Chapter 13- Gallbladder

Question 1

What structures are part of the Biliary System

Answer 1

Gallbladder and bile ducts.

Question 2

The gallbladder is located in the gallbladder fossa. Where in the liver is this located?

Answer 2

The posterior inferior portion of the Right Lobe of the Liver

Question 3

The neck of the gallbladder does not change position. What is the name for this?

Answer 3

Fixed Position.

Question 4

What is the function of the Gallbladder?

Answer 4

It is a reservoir for storing bile.

Question 4

The gallbladder has a fixed anatomic relationship to what 2 structures?

Answer 4

Main Lobar Fissure and Portal Vein

Question 5

What is the function of the liver?

Answer 5

Hepatocytes in the liver produce bile

Question 6

What is the function of the bile ducts?

Answer 6

They drain the liver of bile and empties into the duodenum

Question 7

List 3 of the compounds that make up bile

Answer 7

Bile Salts, Water,, Billirubin

Question 8

Bile Salts are the most important component of bile. What do they do?

Answer 8

They break down fats during digestion.

Question 9

Does the gallbladder look the same in every patient?

Answer 9

No, size and shape vary greatly.

Question 10

What is the normal sonographic appearance of the gallbladder

Answer 10

anechoic with echogenic walls

Question 11

What is the inner layer of the gallbladder called?

Answer 11

Mucosa

Question 12

What is the middle layer of the gallbladder called?

Answer 12

Fibromuscular

Question 13

What is the outer layer of the gallbladder called?

Answer 13

Serous

Question 14

Inside the gallbladder, there are many small, inward folds. What are these folds called?

Answer 14

Rugae

Question 15

What is the purpose of Rugae?

Answer 15

they increase the surface area to aid in concentrating bile through the absorption of water and secretion of mucous

Question 16

What ducts converge to form the common hepatic duct

Answer 16

The R and L hepatic ducts

Question 17

The gallbladder neck tapers at one end to form what structure?

Answer 17

The cystic duct

Question 18

The cystic duct joins with the common hepatic duct. what does this union form?

Answer 18

The Common Bile Duct

Question 19

The common bile duct and main pancreatic duct join to form the…?

Answer 19

Ampulla of Vater

Question 20

The ampulla of vater empties through the duodenal papilla. What structure controls this?

Answer 20

The Sphincter of Oddi

Question 21

What is the muscle that controls the flow of pancreatic juices and bile into the duodenum?

Answer 21

The sphincter of Oddi

Question 22

What do the Valves of Heister do?

Answer 22

They are spiral folds that control bile flow in the cystic duct. They prevent the cystic duct from over distending or collapsing.

Question 23

Do the Valves of Heister actually contain valves?

Answer 23

No.

Question 24

Which 3 structures produce, transport, and then store the bile?

Answer 24

The liver produces bile, it is carried by the biliary ducts to the gallbladder where it is stored.

Question 25

When bile is released, it is transported through the Ampulla of Vater. Where does it go?

Answer 25

The duodenum.

Question 26

What happens when the sphincter of Oddi is closed?

Answer 26

The gallbladder is forced to fill with bile.

Question 27

When we eat, what peptic hormone is released by the duodenum?

Answer 27

Cholecystokinin (CCK)

Question 28

What does Cholecystokinin (CCK) do?

Answer 28

CCK stimulates the gallbladder to contract and tells the sphincter to relax. This allows bile into the duodenum.

Question 29

How thick should the gallbladder wall be?

Answer 29

3 mm or less.

Question 30

What should the diameter of the Right, Left, and Common Hepatic Ducts be?

Answer 30

0.1-0.2 cm

Question 31

What should the diameter of the Common Bile Duct be?

Answer 31

0.1-0.7 cm

Question 32

What should the diameter of the Cystic Duct be?

Answer 32

0.1-0.4

Question 33

How long should the normal gallbladder be?

Answer 33

8-12 cm long

Question 34

When is a gallbladder considered Hydropic?

Answer 34

When it is enlarged: measuring more than 5 cm in a transverse plane.

Question 35

Describe a Phrygian Cap. What percent of patients have one?

Answer 35

A normal variant of the gallbladder when the fundus is folded onto the body. It is found in 1-6% of patients.

Question 36

Describe a Junctional Fold and what it may be confused with on ultrasound.

Answer 36

A fold anywhere in the gallbladder wall. It could be confused with polyps or calculi and cause high-amplitude echos.

Question 37

What is Hartmanns Pouch

Answer 37

A small sac that may be seen in the area of the gallbladder neck

Question 38

Describe a floating gallbladder

Answer 38

a gallbladder positioned low in the abdomen

Question 39

Describe agenisis of the gallbladder

Answer 39

no gallbladder due to failure to develop

Question 40

Describe a bilobed gallbladder

Answer 40

"hourglass" or V- shaped

Question 41

Describe a septated gallbladder

Answer 41

One or more internal divisions

Question 42

Describe a duplicated gallbladder

Answer 42

2 complete gallbladders

Question 43

Describe a gallbladder with hypoplasia

Answer 43

an underdeveloped gallbladder.

Question 44

In the portal triad's "mickey mouse" symbol, which vessel is the right side of the patient or "left ear"

Answer 44

The common bile duct

Question 45

Where do we obtain the most accurate sonographic measurement of the Common Bile Duct?

Answer 45

In Porta Hepatis

Question 46

What is the general rule for the measurement of the Common Bile Duct? Give an example.

Answer 46

About 1mm for every decade of life. for a 20 year old patient, their CBD should measure around 2mm.

Question 47

What is the most common location for a stone in the biliary tract?

Answer 47

The gallbladder

Question 48

What could happen if a stone passes to the joining of the bile and pancreatic duct?

Answer 48

It could cause pancreatitis

Question 49

What is Billiruben?

Answer 49

a compound made from the breakdown of Red Blood Cells.

Question 50

Which wall of the gallbladder should you measure, how do you measure it, and what scan plane should you use?

Answer 50

The anterior wall, outer edge to outer edge, and in Transverse

Question 51

How many patient positions should you use when scanning the gallbladder? Why?

Answer 51

2 positions because the gallbladder fundus is not in a fixed position so it moves around. It's important to move the patient in case pathology is hidden in a supine position.

Question 52

What patient positions are accepatable when measuring the gallbladder?

Answer 52

Supine and LLD or Semi-Erect

Question 53

What MUST you do when you are scanning a patient in a non-supine position? Why?

Answer 53

Label the patient's position on the images so the radiologist knows how the patient was laying.

Question 54

What two questions should you ask specifically to a gallbladder patient?

Answer 54

How long since last time eating? What did you eat?

Question 55

Why would you ask when a patient last ate?

Answer 55

In non-emergency situations we NEVER scan a patient who ate less than 4 hours previously, since the gallbladder would not be distended.

Question 56

When and Why would you ask a patient what they last ate?

Answer 56

During a biliary/gallbladder exam. The radiologist may want to know if they've recetnly had fatty foods.

Question 57

What scan plane is used to measure the Common Bile Duct? How do you meausre it?

Answer 57

In a sagittal scan plane. It is measured from inner wall to inner wall.

Question 58

What is the width of the gallbladder

Answer 58

3-5 cm diameter

Question 59

Where are the spiral valves of heister found specifically?

Answer 59

In the lumen of the cystic duct.

Question 60

What is Murphy's sign

Answer 60

Right Upper Quadrant pain. It is used in a physical exam to diagnose cholecystitis