Sono Gb/lv Test

Front 1

Where is AST (SGOT) is produced? When does it increase?

Back 1

Aspartate aminotrasferase is produced by the liver, muslce, & heart. It increases with hepatocyte damage & bile duct obstruction.

Front 2

Where is ALT (SGPT) produced? When does it increase?

Back 2

Alanine aminotransferase is produced by the liver ONLY. It increases with hepatocyte damage and bile duct obstruction.

Front 3

When does Serum Protein decrease/increase?

Back 3

-It increases with Globulin (inflammatory & neoplastic disease).
-It decreases with Albumin (hepatocyt damage).

Front 4

What is prothrombin time (PTT) and how can you decrease it?

Back 4

PTT is clotting time.
It decreases with hepatocyte damage.

Front 5

Fetal antigen is present in 50% f patients with ________.

Back 5

HEPATOMAS

Front 6

Cholesterol decreases with ___ ____ disease and increases with ____ _____.

Back 6

DECREASES: chronic liver disease
INCREASES: bile duct obstruction

Front 7

Where is Serum Alkaline Phosphatase (ALK PHOS; AP) produced? When is it increased?

Back 7

It is produced by biliary ducts when damaged, the liver, bone, kidney, placenta, & intestines.
It increases with biliary obstruction, biliary neoplasm, liver damage, or liver mets.

Front 8

How many mm total Serum Bilirubin should a NL person have?

Back 8

0.1-1.2 mg/dl

Front 9

DIRECT Serum Bilirubin increases with ___ ___ and INDIRECT Serum Bilirubin increases with ___ ___.

Back 9

DIRECT: biliary obstruction
INDIRECT: hemolytic anemia

Front 10

What is urbilinogen?

Back 10

Urbilinogen is a bacterial by-roduct from bilirubin in the intestine

Front 11

When is urine production increased/decreased?

Back 11

INCREASED: hemolytic jaundice (too many RBCs are broken down)
DECREASED: biliary obstruction

Front 12

When does LDH increase?

Back 12

Lactic dehydrogenase increases with obstructive jaundice

Front 13

What is the difference btwn medical jaundice d/t a HEMOLYTIC DISORDER vs. a HEPATOCYTE DISORDER?

Back 13

HEMOLYTIC: increase in amount of breakdown of RBCs done by hepatocytes and creates an increase in by-products
HEPATOCYTE: bilirubin is processed by liver, but is regurgitated back into blood stream

Front 14

What lab values increase d/t medical(hepatic) jaundice?

Back 14

Both direct & indirect bilirubin.

Front 15

What lab values increase d/t obstructive (surgical) jaundice?

Back 15

Direct bilirubin increases & AP (as a result of epithilial damage of obstruction of bile duct)

Front 16

Is it possible to have both medical (hepatic) AND obstructive (surgical) jaundice at the same time???

Back 16

YES

Front 17

Obstructive jaundice can occur at what 3 main areas?

Back 17

Intrahepatic, @ porta hepatis, @ common bile duct (prox & dist)

Front 18

Indirect bilirubin is taken from blood and is conjugated with _____ acid in order to be secreted into bile (water soluble/direct).

Back 18

glucurenic

Front 19

Urobilinogen is created after bile enters the ____, where it is combined with bacteria. Some is excreted as ___.

Back 19

intestines, feces

Front 20

Normal Bile Duct measurements in mm:
1) At Porta Hepatis
2) At Panreatic Head
3) After cholecystectomy

Back 20

1) 2-4 mm
2) 7 mm
3) 10 mm

*remember to add 1 mm to each measurement for each decade over 50 yrs old!

Front 21

What 3 vessels create "mickey mouse"?

Back 21

CBD - left ear
PHA - right ear
MPV - head

Front 22

What is another name for the proximal CBD?

Back 22

Common Hepatic Duct

Front 23

How long is a NL GB?

Back 23

10-13 cm long
(4 cm A-P)

Front 24

What is the capacity of a NL GB?

Back 24

30-50 ml

Front 25

The GB is ____ to the caudate lobe.

Back 25

anterior

Front 26

The GB fossae is found _____ to the GB.

Back 26

inferior

Front 27

A Phyrigian cap is a fold in the GB _____, while a Hartmann's pouch is a fold in the GB _____.

Back 27

Phyrigian cap- FUNDUS
Hartmann's pouch- NECK

Front 28

What valves are found in the neck/cystic duct?

Back 28

Spiral valves (aka Valves of Heister)

Front 29

The NL GB wall measures ____ mm.

Back 29

3 mm or less
(4 mm with ascities)

Front 30

The portal vein is found _____ to the CBD.

Back 30

posterior

Front 31

Porcelain GB can cause non-visulization of the GB. T/F?

Back 31

True!

Front 32

What type of biliary tree pathology is ATRESIA?

Back 32

obliteration of the extrahepatic ducts (can extend into the prox intraheptatic duct system)

Front 33

What type of biliary tree pathology is INTERPOSITION OF GB?

Back 33

absense of the CHD & cystic duct (CBD is NL)

Front 34

What type of biliary tree pathology resembles a "string of pearls" on a sonogram d/t to non-obstructive dilitations of ducts?

Back 34

Caroli's disease (can have a stone, but usually hereditary)

Front 35

What causes a choledocal cyst?

Back 35

A choledocal cysts is caused by congenital weakness of the duct wall OR an obstruction

Front 36

A patient comes in with pain, jaundice, and a palpable mass. What could his pathology be?

Back 36

Choledochal cyst

Front 37

What are the 4 types of choledocal cysts? Which 1 is most common?

Back 37

1) CYSTIC DILATATION (most common)-dilatation begins/ends sharply
2) CHODEOCHOCELE-in intraduodenal part of CBD
3) DIVERTICULUM-outpouching
4) MULTIPLE CYSTS

Front 38

What is the surgical treatment for choledochal cysts?

Back 38

Choledochojejunostomy (connecting of the bile duct to the jejunum)

Front 39

What is the most common biliary tree pathology?

Back 39

Choledocholithiasis (stones in the bile duct)

Front 40

A patient comes in with RUQ pain/tenderness, nausea, vomiting, fever, jaundice, and weight loss. What could his pathology be?

Back 40

Choledocholithiasis (stones int he bile duct)

Front 41

Labs for choledocholithiasis reveal an increase in what 2 areas?

Back 41

AP, serum bilirubin, (& WBCs)

Front 42

Bile ducts respond to respiration or a Valsalva's Maneuver. T/F?

Back 42

False!

Front 43

A shot-gun or double-barrel sign is indicative of what?

Back 43

Choledocholithiasis (CBD & MPV parallel each other and do NOT move b.c they are lodged in CBD)

Front 44

What is cholangitis?

Back 44

Cholangitis is acute inflammation of bile ducts d/t bacteria(associated with the inflammation of the GB, liver, panc, intestine, and choledocholithiasis)

Front 45

Cholangitis is inflammation of the bile duct d/t to bacteria originating from...?

Back 45

PV, liver, lymphatics, regrug of intestinal contents, trauma/surgery, edma

Front 46

A patient comes in with RUQ pain, jaundice, & fever w/ chills. What could his pathology be?

Back 46

Cholangitis

Front 47

Sonographically, cholangitis is associated with...

Back 47

-bile duct narrowing
-marked ductile dialation
-choledocholithiasis
-intrahepatic bile stasis
-local hepatic damage

Front 48

What surgical treatment is available for cholangitis?

Back 48

Decompression with a permanent drain replacement

Front 49

SCLEROSING cholangitis is associated with _____ disease.

Back 49

Crohn's disease

Front 50

What are papillomas, polyps, and adenomas?

Back 50

benign tumors

Front 51

What is the most common type of benign tumor?

Back 51

adenomas

Front 52

A patient comes in with pain, jaundice, weight loss, & dyspepsia. What pathology could he have?

Back 52

A benign tumor

Front 53

Sonographically, abenign tumor appears...

Back 53

hypoechoic, non-shadowing, non-gravity dependent

Front 54

The most common type of carcinoma is _____, which arises from the _____.

Back 54

Adenocarcinomas arise in large ducts (and metastasize to lymph nodes & liver)

Front 55

A patient comes in with jaundice (painless), weight loss, vomiting, anorexia, & RUQ pain. What could his pathology be?

Back 55

carcinoma

Front 56

Sonographically, carcinoma may appear as a...

Back 56

soft-tissue lesion w/in the ductile lumen

Front 57

70-90% cases of carcinoma include gallstones. T/F?

Back 57

True

Front 58

The _____ tumor is found at the confluence of the left & right hepatic ducts.

Back 58

Klatskin

Front 59

What biliary tree pathology is PNEUMOBILIA?

Back 59

Pneumobilia is air in the biliary tree (d/t surgery or reflux)

Front 60

What biliary tree pathology is BILOMA?

Back 60

Biloma is a collection of bile (d/t surgery or rupture)

Front 61

GB pathology is usually characterized by what classic symptoms?

Back 61

Pain/nausea after eating (up to 3 hrs), positive Murphy's sign (pain: RUQ, chest, rt subscapular, upper gastric), fever, RUQ mass

Front 62

What is the mos common GB disease?

Back 62

Cholelithiasis (gallstones)

Front 63

What are 3 reasons for cholelithiasis?

Back 63

1) ABNL bile composition
2) bile stasis
3) infection

Front 64

Gallstones of cholelithiasis are composed of what 3 things?

Back 64

1) cholesterol
2) bile pigment
3) calcium

Front 65

Cholelithiasis is more common in African Americans. T/F?

Back 65

Flase, it is more common in American Indians

Front 66

Cholelithiasis increases with age, diabetes, and pregnancy? T/F?

Back 66

True

Front 67

What lab values increase with cholelithiasis?

Back 67

AP (somewhat AST & ALT)

Front 68

A patient comes in with RUQ pain, chest pain, & nausea/vomiting after meals. What could his pathology be?

Back 68

cholelithiasis

Front 69

Sonographically, we can diagnosis cholelithiasis based on if it exhibits WES sign. What does this stand for?

Back 69

W-wall
E-echo
S-shadow

Front 70

What is a CHOLECYSTOGRAM?

Back 70

A cholecystogram causes stones to float

Front 71

Sludge is associated with pain. T/F?

Back 71

False!

Front 72

Sludge is mainly composed of ____ ____.

Back 72

Calcium bilirubinate

Front 73

Predisposing factors for sludge include...

Back 73

-pregnancy
-cholecystitis
-IV therapy
-alcoholics
-duct obstruction

Front 74

Sonographically, sludge exhibits...

Back 74

non-shadowing, gravity dependency, layering effects, mimics neoplasms (or blood or pus)

Front 75

What is CHOLECYSTITIS?

Back 75

Cholecystitis is inflammation of the GB. (95% of patients have gallstones)

Front 76

What lab values will increase with cholecystitis?

Back 76

AP, Serum bilirubin, AST/ALT (& WBCs)

Front 77

A patient comes in with fever, leukocytosis, RUQ pain, nausea/vomiting, postitive Murphy's sign, & jaundice. What pathology could he have?

Back 77

Cholesystitis

Front 78

Of the 2 types of acute cholecystitis, is acalculous or calculou more common in males?

Back 78

Acalculous (and it's more fatal!)

Front 79

Acute ACLACULOUS cholecystitis is d/t changes in ___ or ___, while acute CLACULOUS cholecystitis is d/t an ____

Back 79

ACALCULOUS: vascularity or stagnant bile
CALCULOUS: obstruction

Front 80

The HALO SIGN is classic echo feature of _____.

Back 80

Cholecystitis

Front 81

Cholecystitis can lead to what type of complications?

Back 81

-empyema of GB (pus)
-gangernous GB (no pain)
-perforated GB (peritonitis)

Front 82

Chronic cholecystitis is associatied with an enlarged GB. T/F?

Back 82

False, chronic causes GB to become small in size

Front 83

Chronic cholecystitis may develop into Porcelain GB. T/F?

Back 83

True

Front 84

_____ syndrome is a biliary-enteric fistula that forms btwn the GB and duodenum.

Back 84

Bouveret's syndrome

Front 85

____ syndrome is a stone impacted in the neck/cystic duct and erodes into adjacent CBD.

Back 85

Mirizzi's syndrome

Front 86

What is Porcelain GB?

Back 86

Porcelain GB is calicified GB walls.

Front 87

What causes porcelain GB?

Back 87

Chonic cholecystitis, toxic bile, chronic irritation of GB wall (stones), infection

Front 88

What is Hydropic GB?

Back 88

Hydropic GB is an enlarged GB containing pus, mucus, or pus d/t an obstruction of the cystic duct.

Front 89

What is Courvoisier GB?

Back 89

Courvoisier GB is enlarged d/t CBD obstruction & panc cancer.

Front 90

How does HIV GB appear sonographically?

Back 90

HIV GB has thickened walls, striations, dilation, pericholic fluid, & sludge (w/o stones)

Front 91

Polyps are benign neoplasms that shadow. T/F?

Back 91

False, they are benign neoplasms but they do NOT shadow b/c they are made of cholesterol

Front 92

What are included in HYPERPLASTIC CHOLECYSTOSES?

Back 92

-Adenomyomatosis
-Cholesterosis
-Neuromatosis
-Fibromatosis
-Lipomatosis
(these are benign non-inflammatory conditions that cause proliferation to GB wall)

Front 93

The hyperplastic cholecystosis ADENOMYOMATOSIS is excesssive proliferation of ____ tissue characterized by formation of mucosal outpouchings called ____.

Back 93

epithelial, diverticula (aka Rokitansky-Aschoff sinuses)

Front 94

What is "Strawberry GB" also known as?

Back 94

Cholesterosis

Front 95

What is Cholesterosis?

Back 95

Cholesterosis is cholesterol deposits in the GB wall. (May be diffuse or localized)

Front 96

______ is the most common type of malignant lesion.

Back 96

Adenocarcinoma

Front 97

Sonographically, Adenocarcinoma can be recognized by...

Back 97

stones, irreg wall thickness, polypoid masses > 1 cm, intrinsic vaculature (shown with color Doppler), non-shadowing