Gallbladder and biliary Abd study cards

What are the small valves found within the cystic duct called?

Spiral Valves of Heister

What organ acts as a storage pouch for bile?

Gallbladder

What is the term used for inflammation of the bile ducts?

Cholangitis

What variant of the GB is seen when the fundus of the GB is bent backwards on itself?

Phrygian cap

What drains into the duodenum after it joins the main panc duct?

Common bile duct

What is the medical term for gallstones in the GB?

Cholelithiasis

Name the small opening in the duodenum where the panc and common bile duct enter

Ampulla of vater

What is the medical term used for tenderness over the area of the GB upon palpation?

Murphy’s sign

What does choledocholithiasis refer to?

Stones in the bile duct

Describe adenomyomatosis

Small polypoid projections from the wall of the GB

Low-level echoes found along the posterior margin of the GB; moves with pt position is called (BLANK)

Sludge

Which bile duct system drains the liver into the common bile duct?

Common hepatic duct

What is the medical term for removal of the GB?

Cholecystectomy

What is the sonographic pattern found when the GB is filled with stones?

Wall echos shadows or WES sign

What is the small muscles that guard the ampulla of Vater?

Sphincter of Oddi

What is the yellow pigment in bile formed by the breakdown of red blood cells?

Bilirubin

Describe polyps

Well-defined small soft tissue projection from the GB wall

What is a junctional fold?

Small septum within the gallbladder usually arising from the posterior wall and considered the most common GB anomaly

Whats is the small part of the GB that lies near the cystic duct where stones can collect?

Hartmann’s pouch

What does WES stand for?

Wall echo shadow

What joins together to form the common bile duct?

Common hepatic duct and cystic duct

What is the normal GB wall thickness?

Less than 3 mm

True or False? Sometimes the GB is situated in an intraphepatic location, or another anomalous location, and it may be difficult to detect unless the entire abdomen is examined.

True

What unites to form the common hepatic duct?

right an left hepatic ducts

What does the body of the GB come into contact with?

Visceral surface of the liver

How much bile can a GB hold?

50 ml

What is the GB divided into?

Neck, body; fundus

How large in the Common hepatic duct?

4 mm

What helps prevents kinking of the cystic duct?

Spiral Valves of Heister

The hepatic duct runs (BLANK) with the portal vein

Parallel

Which bile duct drains the liver into the common bile duct?

Common hepatic duct

What forms the Hartmann’s pouch?

When the GB folds back onto itself at the neck

How long is the cystic duct?

4 cm

Which two ducts join together and open through the ampulla of Vater into the duodenal wall?

Common bile duct and main panc duct

The proximal portion of the common bile duct is located (BLANK) to the hepatic artery and (BLANK) to the portal vein

Lateral; anterior

When the common bile duct and main panc join and enter the duodenum via the ampulla of Vater, what are these ducts and the ampulla of Vater surrounded by?

Sphincter of Oddi

What is the normal size of the common bile duct?

6 mm

What is dilation of the GB known as?

Hydrops

Generally, how large if the GB?

2.5 to 4 cm in diameter; 7-10 cm long

What supplies blood to the GB?

Cystic artery

True or false? When the GB is removed, the sphincter of Oddi gains tonus, and pressure within the common bile duct increase?

False

How is the neck of the GB oriented?

Posteromedially toward the porta hepatis

What does the cystic duct connect with to form the common bile duct?

Common Hepatic duct

Describe a Phrygian cap?

A fold of the GB at the fundus

What does the fundus of the GB come into contact with?

Anterior Abdominal wall

What drains blood from the GB?

Cystic vein

Where are the Spiral Valves of Heister located?

Neck of the GB

What is the principal medium for excretion of bilirubin and cholesterol?

Bile

What causes the GB to contract?

Food

Where does the cystic vein drain?

Portal vein

What is the cystic artery a branch of?

Right hepatic artery

What is referred to as the “Mickey mouse sign”?

The Common bile duct, Hepatic artery, and Portal Vein

Is the common bile duct anterior or posterior to the portal vein?

Anterior

What can cause pressure in the biliary tree with pus accumulation?

Cholangitis

Describe the sonographic appearance of sludge

Prominent GB size, low-level internal echoes layering in the dependent part of the GB, and changes with pt positioning

What position should the GB be scanned in when looking for gallstones?

Left decube, upright, and right decube

What is porta hepatic obstruction usually caused by?

Neoplasm

Is acute cholecystitis found more often in males or females?

Females

Roughly 50% of pts with emphysematous cholecystitis also have what?

Diabetes

What are the clinical symptoms of acute cholelithiasis?

Epigastric pain, nausea and vomiting

What is a hyperplastic change of the GB wall called?

Adenomyomatosis

With emphysematous cholecystitis, what should the sonographer look for if the gas is intraluminal?

Prominent bright echoes along the anterior wall with ring-down or comet tail artifact

What are the clinical findings seen with porcelain GB?

Asymptomatic, usually found incidentally

Sonographically, what is seen when the GB is packed full of stones?

Wall echo shadow or WES

True or false? Pts with carcinoma of the GB are usually asymptomatic?

True

What is associated with the presence of gas-forming bacteria in the GB wall and lumen with extension into the biliary ducts?

Emphysematous cholecystitis

What is the most classic symptom of GB disease?

Right upper quad abdominal pain after a fatty meal

What uncommon condition is an acute inflammation of the GB in the absence of cholelithiasis?

Acalculous cholecystitis

True or false? Carcinoma of the GB is very common

False

What does sludge frequently occur from?

Bile stasis

Where is pneumobilia commonly seen?

Hilum of the liver

What is a painful serious complication of acute cholecystitis that can lead to perforation?

Gangrenous cholecystitis

Where is a Klatskin tumor located?

At the junction of the right and left hepatic ducts

True or false? Sludge is gravity dependent

True

What are the sonographic findings seen with gangrenous cholecystitis?

Medium to coarse echogenic densities that fill the GB lumen, does not shadow, does not layer, and is not gravity dependent

What is the sonographic appearance of milk of calcium bile?

Fluid-filled levels with acoustic shadows

What can a choledochal cyst be associated with?

Gallstones, pancreatitis and cirrhosis

What is carcinoma of the GB associated with in about 80-90% of the time?

Cholelithiasis

What is the most suggestive sonographic feature to indicate cholangiocarcinoma?

Isolated intrahepatic duct dilation

Where does a suprapancreatic obstruction originate?

Between the pancreas and porta hepatis

What is choledocholithiasis?

Stones in the bile duct

Describe Courvoisier GB?

Non-diseased and enlarged GB associated with an obstruction within the distal common bile duct

How is the GB wall best measured sonographically?

In the transverse plane, from outer to outer margins on the anterior wall

What is cholesterolosis commonly referred to as?

Strawberry GB

In cholelithiasis, which is more dangerous: small stones or large stones?

small

What does cholangiocarcinoma originate?

Common duct or common hepatic duct

Where are the three primary areas for extrahepatic biliary obstruction?

Porta hepatic, suprapancreatic, and intrapancreatic

How is a choledochal cyst diagnosis confirmed?

Nuclear medicine hepatobiliary scan

What occurs first: intrahepatic ductal dilation or extrahepatic ductal dilation?

Extraphepatic ductal dilation

What are the sonographic findings of an intrahepatic biliary tumor?

Cystic mass with multiple septa, unilocular, calcified or multiple; papillary excrescence

What is the most common cause of biliary ductal obstruction?

Tumor or thrombus within the ductal system

How big is an abnormal GB wall thickness?

greater than 3 mm

A duct more than (BLANK) in diameter is considered borderline dilated and more than (BLANK) is dilated.

6 mm, 10 mm

Where does Klatskin’s tumor occur?

Bifurcation of the CHD with the central left and right duct

True or false? Most pts with cholesterolosis show thickening of the GB wall

False

True or false? Gallstones greater than 3 mm ALWAYS cast a shadow, and those smaller than 3 mm sometimes do NOT.

True

What will obstruction of the porta hepatis show sonographically?

normal common duct, intrahepatic ductal dilation

What is cholecystitis?

Inflammation of the GB

What are the three conditions that cause biliary obstruction at the level of the distal duct and cause the extrahepatic ducts to dilate?

Chronic pancreatitis with structure formation, pancreatic carcinoma, choledocholithiasis

Which syndrome is an uncommon cause of extrahepatic biliary obstruction due to an impacted stone in the cystic duct?

Mirizzi syndrome