Chapter 2. Biliary Tract Flashcards
What structures join to form the common hepatic duct?
The right and left hepatic ducts join to form the common hepatic duct
What biliary structures join to form the common bile duct?
The common hepatic duct joins with the cystic duct to form the common bile duct.
What structure is formed at the junction of the common bile duct and the duct of wirsung?
The ampulla of vater is formed at the junction of the CBD and main pancreatic duct (duct of wirsung).
What is the name of the sphincter that is located at the ampulla of vater?
The sphinter of oddi is located at the ampulla of vater.
What vessels does the portal triad consist of?
The portal triad is composed of the CBD/CHD, Hepatic artery and main portal vein.
The gallbladder receives it’s blood supply from which vessel? Where does this vessel originate from?
The GB receives blood supply from the cystic artery. The cystic artery is a branch of the right hepatic artery.
A spiral fold that controls bile flow into the cystic duct is called the…
Valve of Heisters
Abnormal sacculation or diverticulum of the GB neck is called…
Hartmans pouch
Term for a fold that is between the GB neck and body…
Junctional folds are folds between the GB body and neck. They are a common GB variant.
Term for a fold within the GB body and fundus…
A phrygian cap is a fold between the body and fundus of the GB.
Why is harmonic imaging needed when doing an US of the GB?
Harmonic imaging is used when investigating the GB to clear reverberation artifact that is commonly seen in the GB’s near field.
Where does the ampulla of vater empty?
The ampulla pf vater empties into the fist portion of the duodenum.
What is the normal GB wall measurement?
The normal GB wall should measure <3mm.
What is the most common cause of GB wall thickening?
Cholecystitis is the most common cause of GB wall thickening.
What is a pre-hepatic cause of jaundice?
Pre-hepatic jaundice may occur due to excessive RBC breakdown which overwhelms the livers ability to conjugate bilirubin. This leads to hyperbilirubinemia (excess bilirubin)
Describe how hepatic jaundice occurs and list causes of hepatic jaundice…
With intrahepatic jaundice, there is dysfunction of the liver itself. The liver loses the ability to conjugate bilirubin, but in cases of cirrhosis, it compresses the intrahepatic portions of the biliary tree, causing a degree of obstruction. Causes of hepatic jaundice include acute and chronic liver disease, hemochromatosis, Wilson’s disease, primary biliary cirrhosis, sclerosing cholangitis, and gilberts syndrome.
List causes of post hepatic jaundice…
Obstruction of the biliary tree causing unconjugated hyperbilirubinemia
List the trademark signs of post hepatic jaundice…
Dark urine and pale stool are trademark findings of a patient with post hepatic jaundice
GB sludge may be found in association of…
Prolonged fasting and IV tube feeding are associated with GB sludge formation (anything resulting in GB stasis may result in sludge)
Gb sludge that has a mass like appearance is called…
Tumefactive sludge may appear as an intraluminal GB mass.
Describe the WES sign. What is another term for this finding?
A GB filled with stones may be seen as a strong shadow in the RUQ. This is called the Wall Echo Shadow or WES sign. Another term for this condition is Double Arc sign.
An intense point of tenderness due to transducer pressure directly on the GB, quoted to be 90% sensitive and specific…
Murphy’s sign
List complications that may occur due to acute cholecystitis…
Empyema (collection of pus)
Gangrenous cholecystitis
Perforation
pericholecystic abscess
How can a sonographer distinguish acute cholecystitis from chronic cholecystitis based on the US alone?
Sonographically, acute and chronic cholecystitis appear identical.
