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Biliary System Flashcards

(59 cards)

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1
Q

What kind of structures are the gallbladder and biliary tract?

A

Intraperitoneal

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2
Q

What are the three sections of the gallbladder?

A

Fundus
Body
Neck

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3
Q

What duct does the gallbladder neck connect to?

A

Cystic duct

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4
Q

The confluence of what ducts creates the common bile duct?

A

Common hepatic duct

Cystic duct

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5
Q

What is the typical length of the gallbladder?

A

7-10 cm

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6
Q

What is the normal thickness of the gallbladder wall?

A

Less than 3 mm

Less than 0.3 cm

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7
Q

Where is bile produced?

A

In the liver parenchyma

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8
Q

What duct takes bile in and out of the gallbladder?

A

Cystic duct

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9
Q

The confluence of what two ducts creates the ampulla of Vater?

A

Common bile duct

Pancreatic duct

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10
Q

What is the function of the sphincter of Oddi?

A

Regulates the flow of bile into the intestinal system

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11
Q

What is the normal measurement of the common bile duct?

A

Less than 6 mm in dia

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12
Q

How does the CBD diameter increase?

A

It increases 1 mm for every decade of life after 60

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13
Q

What is the primary role of the gallbladder?

A

To store, concentrate, and release bile

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14
Q

What triggers the release of bile into the duodenum?

A

Proteins and fatty acids in the stomach

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15
Q

What is the main lobar fissure?

A

Echogenic linear structure between the gallbladder neck and the portal vein

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16
Q

Why is the main lobar fissure important in ultrasound?

A

It helps differentiate the gallbladder from liver vasculature

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17
Q

What causes the gallbladder posterior enhancement?

A

The duodenum with bowel gas

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18
Q

What is the Hartmann’s pouch?

A

When there is a small outpouching along the gallbladder neck

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19
Q

What is a Phrygian cap?

A

When the fundus folds on itself

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20
Q

What do the bile ducts, hepatic artery, and portal vein walls look like on ultrasound?

A

Echogenic

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21
Q

What do the hepatic vein walls look like on ultrasound?

A

Thin and dull

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22
Q

Where does the main portal vein arise from?

A

The confluence of the superior mesenteric and splenic veins

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23
Q

Where does the hepatic vein drain?

A

Into the IVC

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24
Q

What do the bile ducts and gallbladder show on color Doppler?

25
What kind of flow does liver vasculature have?
Hepatic artery and portal vein are hepatopedal | Hepatic veins are hepatofugal
26
What is the correct method for measuring the CBD?
From inner wall to inner wall in long axis
27
What is the sonographic difference between the gallbladder and intestinal loops?
Intestinal walls are hypoechoic and have echogenic lumen | Gallbladder has hyperechoic walls and a echoing lumen
28
What is patient preparation for biliary tree scanning?
NPO for 6-8 hours before exam
29
Why should a patient be NPO before biliary scanning?
Ensures the gallbladder will be dilated | Minimizes bowel gas
30
What are the basic objectives for imaging the gallbladder and biliary tract?
Visualize the biliary system in two planes in two body positions (supine, LLD) Scan gallbladder from fundus through neck Measure the thickness of the anterior gallbladder wall Measure CBD diameter
31
Is the gallbladder always in the same location?
No, it depends on body habitus
32
Where is the gallbladder likely located in thinner patients?
Anteriorly located in subcostal position | Beam directed toward head
33
Where is the gallbladder likely located in heavier patients?
More laterally located | X-7 approach - start in subxiphoid position and move 7 cm laterally
34
What major structures should be included in biliary scanning?
Gallbladder in long and trans Intrahepatic and extrahepatic ducts Pancreatic head with common bile duct
35
What measurements are suggested for biliary scanning?
Anterior wall of gallbladder | Bile duct in ports hepatis
36
What is the maximum measurement for the the bile filled gallbladder?
9 cm
37
What aspect is the common duct is considered the common bile duct?
The distal
38
What congenital sonographic finding can appear similar to an hourglass?
Bilobed
39
What sonographic finding is associated with the presence of stone in the ductal system?
Choledocholithiasis
40
What clinical indication presents as yellowish skin?
Jaundice
41
What imaging test is used to test the function of the gallbladder?
HIDA scan
42
What is the widest portion of the gallbladder?
Fundus
43
What does the extrahepatic portal triad consist of?
Left portal vein Left hepatic artery Common bile duct
44
What ducts form the ampulla of Vater?
Pancreatic and bile ducts
45
What circle of muscle fibers surrounds the ampulla of Vater?
Sphincter of Oddi
46
What is the neck of the gallbladder fixed to?
Main lobar fissure
47
What do the walls of the gallbladder look like?
Echogenic
48
What do the walls of the hepatic artery, portal vein, and bile duct look like?
Echogenic walls | No color doppler flow
49
Where does the CBD deliver bile?
Into the duodenum
50
What regulates the CBD?
Sphincter of Oddi
51
Where does the CBD run?
Anterior and parallel to the portal vein
52
How does the gallbladder concentrate bile when fasting?
By reabsorbing water and electrolytes The sphincter of oddi is closed Bile goes to the liver through the cystic duct
53
What is the function of cholecystokinin?
Causes the liver to synthesize more bile and the sphincter of oddi to open
54
What are the vasculature included in the Mickey Mouse sign?
Left ear is CBD Right ear is HA Head is PV
55
How do you scan the gallbladder?
Hold deap breath | Two planes in two positions
56
What is the normal diameter of the CBD?
< 7 mm
57
How do stones appear in the biliary system?
Echogenic stones within anechoic lumen that cause posterior shadowing Increased gallbladder wall thickness and elnarged gallbladder lumen
58
What are the risk factors of gallstones?
The five F's | Fat, female, forty, fertile, and fair
59
What are symptoms of gallstones?
Sharp epigastric or RUQ pain Shoulder/back pain Nausea/vomiting

General Sonography (8 decks)

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