The gallbladder and biliary system Flashcards
the right and left hepatic ducts emerge from the right lobe of the liver in the _____ and unite to form the common hepatic duct; runs parallel with the portal vein
porta hepatis
the common hepatic duct is approximately _____ in diameter and descends within the edge of the lesser omentum; it is joined by the cystic duct to form the common bile duct
4 mm
the normal common bile duct has a diameter of up to _____
6 mm
the CBD joins the main pancreatic duct, and together they open through a small ampulla (called the _____) into the duodenal wall
ampulla of vater
the end parts of both ducts and the ampulla are surrounded by circular muscle fibers known as the _____
sphincter of Oddi
the cystic duct is about _____ long and connects the neck of the gallbladder with the CHD to form the CBD
4 cm
the neck of the GB is _____ toward the porta hepatis
posteromedially
generally the normal GB measures about _____ in diameter and _____ in length; the walls are less than _____ thick
2.5 to 4 cm; 7 to 10 cm; 3mm; dilation of the GB is known as hydrops
the GB may fold back on itself at the neck, forming _____
Hartmann’s pouch; other anomalies include partial septation; complete septation (double GB); and folding of the fundus (phrygian cap)
______ in the neck of the GB helps to prevent kinking of the duct
heister’s valve
the arterial supply of the GB is from the _____, which is a branch of the right hepatic artery
cystic artery
_____ of the extrahepatic ducts (usually less than 1 cm) occur after cholecystectomy
dilation
_____ is the principal medium for excretion of bilirubin and cholesterol
bile; bile salts from the intestines stimulate the liver to make more bile, they activate intestinal and pancreatic enzymes
______ sign indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarge GB
Courvoisior’s
_____ and _____ may indicate stones in the CBD
nausea and vomiting
______ may develop when a tiny stone blocks the bile duct between the gallbladder and the intestines, producing pressure on the liver and forcing bile into the blood
jaundice
_____ or thickened bile frequently occurs from bile stasis
sludge; low-level echos layering in dependent parts of GB; prominent GB size; changes with position
biliary cause of _____ include cholecystitis, adenomyomatosis, cancer, acquired immunodeficiency syndrome, cholangiopathy, and sclerosing cholangitis
wall thickening; non biliary include diffuse liver disease, pancreatitis, portal hypertension, and heart failure, ascites
_____ is an inflammation of the GB that may have one of several forms; acute, chronic, acalculous, emphsysematous, or gangrenous
cholecystitis
the most common cause of _____ cholecystitis is gallstones; stones maybe impacted in hartmann’s pouch or cystic duct
acute; increased serum amylase, abnormal LFT’s; dilation of the rounding of GB; + murphy sign; thick GB wall with irregular wall; stones; pericholecystic fluid (same signs with acalculous)
with _____ cholecysitis, there is gas-forming bacteria in GB with abnormal LFT’s; 50% of times in diabetics
emphysematous; bright echoes in area of GB with ring down or comet tail artifact may appear as WES
with _____ cholecysitis, medium to coarse echogenic densities that fill the GB lumen in absence of duct obstruction; no shadow; not gravity dependent; and does not layer
gangrenous; causes the GB to undergo necrosis because of prolong infection; the walls may become inflamed with hemorrhage
_____ is the most common disease of the GB; check bilirubin levels; dilated GB wall
Cholelithiasis; gravity dependent calcification in GB; the tiny stones are more dangerous because they can enter the bile ducts and obstruct the outflow of bile
with cholelithiasis the patient normally falls under the five F’s, what are they?
fat, female, fertile, forty, and fair
_____ of the GB is a rare condition that is found more in elderly females and is associated with a mobile GB with a long suspensory mesentery
torsion; causes acute cholecystitis
a _____ GB is a rare occurrence that is defined as calcium incrustation of the GB wall; wall is thickly calcified with shadowing
porcelain; female predominance; found in patients over 60; small percent may develop carcinoma of the GB
_____ cholecystosis is represented by a variety of degenerative and proliferative changes of the GB characterized by hyperconcentration, hyperexcitability, and hyperexcretion
hyperplastic; cholesterolosis and adenomyomatosis are 2 types of this condition; malignancy is suspected when the polyp is singular and measures greater than 10mm
_____ is a condition in which cholesterol is deposited within the lamina propria of the GB; echogenic structure in extrahepatic duct; dilated biliary tree
cholesterolosis; increase in direct bilirubin; abnormal liver enzymes; leukocytosis; increased alkaline phosphatase; referred to as the strawberry GB
______ of the GB are small, well-defined soft tissue projections from the GB wall
polyps; cholesterol polyps are the most common pseudotumor of the GB; they are small, smooth ovoid wall projections; no shadow; comet tail
_____ are benign neoplasms of the GB with a premalignant potential; usually is a solitary lesion
adenoma; occurs as flat elevations located in the body of the GB, almost always near the fundus; does not change with position; no shadow produced
with _____ papillomas may occur single or in groups and may be scattered over a large part of the mucosal surface of the GB; does not move position changes; comet-tail artifact
adenomyomatosis
primary carcinoma of the GB is associated with _____ most cases; the mass is heterogenious, solid or semi-solid, there is dilated biliary ducts causing a shotgun sign (PV and dilated duct)
cholelithiasis; most frequently in women 60 years or older; adjacent liver is often invaded by direct continuity extending through tissue spaces, the ducts of Luschka, and the lymph channels,
_____ cysts are an unusual diverse group of diseases that may manifest as congenital, focal, or diffuse cystic dilatation of the biliary tree; may result form pancreatic juice refluxing
choledochal; jaundice; localized dilated cystic CBD; diverticulum in CBD; invagination of CBD into duodenum; dilated CBD and CHD
_____ is a rare congenital abnormality that is most likely inherited in an autosomal recessive fashion; 2 types simple classic form, and more common form that is associated with periportal hepatic fibrosis
Caroli’s disease; strongly associated with cystic disease of the kidney; multiple cystic structures in the area of the ductal system; sludge or calculi may reside in the dilated ducts
sonography cannot image the biliary ducts routinely until their size dilates to greater than _____
4mm; ducts greater than 6mm is considered borderline and more than 10 mm is dilated
_____ dilation occurs before intrahepatic, because ducts expand centrifugally from the point of obstruction
extrahepatic
what are the 3 primary areas for obstruction to occur in extrahepatic ducts?
intrapancreatic, suprapancreatic, and porta hepatic
what are the 3 important conditions that cause the majority of biliary obstruction at the level of the distal duct
pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation
_____ obstruction originates between the pancreas and porta hepatis
suprapancreatic
a ______ tumor is a specific type of cholangiocarcinoma that can occur at the bifurcation of the CHD, with involvement of both the central left and right duct
klatkin’s tumor; isolated intrahepatic duct dilation indicates cholangiocarcinoma
_____ syndrome is an uncommon cause for extrahepatic biliary obstruction resulting from an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the CHD
Mirizzi
choledocholithiasis is common duct stones; they are usually associated with _____
calculous cholecystitis; they tend to become impacted into the ampulla of Vater
biliary trauma secondary to percutanous biliary procedures or liver biopsies account for the majority of _____ cases
hemobila; blood in the biliary tree
_____ is air within the biliary tree
pneumobilia; bright echogenic linear structure that follow the portal triads; posterior dirty shadowing and reverberation artifact is seen
_____ is an inflammation of the bile duct
cholangitis; elevated lab values of serum alkaline phosphatase and bilirubin; decompression of CBD is necessary; may be hypoechoic or echogenic with stones
______ is a parasitic roundworm that uses a fecal-oral route of transmission; may be 20-30 cm long and 6 cm diameter; travels from the small bowel
ascariasis; gives a target appearance;
_____ biliary tumors are rare and are primarily limited to cystadenoma and cystadenocarcinoma
intrahepatic; cystic mass with multiple septa and papillary excrescences
_____ cholangiocarcinoma is found in the distal CBD
papillary
_____ is the second most common primary malignancy of the liver
intrahepatic cholangiocarcinoma; large hepatic mass; hypovascular
_____ cholangiocarcinoma usually begins in the right or left bile duct and then extends into the proximal duct and distally into the common hepatic duct and contralateral bile duct; can lead to atrophy of involved lobes
hilar; should also evaluate the hepatic artery for adenopathy and metastases; elevated cholestatic liver parameters
_____ cholangiocarcinoma may extend into the adjacent lymph nodes; tumor mass may be sclerosing or polypoid
distal; sclerosing tumor is nodular with focal irregular ductal constriction and wall thickening; hypoechoic and hypovascular; poorly defined margins
what is the most common sites that can spread to the biliary system?
breast, colon, or melanoma
