Gb And Billiary(Module 4)

Front 1

which anatomic varient is a fold bt the fundus and the body?

Back 1

phyringian cap

Front 2

which anatomical varient is a fold btw the neck and the body?

Back 2

junctional fold.

Front 3

what is one of the main broblens for sonographers when encountering folds of the gallbladder?

Back 3

they can shadown, and look like stones.

Front 4

which of the congeital anomalies features absense of the billiary system? what are the clinical symptoms, and sonographic appearence of this?

Back 4

billiary atresia:
clinical:
-persistant of sudden jaundice
-light stool, and dark urine
-irritability, and weight loss
-swoolen abdomen(enlarged liver)

Sonographic appearence:
-absence of CBD
-triangular cord
-fasting GB>1.5 cm.
-intrahepatic biliary dialation
-hepatomegaly
-splenomegaly
-ascites

Front 5

what is the triangular cord?

Back 5

remnant of the CBD in the porta. Associated with billiary atresia.

Front 6

which of the congenital anomalies features an absence of the common hepatic duct and cystic duct? what is the typical clinical presetation of this anomoly? what is the sonographic appearence?

Back 6

interposition of GB:
clinical:
-childhood jaundice
-surgically correctable

Sonography:
-dialated intrahepatic duct
-normal GB and CBD

Front 7

what would you suspect if you detected a large cyst in the region of the porta hepatis that was separate from the Gallbladder? What is this?

Back 7

cholecochal cyst
-a dilatation of the intrahepatic or extrahepatic bile ducts. It may be caused by pancreatic enzymes entering the biliary system, causing weakening of the wall and dilatation and cyst formation.

Front 8

what are the clinical symptoms and sonographic appearence of cholecocho cysts?

Back 8

clinical:
-pain
-palpable subheptaic mass
-fever
-jaundice

Sonography:
-cystic mass in porta hepatis separate from GB
-communication btw the cyst, and the bile duct
-may see dialated intraheptaic ducts
-sludge in cysts

Front 9

what are examples of a mobile/ectopic GB?

Back 9

retrohepatic-behind the liver
intrahepatic-within the lier
suprahepatic-above the liver(between liver and diaphragm)

Front 10

what is a floating gb? where might it go?

Back 10

not connected by messentary, may herniate through the foramen of winslow.

Front 11

in the case of a duplicated GB, do both work, and have the same ducts?

Back 11

Usually one works, and one doesn't; both have cystic ducts.

Front 12

what is a bilobed GB?

Back 12

two GB's attached to one cystic duct.

Front 13

explain the anatomy of interposition of the GB?

Back 13

There is an absence of the CHD, and cystic duct, so the right and left hepatic ducts feed directly into the GB, and the GB drains directly into the CBD

Front 14

what is caroli's disease? what is the sonographic appearence of it?

Back 14

when the intrahepatic ducts are cystically dialated
sonographic appearence:
-multiple dialated tubular structures that extend to the liver periphery
-tubular structures communicate with cystic areas
-central dot sign.

Front 15

what is the typical sonographic appearence of biliary sludge.

Back 15

-homogenous low level echos that layer dependantly
-moves with patient positon
-no shadow

Front 16

what is tmefactive sludge?

Back 16

sludge balls that may mimic a mass, but they move with patient postion.

Front 17

what are some resons why you wouldn't see a GB?

Back 17

-previous chelcystectomy
-physiologic contraction
-fibrous GB duct
-air filled GB
-cholecystitis
-tumefacient sludge
-agenesis
-actopic location

Front 18

what is the typical sonographic appearence of chelelithiasis?

Back 18

-echogenic; mobile; posterior shadow

Front 19

what is a WES sign? when do you see it

Back 19

wall-echo-shadow; when many stones fill the lumen of the GB.

Front 20

what is the typical clinical presentation of acute cholecystitis?

Back 20

-RUQ pain
-positive murphys' sign
-nausea, vomitting, distension, fever
-jaundice

Front 21

what tests are elevated with acute cholecystitis?

Back 21

elevated ALP, AST, ALT, billirubin and WBC

Front 22

what is the typical sonographic appearence of acute cholecystitis?

Back 22

-increase GB wall thickness
-cholelithiasis
-positive murphys' sign
-halo sign
-tnest round GB
-increased blood flow in GB wall
-impacted stone in GB neck
-pericholecystic fluid

Front 23

what is acute cholecystitis/

Back 23

when a stone obstructs the cystic duct.

Front 24

what are some other causes of GB wall thickening?

Back 24

-congestive heart failure
-renal failure
-end cirrhosis
-hypoalbumino
INFLAMMATORY:
Primary:
-acute cholecystitis
-cholangitis
-chronic cholecystitis
Secondary:
-acute hepatitis
-perforated duodenum
-pancreatitis
-diverticula
NEOPLASMIC:
-GB adenocarcinoma
-metastasis
MISC:
-adenomyomatosis
-mural varicositis

Front 25

when might a murphy's sign be absent?

Back 25

-in elderly patients when painkillers have recently been administered.
-gangrenous cholecystitis

Front 26

what is a hypropic gallbladder? what is the typical sonographic appearence?

Back 26

When the GB fills with mucous as a result of a stone imacted in the neck.
SONOGRAPHIC APPEARENCE:
-increase GB size
-distended/swoolen GB
-normal wall thickness
-no symptoms

Front 27

Who would normally get emphysemtous cholecystitis? What is the typical sonographic appearence of it?

Back 27

Mostly in men with diabetes:
sonography:
-may not have associated gallstones
-intraluminal/intramural gas.

Front 28

what is gangrenous cholecystitis? what is the sonographic appearence of it?

Back 28

from absent blood supply or infection.
sonography:
-irregular walls and lumen
-mucosal sloughing(bands of non-layering, echogenic tissue within the lumen)

Front 29

what are the symptoms of chronic cholecystitis? what is the sonographic appearence?

Back 29

symptoms:
-repeated attacks producing inflammatory changes
-generally asympotmatic and mild
SONOGRAPHY:
small contracted GB with stones and thick fibrous echogenic wall

Front 30

what is bouvaret's syndrome?

Back 30

-gallstone ileus caused by the erosion of a stone through the GB and into the duodenum.

Front 31

What is mirrizi's syndrome?

Back 31

clinical syndrome of jaundice with pain and fever resulting from obstruction of the CHD by a stone impacted in the cystic duct.

Front 32

What is porcelin GB?what is the typical sonographic appearence of porcelin GB?

Back 32

it is rare, and is where the GB wall is calcified. Associated with increased risk of carcinoma

Front 33

what is perforation?

Back 33

Small defect in the wall of the GB and it happens with acute cholecystitis:
-a clue is deflation of GB and loss of normal shape

Front 34

what is empymea?what are some symptoms of it

Back 34

puss in GB:
patient's fever spikes, chills, and high WBC count

Front 35

what is commonly seen post-cholecystectomy?

Back 35

After the gallbladder is removed, the empty gallbladder fossa is filled with bowel loops. You may see surgical clips, fluid collections (hematoma, biloma, seroma, abscess). You may also see pneumobilia (air in the bile ducts in the liver). It is commonly known that the common bile duct increases in size post cholecystectomy.

Front 36

Describe how different levels of billiary obstruction can cause different levels of billiary dialatation?

Back 36

-CBD obstruction=intrahepatic bile duct dialation
-cystic duct obstruction=hyropic GB
-complete CBD obstruction=GB dialation
-obstruction at ampulla=dialation of pancreas and CBD

Front 37

what is choledocholithiasis?what is the typical sonographic appearence of cholechocholithiasis?

Back 37

common bile duct stones:
-echogenic shadowing mass
-some small stones may not shadow

Front 38

what is courvoiser's law?

Back 38

states that a palpable gallbladder in a jaundiced paitent means that there is likely a tumor at the distal common bile duct (often in the head of the pancreas). This causes obstruction of the biliary tree (including CBD, gallbladder and intrahepatic ducts).

Front 39

what is cholangitis? describe some typical sonographic appearences, and symptoms of it?

Back 39

inflammation of the ducts
symptoms:
-jaundice
-itching
-fatigue

Sonography:
-dialated intrahepatic ducts
-unremarkable bile ducts
-thickened duct walls which dialate proximally

Front 40

what is pneumobilia?

Back 40

air in ducts

Front 41

what is hematobillia?

Back 41

blood in ducts

Front 42

what sigs of a mass in the gallbladder make it more likely benign

Back 42

less than l cam and multiple masses.

Front 43

what is the typical sonographic appearence of gallbladder polyp's?

Back 43

-non-moblie
-no shadow
-homogenous mass
-less than 1 cm
-multiple masses
-echogenic

Front 44

what are some other types of cholangitis?

Back 44

Ascending- from surgery or biliary stasis
Pyogenic (Oriental) cholangitis is a condition common in Asia, occurring because of biliary stasis due to biliary flukes
AIDS cholangitis caused by bacteria that are normally kept in check by a functioning immune system. Since the AIDS patient is immune compromised, these bacteria cause infection

Front 45

what is a polyp?

Back 45

non-gravity dependant homogenous mass pertruding into the GB lumen

Front 46

what conditions are associated with gallbladder carcinoma?

Back 46

chronic cholecystitis
-porcelin GB

Front 47

what is a trapped zone?

Back 47

when a stone is in a GB mass( likely malignant)

Front 48

what is the most common cancer to metasize to the GB?

Back 48

malignant melanoma

Front 49

what is a klaskin tumor?

Back 49

a cholangiocarcinoma that arises in the LHD and is usually found near the RHD and LHD confluence.

Front 50

what is a adenomyomatosis? what is the sonographic appearence of it?

Back 50

the epithelium undergoes hyperplasic changes exgtending the diverticula into the adjacent muscular wall
SONOGRAPHY:
-thickened GB wall
-internal cystic spaces
-comet tail artifacts seen distally.

Front 51

describe gallbladder carcinoma, and how it looks sonographically

Back 51

gallstones present 98%of the time, and it is highly malignant.
SONOGRAPHY:
-irregular wall thickening
-poorly defined mass
-may portrude into bowel
-stone erosed in tumore
-color flow in mass
-large polyps

Front 52

explain a cholangiocarcinoma, the symptoms and sonographic appearence of it?

Back 52

primary malignancy arising from the wall of the bile ducts that grows slowly and extends along the length of the CHD and CBD.
SYMPTOMS:
-jaundice, pruities, and elevated LFT's

SONOGRAPHY:
-persistant soft tissue tumor with similar echogenicity to the liver.
-signs of malignancy and billiary obstruction might be seen

Front 53

If a patient has chronic choledocholithiasis, which structures are dialated?

Back 53

distal duct, proximal duct, common hepatic duct

Front 54

what is the diameter of the common hepatic duct?

Back 54

4mm

Front 55

what is the hepatic duct joined by? to form what?

Back 55

the common bile duct to form the cystic duct

Front 56

in a 60-year old adult, what is the normal CBD measurement?

Back 56

6mm

Front 57

a phryingian cap is what?

Back 57

a folding of the fundus

Front 58

where is hartmans's pouch formed?

Back 58

where the GB folds back on itself at the neck

Front 59

what is an enlarged GB known as?

Back 59

a courvoirsier sign

Front 60

Does pancreatitis cause a thickened GB wall?

Back 60

no

Front 61

what is the most common sign for carcinoma of the GB?

Back 61

irregular fungating mass that contains low intensity echoes within the GB.

Front 62

what is a fisuform dialtion of the CBD that cuases obstruction called?

Back 62

choledochal cyst

Front 63

will gallbladder perforation appear with negatibe murphy's sign?

Back 63

no

Front 64

what happens as a result of a fatty meal/

Back 64

-stimulation of CCK
-contraction of the GB
-relaxation of the sphincter of oddi

Front 65

is the pancreas intra or retroperitoneal?

Back 65

retroperitoneal

Front 66

where is the head of the pancreas in relation to the caudate lobe?

Back 66

not superion, lateral

Front 67

whree is the uncinate process in relation to the superior mesenteric vessels/

Back 67

posterior

Front 68

where is the gastroduodenal artery compared to the ehad of the pancreas?

Back 68

anterolateral

Front 69

what passes through a groove posterior to the head of the pancreas?

Back 69

the CBD

Front 70

whee is the tail of the pancreas found in relation to the kidney and spleen?

Back 70

anterior to the left kidney, and in the splenic hilum.

Front 71

what is the primary pancreatic duct?

Back 71

duct of santorini

Front 72

what are the head of the pancreas, duodenum, and parts of the stomach supplied by?

Back 72

the gastroduodenal artery

Front 73

which direction should the sonographer move the transducer to see the pancreas when looking at the celiac axis?

Back 73

inferior

Front 74

where is the splenic artery in relation to the pancreas?

Back 74

superior border of the pancreas

Front 75

what vessel runs poserior to the lower neck of the pancreas and anterior to the uncinate process?

Back 75

splenic vein.

Front 76

someone with a history of alcoholism, and acute pancreatitis presents with hematocrit, and hypotension, what is your differential?

Back 76

pancreatic hemorrage.

Front 77

a patient with jaundice, weight loss, and RUQ mass should be evaluated for what?

Back 77

adennocarcinoma of the pancreas