Abdm Ultra: 100512: Gallbladder

Front 1

Of what is the "biliary tract" composed?

Back 1

1. The left and right hepatic ducts
2. The common hepatic duct
3. The cystic duct
4. The common bile duct

Front 2

In what body quadrant is the gallbladder located?

Back 2

RUQ

Front 3

What does the gallbladder lie lateral to?

Back 3

The second part of the duodenum

Front 4

Where is the gallbladder with respect to the peritoneum?

Back 4

It's intraperitoneal

Front 5

What organ produces bile, and what is it made from?

Back 5

It is produced by the liver, and is made from the broken-down product of worn or defective RBCs

Front 6

What enzyme does bile facilitate, and what is its function?

Back 6

Lipase, which breaks down fats and acids

Front 7

What is the name for the spiral valves / mucosal folds within the cystic duct?

Back 7

Valves of Heister

Front 8

What are the 3 functions of the Valves of Heister?

Back 8

1. To control the inward and outward flow of bile
2. The prevent the cystic duct from kinking
3. To protect the cystic duct from collapse or over distention because of sudden positional changes

Front 9

What makes up the inner surface of the gallbladder?

Back 9

Epithelial mucosa with folds

Front 10

What makes up the middle surface of the gallbladder?

Back 10

A muscular layer

Front 11

What makes up the outer surface of the gallbladder?

Back 11

A subserous layer, covered by an outer subserosal surface (Adventitia)

Front 12

What's the typical storage capacity of the gallbladder?

Back 12

30-60 ml of bile

Front 13

What's the typical diameter of a distended gallbladder (measured at the widest part of the body)?

Back 13

3-4 cm

Front 14

What the typical length of a distended gallbladder?

Back 14

7-10 cm

Front 15

What's the typical wall thickness of a distended gallbladder?

Back 15

1-2 mm

Front 16

What pressure is regulated by the gallbladder?

Back 16

Biliary pressure, which increases if bile "backs up" in the liver rather than draining to the gallbladder

Front 17

What enzyme, secreted by what structure, stimulates the gallbladder to release bile?

Back 17

Cholecystokinin, secreted in the duodenum

Front 18

By what path does bile enter the gallbladder?

Back 18

It starts in the small intrahepatic ducts, then drains to the common hepatic duct, then enters the gallbladder through the cystic duct

Front 19

How do the Valves of Heister appear sonographically?

Back 19

As short echogenic lines

Front 20

What is the length of the cystic duct?

Back 20

2-6 cm

Front 21

What visible symptom would you expect to see in a patient whose sonogram showed excessive dilatation of bile ducts?

Back 21

Jaundice (yellowish skin or eyes)

Front 22

What path does the common bile duct take as it travels away from the common hepatic duct?

Back 22

It courses inferior medially toward the pancreas, which it enters.

Front 23

What joins the CBD inside the pancreas?

Back 23

The pancreatic duct

Front 24

Where does the CBD exit the pancreas?

Back 24

At the head of the pancreas

Front 25

Where does the CBD enter the duodenum?

Back 25

Through an opening called the ampulla of Vater

Front 26

What controls the flow through the ampulla of Vater?

Back 26

The sphincter of Oddi

Front 27

Are the right and left hepatic ducts intrahepatic or extrahepatic?

Back 27

They are mostly intrahepatic, but a small portion of each is extrahepatic, right before they exit the liver at the porta hepatis to join and form the common hepatic duct.

Front 28

The CBD is ____ to the CHA

Back 28

right lateral

Front 29

The CBD is ____ to the portal vein

Back 29

anterior and lateral

Front 30

What aspect of the duodenum does the CBD enter?

Back 30

posteriormedial

Front 31

What is the normal diameter of the CHD / CBD (if the gallbladder is intact)?

Back 31

< 7 mm (regardless of age)

Front 32

What is the normal diameter of the CBD (if the gallbladder has been removed)?

Back 32

< 10 mm

Front 33

Does the diameter of the CBD tend to vary or remain constant with age?

Back 33

There is a rule of thumb that the CBD diameter is 1mm for each decade of age after age 30 - but it isn't always true

Front 34

Does the diameter of bilary ducts tend to vary or remain constant throughout the day?

Back 34

remain constant

Front 35

What is the medical term for removal of the gallbladder?

Back 35

Cholecysectomy

Front 36

Under what condition can intrahepatic ducts be sonographically noticable?

Back 36

If they are extremely dilated, which is known as "too many tubes" in the liver

Front 37

The portal vein lies ____ to the IVC

Back 37

immediately anterior

Front 38

What is the best plane in which to view the distal CBD, and in what region?

Back 38

Transverse, in the posterior-lateral aspect of the pancreas

Front 39

What is the normal diameter of an intrahepatic bile duct?

Back 39

< 2 mm

Front 40

When measuring the diameter of a duct, exactly where do we set the calipers?

Back 40

We want to measure the lumen only, which means inner wall to inner wall, not the anechoic area

Front 41

What can we say about the course of the distal CBD in elderly patients?

Back 41

It can be ectatic (windy, not straight)

Front 42

What are the two best ways to differentiate between ducts and arteries?

Back 42

1. Note the pulsations in the arteries
2. Doppler will show color in arteries, no color in ducts

Front 43

What is biliary atresia?

Back 43

Absence of a gallbladder

Front 44

What type of patient might be likely to present with biliary atresia?

Back 44

Pediatric

Front 45

Is duplication of the gallbladder as common as biliary atresia?

Back 45

No, it is less common, and the appearance of it is usually due to an artifact

Front 46

What is the term for when the fundus folds back onto the body of the gallbladder?

Back 46

Phrygian cap

Front 47

Are junctional folds in the gallbladder common or rare?

Back 47

Common

Front 48

What is the name for an an out-pouching of the wall of the gallbladder at the junction of the neck of the gallbladder and the cystic duct?

Back 48

Hartmann's Pouch

Front 49

Which two blood tests would be mildly elevated with biliary obstruction?

Back 49

1. Aspartate aminotransferase (AST)
2. Alanine aminotransferase (ALT)

Front 50

Which blood test would be mildly elevated with obstructive jaundice?

Back 50

Lactase dehydrogenase (LDH)

Front 51

Which blood test would increase with infection of gallbladder wall (cholecystitis)?

Back 51

White Blood Count (WBC)

Front 52

Which 2 blood tests would be markedly increased with obstructive jaundice?

Back 52

1. Alkaline phosphatase (ALP)
2. Direct (conjugated) bilirubin

Front 53

Which blood test would be elevated with hepatocellular disease or anemias?

Back 53

Indirect (unconjugated) bilirubin

Front 54

Which blood tests are most specific for gallbladder disease?

Back 54

The bilirubin tests

Front 55

What is the term for tenderness over the area of the gallbladder?

Back 55

Murphy's sign

Front 56

What are possible symptoms of biliary disease or obstruction?

Back 56

1. Intermittent RUQ pain (especially after ingestion of fatty foods)
2. Murphy's sign
3. Nausea & vomiting
4. Pain may radiate to right shoulder
5. Increased gas
6. Jaundice with obstruction

Front 57

What are the 2 components of biliary patient prep?

Back 57

1. Patient fast for 8-12 hours
2. Fat-free dinners (often)

Front 58

How long after eating can the gallbladder usually be properly scanned?

Back 58

After 6 hours

Front 59

What type of transducer would be most appropriate for a very thin or pediatric patient with an anterior gallbladder?

Back 59

Linear, high frequency

Front 60

If a neonatal has been fasting (missing one feeding), what gallbladder transverse diameter would suggest atresia (presence of only a rudimentary gallbladder)?

Back 60

< 1.5 cm