duodenum to join the ____ _____ ____. Together they open into the duodenum through the ____ ____ ____.
Main Pancreatic Duct; Ampulla of Vater
The CBD lies laterally to the ____ ____ and anterior to the ____ ____ .
Hepatic artery; portal vein
WHat is the normal measurement of the CBD?
1 mm per decade; 6mm = 60 yrs
The cystic duct connects the neck of the GB to the ___ ____ ____.
Common hepatic duct
What is the med term for removal of the gallbladder?
cholecystectomy
Where does bile goes when a patient has a cholecystectomy?
Bile is stored in the CBD, which makes it larger in diameter; it freely moves into the duodenum at fasting or non-fasting states
hydropic gallbladder
enlargement of the gb
Courvoisier gallbladder
An enlarged often palpable on physical exam
caused by a pancreatic head mass
Cholelithiasis
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)
Asymptomatic Biliary colic Abdominal pain after fatty meals Epigastric pain Nausea and vomiting Pain that radiates to shoulders
Cholelithiasis
Echogenic, nonshadowing, and nonmobile
masses that projects from the gallbladder wall into the gallbladder lumen
Also called adenoma
polyps
polyps
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
Adenomyomatosis
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
Acute cholecystitis
Sudden onset of gallbladder inflammation
Focal tenderness, caused by inflammation is
termed a positive sonograghic Murphy’s sign
Murphy’s sign is local tenderness over the
gallbladder with transducer pressure
Chronic cholecystitis
Most common form of gallbladder
inflammation
Gallbladder carcinoma
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
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
Acute cholecystitis
Gallstones Positive sonographic Murphy’s sign Gallbladder wall thickening Pericholecystic fluid Sludge
Acute cholecystitis
Acalculous cholecystitis
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
Rare Seen mostly in elderly females
torsion of the gallbladder
Porcelain gallbladder
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%
Weight loss Right upper quadrant pain Jaundice Nausea and vomiting Hepatomegaly
Gallbladder carcinoma
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
Gallbladder carcinoma
the opening that allows bile and pancreatic juices to flow into the duodenum
The spincter of Oddi
Choledocholithiasis Primary –
formation of stones in the bile duct
resulting from a disease that leads to stasis or
dilation of the ducts
Caroli’s disease
form of Primary Choledocholithiasis
Choledocholithiasis Secondary
Stones found in the bile duct that has migrated down
from the gallbladder
Cholangitis
Inflammation of the
biliary ducts >5mm
Caroli’s disease
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
Dilated intrahepatic ducts that abruptly terminate at the level of the tumor
A solid mass may be noted within the liver or ducts
Cholangiocarcinoma
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
Choledochal cyst
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
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
Cholangiocarcinoma
Cholangiocarcinoma
Jaundice Pruitis Unexplained weight loss Abdominal pain Elevated bilirubin Elevated alkaline phosphatase
