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137 Cards in this Set
- Front
- Back
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The gallbladder is a _____ structure.
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Intraperitoneal
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Where is the gallbladder situated?
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In the GB fossa
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Where is the GB fossa located?
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On the posterior-inferior surface of the RLL (right liver lobe)
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True or False. Gallbladder anatomic position varies.
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True
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The ____ projects below the inferior margin of the RLL.
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Rounded fundus
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The _____ bears a fixed anatomic relationship to the _____.
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GB neck, main lobar fissure
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When cystic duct meets common hepatic duct is becomes the _____.
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Common bile duct
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How many layers does the GB have?
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Three
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The gallbladder is covered by a _______.
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Outer serous layer of visceral peritoneum
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What are the 3 layers of the gallbladder?
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Outer subserous layer, middle muscular layer, and inner epithelial layer
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True or False. The size and shape of the gallbladder is variable.
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True
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How long is the gallbladder?
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7-10 cm (usually 8 cm)
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What is the TRV diameter of the GB?
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3-5 cm
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The gallbladder is made up of ____ segments.
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Three
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The 3 segments of the gallbladder include...
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Fundus, body, and neck
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The ____ is a hemispherical shape & projects from inferior margin of liver.
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Fundus
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Where does the body of the gallbladder lie?
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Between the fundus and GB neck
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The neck is continuous with the _____.
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Cystic duct
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The biliary system has ____ main functions.
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Three
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What are the 3 functions of the gallbladder?
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1. Concentrate bile, 2. Store concentrated bile in GB, and 3. Transport bile thru ducts from liver to the GB than to duodenum
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_____ emulsifies ingested fat and aids in fat absorption.
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bile
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What does bile contain?
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bile salts, cholesterol, amino acids, conjugates of steroid hormones
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When is bile released?
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Released when the GB contracts and the sphincter of Oddi relaxes
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The contraction of the GB & relaxation of the sphincter of Oddi occurs when...
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Occurs when the hormone cholecystokinin is released into blood
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Cholecystokinin is stimulated when ____ enters the ____.
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Food enters the duodenum
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Anything close to the gallbladder is considered _____.
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Proximal
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The sonographic appearance of the gallbladder is ____, ____, and ____.
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Anechoic, fluid-filled, and ellipsoidal
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The GB is adjacent to & indents the _____ aspect of the _____.
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inferior-medial, right liver lobe
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The walls of the gallbladder are described as being ____ and ____ in thickness.
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Smooth, 1-2 mm (not greater than 3 mm)
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The gallbladder has _____ through transmission (posterior enhancement)
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increased
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The gallbladder lies ____ to the main lobar fissure.
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Inferior
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What are the 4 normal variants of the gallbladder?
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Junctional fold, Hartman's pouch, phrygian cap, and septation.
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The most common variant is the ______.
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Junctional fold
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The junctional fold occurs when the gallbladder _____.
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Folds on itself
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Where is the junctional fold located?
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Between the body and neck of the GB
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How does the GB fold with Hartman's pouch?
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folds back on itself at the neck
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What is Hartman's pouch?
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A small sacculation (outpouching) seen in some patients in the area of the GB neck
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What other term is applied to the dilatation of the gallbladder neck?
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Infundibulum
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Hartman's pouch is a common place for _____.
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stones to develop
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The phrygian cap occurs when...
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there is folding of the fundus
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Complete septation of the GB is known as a _____.
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double gallbladder
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The cystic artery is a branch of the _____.
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right hepatic artery
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What does the cystic artery do?
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It supplies blood to the gallbladder
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The cystic vein ____ the gallbladder directly to the _____.
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drains the GB directly to the portal vein
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The 3 major ducts of the biliary system include:
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cystic duct, common hepatic duct, and common bile duct
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What are the biliary ducts divided into?
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into the intrahepatic & extrahepatic ducts
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Where are the biliary ducts located?
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In the liver parenchyma (intrahepatic)
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The bile ducts follow the same course as the _____ & _____.
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portal venous branches & hepatic arterial branches (mickey mouse)
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The right & left bile ducts lie ____ to the portal vein.
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anterior
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The hepatic artery lies ____ to the portal vein.
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anterior
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The left hepatic artery lies _____ to the left portal vein.
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posterior
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What makes up the mickey mouse sign?
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The portal vein, hepatic artery and common duct.
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When do the common ducts not follow the same course as the hepatic artery and portal vein?
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outside of the liver (extrahepatic)
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The right & left hepatic ducts emerge from the _____ at the ______ .
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liver, porta hepatis
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When the right and left hepatic ducts unite they form the ____.
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common hepatic duct
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What 2 ducts form the common bile duct?
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The common hepatic duct and cystic duct
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The common bile ducts courses ____ through the head of the pancreas.
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Posterior
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The common bile duct descends down to join the _____ @ the ______.
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main pancreatic duct, at the ampulla of vater
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Where does the junction of the common bile duct & main pancreatic duct enter?
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Enters into the 2nd portion of the duodenum
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The ampulla of vater is also known as the...
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Hepatopancreatic ampulla
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The ampulla of vater is formed by the union of the ____ & ____.
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common bile duct, and pancreatic duct
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The muscular valve that controls flow of digestive juices through the ampulla of vater is the ________.
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Sphincter of Oddi
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The length of the cystic duct is _____.
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2 - 6 cm
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What does the cystic duct do?
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Drains the gallbladder
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The cystic duct contains _____ which are internal muscosal folds.
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Spiral valves of Heister
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The AP diameter of the cystic duct is variable and usually ____.
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2 - 4 mm
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Is the cystic duct usually visualized on ultrasound?
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NO
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The ______ prevent cystic duct from overdistending or collapsing.
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spiral valves of heister
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What is the average AP diameter of the common hepatic duct?
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4 mm, but < 6 mm is normal
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The common hepatic duct is formed by the union of the _____.
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right & left hepatic ducts
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True or False. The right & left hepatic ducts run parallel with the portal veins & hepatic arteries.
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True
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The common bile duct is ____ in length.
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Variable
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Where is the common bile duct seen?
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In the posterior aspect of the pancreatic head
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What regulates the amount of bile flow into the duodenum?
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The sphincter of Oddi
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The common bile duct usually ____ in diameter after a cholecystectomy.
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increases
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True or False. Normal intrahepatic ducts are not seen sonographically
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True
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What ducts can be seen sonographically?
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The extrahepatic CHD & CBD (aka common duct)
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The portal vein is ____ to the IVC, and ____ to the porta hepatis.
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Anterior to IVC, inferior to porta hepatis.
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The portal vein lies ____ to the head of the pancreas.
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Superior
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The common bile duct is situated ______ to the portal vein.
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Anterio-lateral
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The common bile duct becomes more _____ as it courses dorsal.
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posterior
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The distal CBD is best seen on a ____ scan ____ to the SMV.
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TRV, inferior to the SMV
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The CBD is in the region of the ______ portion of the pancreas head.
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Posterior-lateral
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An anterior to posterior course of the CBD is seen to allow....
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Differentiation of the CBD from the SMV
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The SMV is located slightly to the ____ of the common bile duct.
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Left
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Only the _____ dimensions of the common duct are measured.
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internal dimensions
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A common hepatic duct diameter between 6 and 7 mm in adults is considered _____.
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equivocal (difficult to interpret, ambiguous)
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Starting at age ___, the common hepatic duct can increase ____ per decade and is normal.
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At age 60, can increase 1 mm
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The distal end of the common duct (CBD) has a diameter of _____.
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6 - 8 mm (normal is < 8 mm)
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There are ____ ____ in the arteries.
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Intrinsic pulsations
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What kind of blood flow is in the bile ducts?
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NO BLOOD FLOW
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The central region of the biliary ducts refers to the...
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Hilum or porta hepatis region
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What are some of the lab values of the biliary system?
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WBC count, serum bilirubin, alk phos, AST, ALT, and prothrombin time
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The WBC count is a count of the _____.
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Leukocytes
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An increased WBC count is associated with...
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acute cholecystitis, chronic cholecystitis, and injury to bile ducts
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What causes serum bilirubin to increase?
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subacute cholecystitis, choledocholithiasis, injury to bile ducts, GB carcinoma, and internal biliary fistula.
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Inflammation of the gallbladder usually caused by infection or stones is known as...
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subacute cholecystitis
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An opening or passage between 2 organs or between an organ and the skin caused by disease or congenital malformation is...
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internal biliary fistula
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Where is Alkaline phosphatase (ALP) found in?
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Bone, liver, intestines, kidneys, and placenta
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What does an increase of ALP (alkaline phosphatase) usually indicate?
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An obstruction of post-hepatic jaundice
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AST & ALT both contain _____.
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Transferase
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What happens to tissue that contains transferase when it is injured?
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The transferase is released into the serum and causes ride in serum concentration
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What do increased serum levels suggest?
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Active primary liver disease
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AST is used to diagnose ____ before ____ occurs.
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liver disease, jaundice
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____ remains higher longer than ____ in liver disease.
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ALT remains higher longer than AST
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What is used to assess jaundice?
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ALT (alkaline transanimase)
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Prothrombim time is also known as _____ _____.
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Clotting time
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Prothrombin time is typically lower in patients with...
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cholecystitis, internal biliary fistula, carcinoma of GB, injury to bile ducts, & extrahepatic bile duct obstruction
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An ____ form of ____ indicates liver cell disease.
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inactive form of vitamin K
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What are abnormal values of Vit. K associated with?
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cholecytitis, choledocholithiasis, internal biliary fistula, and injury to bile ducts
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In order to scan the gallbladder the patient must be ____.
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NPO (for at least 6 hrs)
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What type of transducer should be used when examining the GB?
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The highest frequency transducer
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When beginning an exam of the biliary system the patient should be in a ____ position.
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Supine
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If the GB is superior or there is question of gallstones you should evaluate patient in a ___ position.
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erect/prone
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SAG & TRV views of the GB are always performed in ___ & ___ positions.
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supine & RSU
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What 2 positions may assist in imaging the cystic duct?
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LSU and trendelenburg position
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What should be done is calculi are seen in the gallbladder?
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Examine the biliary ducts and pancreas
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True or False. Providing the patient with water provides better visualization of the distal CBD.
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True
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Stones in the GB or duct may be associated with ____.
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Pancreatitis
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With pancreatitis the pancreas should be evaluated for...
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parenchymal echo pattern, mass effect, ductal size, and configuration
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What must be done in a patient with obstructive jaundice?
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Determine the level of obstruction & search for etiology
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What does the protocol of the gallbladder in supine position consist of?
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SAG length, 2-3 images of neck, body, and fundus.
TRV neck, body, and fundus, and AP diameter of gallbladder wall |
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When doing examination in decubitus position what should you assess for?
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mobile stones, masses, and sludge
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What causes non-visualization of GB?
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cholecystectomy, contraction, agenesis, ectopic location, porcelain GB (calcified), and emphysematous cholecytitis (air filled)
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What is the removal of the gallbladder called?
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cholecystectomy
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What is a laparoscopy?
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3 small incisions made in RUQ to remove gallbladder
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A _____ is a larger oblique incision made in the RUQ to remove the gallbladder.
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laparotomy
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True or False. Sonography is known as the modality of choice for gallbladder pathology.
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True
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What is a HIDA scan?
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Hepatobiliary Iminodiacetic Acid scan that evaluates gallbladder function
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A HIDA scan is a ____ test.
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Nuclear medicine (NM) test
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What does MRCP stand for?
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magnetic resonance cholangiopancreatography
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What does the MRCP do?
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Uses a dye injected into the liver to allow imaging of GB and ducts
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What is ERCP?
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Endoscopic Retrograde Cholangiopancreatography
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ERCP is an ____ procedure using _____.
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Xray, endoscopy
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PTC is known as...
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Percutaneous Transhepatic Cholangiography
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An X-ray procedure used to image the liver using a needle inserted between the ribs with contrast is a ____ procedure.
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PTC
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During an ERCP procedure, a ____ is inserted into the _____ to image the ducts.
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Catheter, endoscopy
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