Gallbladder and the Biliary System Flashcards

Comprehensive vocabulary flashcards covering the anatomy, pathology, and sonographic evaluation of the gallbladder and biliary system.

Biliary Apparatus

The system consisting of the right and left hepatic ducts, common hepatic duct, common bile duct, the pear-shaped gallbladder, and the cystic duct.

Hepatic Ducts

Ducts that emerge from the right lobe of the liver in the porta hepatis and unite to form the common hepatic duct.

Common Hepatic Duct

A duct approximately $4\,mm$ in diameter that descends within the edge of the lesser omentum and joins the cystic duct to form the common bile duct.

Common Bile Duct (CBD)

A duct with a normal diameter of up to $6\,mm$; its course includes four parts, ending where it pierces the medial wall of the second part of the duodenum.

Sphincter of Oddi

Circular muscle fibers surrounding the end parts of the common bile duct, the main pancreatic duct, and the ampulla.

Ampulla of Vater

A small ampulla in the duodenal wall through which the joined common bile duct and main pancreatic duct open.

Portal Triad

The group formed by the hepatic and bile ducts encased in a common collagenous sheath, following the same course as portal venous and hepatic arterial branches.

Cystic Duct

A $4\,cm$ long, somewhat S-shaped duct connecting the neck of the gallbladder with the common hepatic duct to form the common bile duct.

Gallbladder Divisions

The pear-shaped sac is divided into three sections: the fundus, the body, and the neck.

Normal Gallbladder Dimensions

Generally measures $2.5$ to $4\,cm$ in diameter and $7$ to $10\,cm$ in length, with walls less than $3\,mm$ thick.

Hydrops

The clinical term for dilation of the gallbladder.

Hartmann’s Pouch

An anatomic variation where the gallbladder folds back on itself at the neck.

Phrygian Cap

An anatomic variation involving the folding of the gallbladder fundus.

Heister's Valves

Valves located in the neck of the gallbladder that help prevent kinking of the duct.

Cholecystectomy

The removal of the gallbladder, after which the sphincter of Oddi loses tone and extrahepatic bile ducts may dilate to less than $1\,cm$.

Main Lobar Fissure (MLF)

An echogenic linear echo within the liver connecting the right portal vein to the neck of the gallbladder; used as a sonographic landmark.

Sludge

Thickened bile frequently resulting from bile stasis, appearing on US as non-shadowing low amplitude echoes in a dependent gallbladder.

Common Gallbladder Wall Thickening Causes

Includes intrinsic factors like cholecystitis and extrinsic factors such as hepatitis, cirrhosis, and right heart failure.

Acute Cholecystitis

Inflammation of the gallbladder most commonly caused by gallstones impacted in the cystic duct or Hartmann’s pouch.

Positive Sonographic Murphy’s Sign

The presence of maximal tenderness elicited over a sonographically localized gallbladder.

Emphysematous Cholecystitis

A rare, rapidly progressive and fatal ($15\%$) complication of acute cholecystitis associated with gas-forming bacteria in the gallbladder wall.

WES Sign

The "Wall Echo Shadow" sign; a curvilinear echogenic area with complete posterior fuzzy shadowing indicating a gallbladder packed with stones.

Gangrenous Cholecystitis

A serious complication involving gallbladder necrosis, characterized by diffuse medium to coarse echogenic densities in the lumen that do not shadow.

Acalculous Cholecystitis

Acute inflammation of the gallbladder in the absence of cholelithiasis, likely caused by decreased blood flow through the cystic artery.

Chronic Cholecystitis

The most common form of gallbladder inflammation, resulting from numerous attacks of acute cholecystitis with subsequent fibrosis of the wall.

Cholecystokinin

A hormone released by the proximal intestine that stimulates gallbladder contraction after the ingestion of fatty foods.

The Five F’s

Risk categories for gallbladder disease: Fat, Female, Forty, Fertile, and Fair.

Porcelain Gallbladder

A rare occurrence of calcium incrustation of the gallbladder wall, where $25\%$ of patients will develop cancer on the wall.

Cholesterolosis

A condition where cholesterol is deposited within the lamina propria, often called "strawberry gallbladder" because the mucosa resembles a strawberry surface.

Adenomyomatosis

A hyperplastic change of the gallbladder wall producing "comet tail" artifacts from multiple papillamas.

Gallbladder Carcinoma

A rare, rapidly progressive primary cancer with a mortality rate near $100\%$, associated with cholelithiasis in $80\%$ to $90\%$ of cases.

Choledochal Cysts

Congenital, focal, or diffuse cystic dilation of the biliary tree; Type I (fusiform dilation of the CBD) is the most common.

Caroli’s Disease

A rare congenital abnormality characterized by segmental saccular cystic dilation of major intrahepatic bile ducts, often associated with renal disease.

1 mm per decade rule

The principle that the CBD normally loses tone and can be considered normal over $6\,mm$ starting at $60$ years of age (e.g., $7\,mm$ at $70$ years).

Shotgun Sign

Also called the "too many tubes" sign, which refers to the sonographic appearance of dilated intrahepatic bile ducts.

Klatskin Tumor

A specific type of cholangiocarcinoma occurring at the bifurcation of the common hepatic duct, causing isolated intrahepatic duct dilation.

Mirizzi Syndrome

Extrahepatic biliary obstruction caused by an impacted stone in the cystic duct compressing the common hepatic duct.

Choledocholithiasis

The presence of stones in the bile ducts; primary involves de novo calcium stone formation, while secondary involves migration from the gallbladder.

Hemobilia

Blood in the biliary tree or gallbladder, most commonly caused by biliary trauma from percutaneous procedures or liver biopsies.

Pneumobilia

Air within the biliary tree, appearing as bright, echogenic linear structures with posterior dirty shadowing and reverberation artifact.

Cholangitis

Inflammation of the bile ducts which can cause malaise, fever, RUQ pain, jaundice, and elevated serum alkaline phosphatase.

Ascariasis

Biliary tree infection by the parasitic roundworm Ascaris lumbricoides, which enters through the ampulla of Vater.

Intrahepatic Cholangiocarcinoma

The second most common primary malignancy of the liver, originating within the larger bile ducts such as the common duct or CHD.