Lesson 10 (Part 2) Flashcards
What is the number one imaging modality for the biliary system?
Ultrasound
Why is U/S the number 1 modality for scanning the gallbladder? (3)
- We see fluid well
- Can identify stones easily
- Is in real time so we can see the stones move
What are clinical indications for scanning the gallbladder? (2)
- Pain
2. Jaundice
Jaundice
A medical condition of yellowing of the skin
What are 3 patient history questions regarding the gallbladder?
- Have you had any surgery?
- Does it hurt to push directly on the gallbladder?
- positive Murphy’s sign - Do they experience pain after eating?
What are the measurements of the gallbladder in transverse?
<4cm
What is the measurement of the wall thickness in gallbladder?
<3mm
What is the echogenicity of the gallbladder (lumen)?
Anechoic
What is the echogenicity of the walls of the gallbladder?
Hyperechoic or echogenic
What is the contour of the gallbladder?
Smooth
What does the gallbladder look like in sagittal position?
Anechoic and pear shaped with echogenic walls
- should see fundus, body and neck
What does the gallbladder look like in transverse position?
Round/oval anechoic structure with echogenic walls
- looks similar to the aorta or IVC (so be careful)
What happens when someone does not fast for a gallbladder scan? (3)
- The gallbladder contacts
- Lumen is anechoic with random echoes
- Thicker walls
When is it common for women to get gall stones?
During pregnancy
- or right after
How long do patients fast for a biliary system scan?
6-8 hours
- min 4
What are 2 typical positions patients can lay in for a biliary system scan?
- Supine
2. Left lateral decubitus
What are 2 windows used to scan the biliary system?
- Anterior
- subcostal approach - Intercostal
Why is it important to scan the gallbladder in 2 patient positions?
Because if you think you are seeing stones and you turn the patient on their side they should move because we scan in live time
- otherwise it could be an artifact in your image
What wall do we measure and why? (2)
- Anterior wall
2. Because it is closer to the transducer
What does gravity dependant mean?
That we can tell if the stones are mobile or not
Where is the fundus situated in the supine position?
More anterior
- higher up
Where is the fundus situated in the decubitis position?
More posterior
- lower down
What are 2 important questions to ask a patient before you scan the gallbladder?
- Have they fasted
- Have they had any surgeries
- need to make sure they have a gallbladder
What are 4 landmarks for the gallbladder?
- Right upper quadrant
- Right kidney
- Main lobar fissure
- Trans liver portal vein
- starting point
What are the challenges with scanning the gallbladder? (2)
- Its close to the bowel
- could cause shadowing - Reverberation artifact
How to overcome challenges when scanning the gallbladder? (3)
- Change the patients position
- gravity helps clear it up - Exam the origin to distinguish between normal and the pathology
- Have them breath in
What button on the ultrasound machine can help with clearing up the gallbladder?
Harmonics
- THI
What is it called when the common hepatic duct meets the cystic duct?
The common bile duct
If you follow the common bile duct where does it lead you to?
The pancreatic head
What is the normal caliber of the CHD/CBC?
<7mm
What does >7mm caliber for the gallbladder indicate?
That there is a problem
What is the size of the CBD affected by? (2)
- Age
2. After surgery
What happens to the CBD as you get older?
It gets more dilated
What happens to the CBD after surgery?
It gets bigger
Why does the CBD get bigger after surgery?
It has to do more work and gets bigger due to the flow of bile
