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110 Cards in this Set
- Front
- Back
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Gallbladder
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Intraperitoneal organ located in the gallbladder fossae
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Common Hepatic Duct
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Joining of the Right + Left Hepatic Ducts
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Common Hepatic Duct
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Transports bile to the Gallbladder
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Cystic Duct
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Where Bile enters and exits the Gallbladder
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Common Bile Duct
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Union of the Cystic Duct + Common Hepatic Duct
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4mm in diameter
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Measurement of the Common Hepatic
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6mm
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Normal Common Bile Duct diameter
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Ampulla Vattera
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Opening where the CBD joins with the Main Pancreatic Duct
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Sphincter of Odi
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Circular Muscle Fibers around the Ampulla
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4cm
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Length of the Cystic Duct
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Cystic Duct
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Connects the the neck of the Gallbladder with the Common Hepatic Duct
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Gallbladder
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Pear shaped organ
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Visceral
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Where the GB is located--between the RT & LT Lobe of the Liver
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Parts of the Gallbladd
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Fundus, Body, Neck
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Neck
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Has a fixed anatomic relationship to the Right Portal Vein & Main Lobar Fissure
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Fundus
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Most anterior segment of the gallbladder
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Neck
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Part of the gallbladder that tappers off to form the Cystic Duct
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Heisters Valve
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Present in the Neck of the Gallbladder and prevent kinking in the duct
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7-10cm
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Length of the Gallbladder
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5cm
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Length of the Gallbladder in Transverse
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3mm
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Measurement of the wall of the Gallbladder
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Hydrops
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Dilation of the Gallbladder
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Transverse
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Plane the gallbladder must be in to measure its walls
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Anterior Wall
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Wall always measured in the Gallbladder
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Hartmann's Pouch
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Small sac located in the Neck of the gallbladder where stones may collect
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Phrygian Cap
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Fold located in the Fundal portion of the gallbladder
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Junctional Fold
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Fold or septum located on the Posterior gallbladder wall between the Body and the Neck
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Septations
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Folds that protrude into the Lumen of the Gallbladder
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3 Functions of the Gallbladder
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1. Concentrate Bile 2. Stores Bile 3. Transports the Bile to the Duodenum
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Cholecystokinin
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Hormone that stimulates the gallbladder to contract and the sphincter of Odi to relax & open
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Small Intestine
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Where the Bile goes after being released by the Gallbladder
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Fatty Foods & Dairy Products
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Stimulate the release of Cholecystokinin
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1.1cm
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Size of CBD after a Cholecystectomy
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8-12 hours
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Amount of time the patient must fast before having an ultrasound done on their gallbladder
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Description of US appearance of GB
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Anechoic, oblong structure located anterior to the right kidney and lateral to the head of the Pancreas
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Main Lobar Fissure
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A bright echogenic line that connects the neck of the gallbladder to the Right Portal Vein
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Sonographic Non-Visualization of the GB
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-Normal contraction of the GB when patient has not fasted
-Cholecystectomy -Ectopic GB -Chronic Cholecystitis w GB filled w stones -Any mass coming in front of the GB -Intrahepatic Obstruction -Calcification of the GB -Agenesis of the GB (born without) |
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Causes of Large GB (hydrops)
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-prolonged fasting
-cystic duct obstruction -obstruction in the CBD -diabetes -pancreatitis |
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Courvoisier GB
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Large Gallbladder caused by obstruction at the distal portion of the CBD
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Courvoisier Symptoms
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-painless jaundice
-elevated bilirubin -abnormal LFT's - |
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Causes for Courvoisier GB
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-Pancreatic Head Carcinoma
-CBD Carcinoma -Duodenal Carcinoma -Apulla Vatera Carcinoma |
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Causes for a Small GB
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-patient has eaten
-intrahepatic billary obstruction -chronic cholecystitis -and Liver disease that decreases the production of Bile |
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General Symptoms of GB Pathology
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Pain in the RUQ usually after eating greasy food (stone)
Nausea May cause pain in the Right Shoulder |
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Sludge
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Thickened Bile
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Sludge
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Occurs from bilestasis
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Bilestasis
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Bile thats does not move
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Sludge
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Gravity dependent
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Features of Sludge
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GB contains low level internal echoes
Particles are gravity dependent non shadowing |
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Causes for GB wall thickness
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Cholecystitis
Adenomyomatosis Cancer AIDS Diffuse Liver Disease Portal Hypertension Pancreatitis Heart Failure |
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Gallbladder wall thickness
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Should always be Less Than 3mm
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GB wall in US
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In transverse plane, the anterior GB is measured from outer to outer margins and should be less than 3mm
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Cholecystitis
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Inflammation of the Gallbladder Wall with decreased GB function
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Acute Cholecystitis
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Most common cause Cholelithiasis that causes a Cystic Duct Obstruction
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Cholilithiasis
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Gallstones
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US appearance of Acute Cholecystitis
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Diffused wall thickening more than 3mm
Enlarged GB Presence or absence of pericholecystic fluid |
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pericholecystic
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Fluid around GB
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Complication of Acute Cholecystitis
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Emphysematous Cholecystitis
Empyema Gangrenous Cholecystitis |
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Emphysematous Cholecystitis
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Rare Occurrence caused by gas forming bacteria in the wall and lumen of the GB
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US appearance of Emphysematous Cholecystitis
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Prominent Bright Echoes in the Anterior Wall with Comet Tail directly posterior
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Empyema
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Pus in the Gallbladder
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US of Empyema
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Low Level Echoes in the GB Lumen with thick GB wall
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Gangrenous Cholecystitis
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May lead to perforation
Occurs bc absence of blood supply to the GB |
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Chronic Cholecystitis
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Caused by recurrent or chronic inflammatory changes of the GB
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S & S of Chronic Cholecystitis
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On and Off RUQ pain but not the same tenderness as in Acute Cholecystitis
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US of Chronic Cholecystitis
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Gallstones
Thickened GB Wall WES Sign |
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WES sign
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Wall Echo Shadow
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WES Sign
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contracted bright gallbladder with posterior shadowing caused by packed bag of stones
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US of WES Sign
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Sonographer will only be able to image the anterior wall of the GB bc the stones will cause posterior shadowing
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Acalculus Cholecystitis
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Acute Inflammation of the GB without Stones!
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Acalculus Cholecystitis
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Caused by decreased blood flow through the cystic artery
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S & S of Acalculus Cholecystitis
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Positive Murphy's Sign
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US of Acalculus Cholecystitis
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GB Wall is Extremely Thick
Echogenic Sludge |
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Cholelithiasis
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Most common disease of the GB
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Cholelithiasis
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Can be solitary or multiple stones
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S & S of Cholelithiasis (5 F's)
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Fat
Female 40 yrs old Fertile Fair *pregnancy, diabetes, and use of OC) RUQ Pain that radiates to the shoulder after a fatty meal, epigastric pain, N & V |
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US of Cholelithiasis
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Posterior Shadowing
Echogenic Foci Gravity Dependent |
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Porcelain GB
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Calcification of the GB Wall--Associated with Gallstones and increased instances with GB Carcinoma
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US of Porcelain GB
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-Bright Echogenic Echo is seen in the region of the GB with posterior shadowing
-WES Sign |
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Hyperplastic Cholecystitis
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Hyperconcentration
Hyperexcitibility Hyperexcretion Increase in the Cell #'s |
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Cholesterosis
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Condition in which cholesterol is deposited within the Lamina of the GB
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Cholesterosis
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Also known as Strawberry GB
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Polyps
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Small well defined soft tissue projections from the GB Wall
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US of Cholesterosis
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Usually Multiple
Do not Shadow Remained fixed to the wall Echogenic Comet Tail |
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Adenomyomatosis
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Hyperplastic change in the GB Wall
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US of Adenomyomatosis
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Benign tumors that appear as small elevations in the GB Lumen
Do not change their positions Do not produce shadows |
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GB Carcinoma
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Associated with Cholelithiasis--90% have increased risk of GB cancer
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GB Carcinoma
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Arises in the body of the GB and causes wall thickening
Invades Liver Causes Obstruction of the Cystic Duct Occurs from direct extension of the Tumor |
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US of GB Carcinoma
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Mass with Heterogenous Echo-Texture
GB wall is abnormally Thick May have dilated binary ducts within the Liver (shot gun sign) |
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Shotgun Sign
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Double barrel appearance of Portal Veins and Dilated Ducts
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Common Hepatic Duct Internal Diameter
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4mm
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Common Hepatic Duct Diameter
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5mm (borderline) -- 6mm (needs investigation)
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Biliary Obstruction
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Most common cause for obstruction is the presence of a Tumor or Thrombus in the ductal system
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Shotgun Sign
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Diagnoses obstruction of the biliary system
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Extrahepatic Dilation
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occurs Before Intrahepatic Dilation
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Mirizzi Syndrom
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Uncommon cause for Extra Hepatic Biliary Obstruction due to an IMPACTED stones in the Cystic Duct
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Klatskin's Tumor
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Cholangiocarcinoma that can occur at the bifurcation of the Common Hepatic Ducts
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Cholangiocarcinoma
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Bile Duct Cancer
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US of Klatskin's Tumor
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Intrahepatic ductal dilation
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Cholangitis
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Inflammation of the Bile Ducts
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S & S of Cholangitis
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Fever w/ chills, fatigue
Increase Biliary pressure in the biliary tree with pus accumulation LFT's: Increased ALP & Bilirubin |
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US of Cholangitis
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Common Bile Duct will have smooth or irregular wall thickening
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Choledocholithiasis
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Stones in the Bile Duct
*majority of stones migrate from the GB |
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US of Choledocholithiasis
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Stones are echogenic and posterior shadowing and Duct Dilation
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Choledochal Cyst
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Cyst in the duct
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Choledochal Cyst
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Characterized as cystic dilation and out pouching of the common duct wall
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Choledochal Cysts
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Associated with gallstones pancreatitis or cirrhosis
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S & S of Choledochal Cyst
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Abdominal mass
Pain Fever Jaundice |
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US of Choledochal Cyst
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-Cysts appear as a true cyst in the RUQ with or without an apparent communication with the Biliary System
-Localized cystic dilation of CBD |
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Caroli's Disease
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-Saccular Cystic Dilation of the Ducts INSIDE the Liver
-Found in younger adults and pediatric cases -Associated with Renal Disease or Congenital Hepatic Fibrosis |
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US of Caroli's Disease
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Liver will have multiple cystic structures that communicate with Intrahepatic Ducts
Stones may appear in the Bile Ducts |
