Test 3 - Biliary Flashcards
Where are the spiral valves of Heister located?
Cystic duct
Which portion of the gallbladder is most likely to extend inferior to the edge of the liver?
Fundus
Where is the distal common bile duct located?
at the ampulla of vater
What is the expected diameter of the common bile duct in a normal 30 year old female?
4 - 7 mm
On transverse scans, the fundus of the gallbladder presents as a(n) :
Circular, echo-free structure
Which hormone is released by the presence of fat in the intestine and regulates the gallbladder contraction and gastric emptying?
Cholecystokinin
At what location would you expect to see a Hartmans pouch in a gallbladder?
Neck
In what anatomic variant is the fundus of the gallbladder folded over the body?
Phrygian cap
What are three common symptoms that call for a gallbladder exam?
Jaundice
Nausea / vomiting
RUQ pain
The most efficient method to differentiate a bile duct from other structures is…
By the use of color Doppler
What is the most important factor associated with the formation of cholelithiasis ?
Abnormal bile composition
You are requested to image the gallbladder fossa following a cholecystectomy. Which of the following would best demonstrate this location?
Longitudinal view: including the right portal vein and main lobar fissure
What is unconjugated bilirubin associated with?
Massive hemolysis
What are three characteristics of acute calculus cholecystitis?
- Diffuse gallbladder wall thickening
- Cholelithiasis
- The halo sign
Note: NOT “loss of elasticity of gallbladder”
What are three labs that can be done to help in diagnosing gallbladder disease?
- Direct bilirubin
- ALT
- ALP
Note:
NOT “AFP”
Between males and females, which one has a higher prevalence of gallstones?
Females
What are two precursors to stone formation?
Abnormal gallbladder emptying &
Altered absorption
True/False
The majority of gallstones cause symptoms
False
The majority of stones in the US population are made up of (blank)
Cholesterol
What is the normal relationship of the gallbladder to the right kidney?
The right kidney is posterior to the gallbladder
What is one of the gallbladders physiologic functions regarding bile?
Concentrate
What describes a positive Murphy sign?
Pain with transducer pressure over the gallbladder
Which patient would most likely be diagnosed with biliary atresia?
A neonate male
True/False
The gallbladder remains stationary despite changes in the patients position.
False
You see an echogenic area in the gallbladder lumen. How would you determine if it was a stone, sludge ball, sludge, or an adenoma ?
(You need to give specific details on the sonographic characteristics, maneuvers, or modes used to make you differential diagnosis. Do not simply type one has this and the other doesn’t. Be specific in your answer. For full credit you need to discuss all the possibilities.)
• Start exam w/ patient in supine position. Examine the Shape of the echogenic area, if it is shaped more as a mass, then the diagnosis is narrowed down to gallstones or sludge balls If not, then it is narrowed to sludge or an adenoma. To narrow down the mass-type structures, use the gain and TGC’s to clear out echoes and then asses the appearance of the gallblacker. If the echogenic area is costing a Shadou, this is an indication of gallstones. If the area.
casts no shadow, then it would have to be Sludge balls.
To narrow down the non Circular, non Shadowing structures, adenomas
Sludge, have the patient turn in Left Lateral Decubitus position 3 assess (carefuly) if the echogenic area has moved. If it has stayed Stagnant, the diagnosis would be an adenomc. If it has slowly moved, then the diagnosis would be sludge.
Where are you most likely to find choledocholithiasis?
Common bile duct
What are four of the “F” words used to make you at higher risk for gallstones?
Female
Fertile
Fat
Forty
Fair
List two things that appear similar to choledocholithiasis? (Stone in CBD)
- When there are calcifications in the head of the pancreas
- When the beam is refracting
