Chapter 3 Gallbladder Flashcards
1
Q
Calcifications of the gallbladder wall is termed
A
Porcelain gallbladder
2
Q
_____ is associated with courvoisier gallbladder
A
Pancreatic head mass
3
Q
The spiral valves of Heister are found within the
A
Cystic duct
4
Q
Cholesterol crystals within the Rokitansky Aschoff sinus are found with:
A
Adenomyomatosis
5
Q
Diabetic patients suffering from acute cholecystitis have an increased risk for developing
A
Emphysematous cholecystitis
6
Q
Focal tenderness over the gallbladder with probe pressure describes
A
Murphy sign
7
Q
A nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represent a
A
Gallbladder polyp
8
Q
Intermittent obstruction of the cystic duct by a gallstone results in
A
Chronic cholecystitis
9
Q
_______ would be the least likely finding of acalculous cholecystitis
A
Cholelithiasis (gallstones)
10
Q
The sequela of acute cholecystitis that is complicated by gas within the gallbladder wall is
A
Emphysematous cholecystitis
11
Q
The champagne sign is associated with
A
Emphysematous cholecystitis
12
Q
Tumefactive sludge can resemble the sonographic appearance of
A
Gallbladder carcinoma
13
Q
Clinical findings of adenomyomatosis
A
Asymptomatic
14
Q
WES sign denotes
A
A gallbladder filled with cholelithiasis (stones)
15
Q
Acute cholecystitis that leads to NECROSIS and abscess development within the gallbladder wall describes
A
Gangrenous cholecystitis
16
Q
The diameter of the gallbladder should not exceed
A
5cm
17
Q
The most common variant of gallbladder shape is the
A
Phrygian cap
18
Q
What is/are cholelithiasis?
A
Gallstones
19
Q
Empyema of the gallbladder denotes
A
Gallbladder filled with pus
20
Q
The gallbladder is connected to the biliary tree by the
A
Cystic duct
21
Q
The outermost layer of the gallbladder wall is the
A
Serosal layer
22
Q
The innermost layer of the gallbladder wall is the
A
Mucosal layer
23
Q
The cystic artery is most often a direct branch of the
A
Right hepatic artery
24
Q
The middle layer of the gallbladder wall is the
A
Fibromuscular layer
25
Which structure is a useful landmark for identifying the gallbladder
Main lobar fissure
26
What hormone causes the gallbladder to contact
Cholecystokinin
27
The gallbladder wall should measure not more than
3mm
28
The direct blood supply to the gallbladder is the
Cystic artery
29
At which level of the gallbladder is the junctional fold found
Neck
30
Which part of the gallbladder is involved in Hartmann pouch
Neck
31
_____ is associated with cholelithiasis and is characteristically found in Africans or people of African descent
Sickle cell disease
32
Hepatization of the gallbladder occurs when the gallbladder
Fills with sludge
33
______ is suspected if a polyp or mass within the gallbladder measures greater than 1cm
Gallbladder carcinoma
34
The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with
Cholesterolosis
35
Causes of nonvisualization of the gallbladder (8):
1. Cholecystectomy
2. Gb filled with stones
3. Postprandial
4. Chronic cholecystitis
5. Ectopic location
6. Agenesia
7. Hepatization of the gallbladder (sludge)
8. Air-filled gallbladder or emphysematous cholecystitis
36
Acute cholecystitis can turn into
Gangrenous cholecystitis
37
Patients often complain of focal tenderness over the gallbladder with transducer pressure when the gallbladder is inflamed this is termed
Positive Murphy sign
38
The most common cause of acute cholecystitis is
**Gallstone** lodged in the **cystic duct or neck** of the gallbladder
39
The sudden onset of gallbladder inflammation is referred to as
Acute cholecystitis
40
An enlarged gallbladder can be caused by a blockage of
Cystic duct or other parts of the biliary tree
41
______ are the most common type of polyps
Cholesterol
42
________ which is a group of proliferated and degenerative gallbladder disorder, includes both adenomyomatosis and cholesterolosis
Hyperplastic cholecystosis
43
Sonographic findings of polyps (1):
1. Hyperechoic, **nonshadowing, and nonmobile mass** that projects from the gallbladder wall into the gallbladder lumen
44
Clinical findings of polyps
Asymptomatic
45
Gallbladder polyps are often seen with _______ that results from the disturbance in cholesterol metabolism and accumulation of cholesterol
Cholesterolosis
46
The gallbladder should not exceed ________ in width and _______ in length
•4 to 5cm
•8 to 10cm
47
Sources of focal gallbladder wall thickening (4):
•gallbladder polyp
•adenomyomatosis
•gallbladder carcinoma
•adhered gallstone
48
_____ is hourglass appearance of the gallbladder
Bilobed gallbladder
49
Gallbladder fundus is folded into itself
Phrygian cap
50
Outpouching of the gallbladder neck
Hartmann pouch
51
Blood supply to the gallbladder is via the
Cystic artery
52
_____ is thick and mimics an intraluminal gallbladder mass
Tumefactive sludge
53
______ is thought to be caused by chronic irritation of the gallbladder wall by gallstones
Gallbladder carcinoma
54
The most common metastatic disease of the gallbladder is
Malignant melanoma
55
Sources of diffused gallbladder wall thickening (8):
1. Gallbladder carcinoma
2. Hypoalbuminemia
3. AIDS cholangiopathy
4. Congestive heart failure
5. Postprandial
6. Cholecystitis
7. Adenomyomatosis
8. Hepatic dysfunction
56
The portion of the **biliary tree** that **lies distal** to the **Union** of the **cystic duct with the hepatic duct** is the:
Common bile duct
57
A gallbladder sonogram should be performed after the patient had had nothing to eat for _____
4 to 8 hours
58
Gallstones typically consist of a mixture of
•cholesterol
•calcium
•bilirubinate
•calcium carbonate
59
What are the six F’s for gallstones
•fat
•female
•fertile
•flatulent
•fair
•fourty
60
A gallbladder that is completely filled with gallstones May exhibit the
Wall-echo-shadow sign (WES)
61
_______, within the gallbladder is most often associated with biliary stasis
Sludge (viscid bile)
62
_______ may also form into sludge balls, which are typically mobile and will now produce an acoustic shadow
Tumefactive sludge
63
The gallbladder can also completely fill with Tumefactive sludge, causing the gallbladder to appear:
Isoechoic to the liver tissue (hepatization of the gallbladder)
64
Clinical findings of gallbladder sludge (2):
1. Asymptomatic
2. Any reasons for biliary stasis (sludge)
65
Sonographic findings of gallbladder sludge (1):
1. Low-level nonshadowing, echoes
66
If a thrombus completely occludes the portal vein, what will happen?
Collaterals within the portal vein region
67
Calcifications of the gallbladder wall is termed
Porcelain gallbladder
68
_____ is associated with courvoisier gallbladder
Pancreatic head mass
69
The spiral valves of heister are found within the:
Cystic duct
70
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with:
Adenomyomatosis
71
Diabetic patients suffering from acute cholecystitis have an increased risk for developing
Emphysematous cholecystitis
72
Focal tenderness over the gallbladder with probe pressure describes:
Murphy sign
73
Sonographic findings of porcelain gallbladder (2):
1. **Calcifications** of the **gallbladder wall** with **shadowing**
2. **Chronic cholecystitis** may be present
74
Sonographic findings of gallbladder enlargement (2):
1. Measures more than 4-5cm in diameter or more than 8-10cm in length
2. Search for obstruction
75
____ is a form of acute cholecystitis and is more commonly found in children, recently hospitalized patients, or immunocompromised
Acalculous cholecystitis
76
Clinical findings of acalculous cholecystitis (3):
1. RUQ tenderness
2. Pain
3. Leukocytosis
77
____ results from the **intermittent obstruction** of the **cystic duct by gallstones**, resulting in multiple bouts of **acute cholecystitis**
Chronic cholecystitis
78
Gas bubbles within the gallbladder wall that may rise to the nondependent wall of the gallbladder is known as
Champagne sign
79
______is a form of **acute cholecystitis** that is caused by **gas forming infection** invading the gallbladder lumen, wall, or both
Emphysematous cholecystitis
80
With adenomyomatosis, the liminal epithelium is hyperplastic and the muscular layer becomes thickened producing:
tiny pockets called Rokitansky-Aschoff sinuses
81
Adenomyomatosis is literally interrupted as
The _condition_ of **glands** within the **muscle of the gallbladder**
82
Clinical findings of Adenomyomatosis
•asymptomatic
83
Clinical findings of porcelain gallbladder
•asymptomatic
84
Sonographic findings of gallbladder carcinoma(4):
1. Nonmobile mass that measures more than 1cm
2. Wall thickening
3. Irregular mass
4. Mass invasion into surrounding tissue
85
Clinical findings of gallbladder carcinoma (6):
1. Weightloss
2. Pain
3. Jaundice
4. Nausea and vomiting
5. Hepatomegaly
6. Possible elevation in ALP, ALT, GGT and bilirubin
86
Clinical findings of cholelitiasis (6):
1. Asymptomatic
2. Biliary colic (onset pain)
3. Abdominal pain after fatty meals
4. Nausea and vomiting
5. Pain that radiates to the shoulders
87
Sonographic findings of adenomyomatosis (2):
1. Focal or diffuse thickening of the gallbladder wall
2. Comet tail artifact that projects from the gallbladder wall into the lumen of the gallbladder
88
Clinical findings of acute cholecystitis
•RUQ tenderness
• pain
•luekocytosis
•elevation in ALP,ALT, GGT and bilirubin
•pain that radiates to the shoulders
•nausea and vomiting
89
Sonographic findings of acute cholecystitis (6):
1. Gallstones
2. Murphy sign
3. Gb wall thickening
4. Gb enlargement
5. Pericholecystic fluid
6. Sludge
90
Sonographic findings of emphysematous cholecystitis (2):
1. Dirty shadowing, reverberation, or ring down artifact
2. Champagne sign
91
Clinical findings of emphysematous cholecystitis (4):
1. Diabetic or immunosuppressive pt
2. Pain
3. Fever
4. Sepsis
92
Sonographic findings of chronic cholecystitis (4):
1. Contracted gallbladder
2. WES sign
3. Gallstones
4. Wall thickening
93
Clinical findings of chronic cholecystitis (2):
1. Intolerance too fatty foods because of subsequent abdominal pain
2. Nontender gallbladder
94
Clinical findings of gallbladder enlargement (3):
1. Palpable gallbladder
2. Painless jaundice
3. Possible elevation in ALP, ALT, GGT, and bilirubin
95
Sonographic findings of Acalculous choleystitis(4):
1. Murphy sign
2. Gallbladder wall thickening
3. Pericholecystic fluid
4. No stones
