Chapter 3: The Gallbladder Flashcards
(221 cards)
1
Q
inflammation of the gallbladder without associated gallstones
A
acalculous cholecystitis
2
Q
the sudden onset of gallbladder inflammation
A
acute cholecystitis
3
Q
benign hyperplasia of the gallbladder wall
A
adenomyomatosis
4
Q
when a polyp appears to be a round object, like a ball, that is stuck to the gallbladder wall
A
“ball on the wall” sign
5
Q
pain located in the RUQ in the area of the GB
A
biliary colic
6
Q
the effect of dirty shadowing, reverberation, or ring-down artifact caused by gas or air bubbles produced by bacteria within the nondependent (typically anterior) gallbladder wall
A
champagne sign
7
Q
the surgical removal of the GB
A
cholecystectomy
8
Q
the hormone produced by the duodenum that causes the GB to contracty
A
cholecystokinin
9
Q
the presence of gallstone(s) within the biliary tree
A
choledocholithiasis
10
Q
gallstone(s)
A
cholelithiasis
11
Q
a condition that results from the disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the GB wall; may be diffuse and referred to as a strawberry GB
A
cholesterolis
12
Q
results from intermittent obstruction of the cystic duct by gallstones
A
chronic cholecystitis
13
Q
partially digested food from the stomach
A
chyme
14
Q
artifact caused by several small reflective interfaces
A
comet-tail artifact
15
Q
the clinical detection of an enlarged, palpable GB caused by an obstruction in the area of the pancreatic head, typically caused by a pancreatic head mass
A
courvosier GB
16
Q
chronic inflammatory bowel disease that leads to thickening and scarring of the bowel walls, leading to chronic pain and recurrent bowel obstructions
A
Crohns disease
17
Q
the duct that connects the gallbladder to the common hepatic duct
A
cystic duct
18
Q
having two gallbladders that are often, but not always, paired with their own cystic ducts
A
duplication of the gallbladder
19
Q
abnormal distention of an organ with air or gas
A
emphysematous
20
Q
the presence or collection of pus
A
empyema
21
Q
a gallbladder that is highly mobile and thus prone to torsion
A
floating gallbladder
22
Q
the twisting of the vascular supply to the gallbladder
A
gallbladder torsion
23
Q
an outpouching of the gallbladder neck
A
Hartmann pouch
24
Q
a condition that results in the destruction of red blood cells
A
hemolytic anemia
25
situation in which the gallbladder is completely filled with tumefactive sludge, causing the gallbladder to appear isoechoic to the liver tisue
hepatization of the gallbladder
26
an enlarged gallbladder; also referred to as mucocele of the gallbladder
hydropic gallbladder
27
the intravenous administration of nutrients and vitamins
hyperalimentation
28
a group of proliferative and degenerative gallbladder disorders, which includes both adenomyomatosis and cholesterolysis
hyperplastic cholecystosis
29
abnormal low level of albumin in the blood;
hypoalbuminemia
30
performing sonographic imaging between the ribs
intercostal sonographic imaging
31
rare anomaly of the biliary tree where the main hepatic ducts drain directly into the gallbladder and the gallbladder drains directly into the common bile duct; may lead to childhood jaundice, enlarged gallbladder, and intermittent abdominal pain
interposition of the gallbladder
32
a gallbladder that is completely surrounded by the hepatic parenchyma
intrahepatic gallbladder
33
a fold in the neck of the gallbladder
junctional fold
34
a condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes; also referred to as mucocutaneous lymph node syndrome
Kawasaki disease
35
an elevated white blood cell count
leukocytosis
36
pain directly over the gallbladder with applied probe pressure
Murphy sign
37
the total number of completed pregnancies that have reached the age of viability
parity
38
fluid around the gallbladder
pericholecystic fluid
39
inflammation of the peritoneal lining
peritonitis
40
gallbladder variant when the gallbladder fundus is folded onto itself
Phyrgian cap
41
the calcification of all or part of the gallbladder wall
porcelain gallbladder
42
after a meal
postprandial
43
tiny pockets within the gallbladder wall
Rokitansky-Aschoff sinuses
44
a life-threatening condition caused by the body's response to systemic infection; also referred to as blood poisoning; results in a number of issues including low blood pressure, rapid heartbeat, and fever
sepsis
45
a gallbladder that has one or more septa within its lumen; a gallbladder with several septa; may be referred to as a multiseptate gallbladder
septate gallbladder
46
an illness resulting from another disease, trauma, or injury
sequela
47
form of hemolytic anemia typically found in Africans or people of African descent; characterized by dysfunctional sickle-shaped red blood cells
sickle cell disease
48
folds located within the cystic duct that prevent it from collapsing and distending
spiral valves of Hester
49
complication of acute cholecystitis characterized by pus accumulation within the gallbladder
suppurative gallbladder
50
the feeding of a person intravenously
total parenteral nutrition
51
thick sludge
tumefactive slude
52
shadowing from the gallbladder fossa produced by a gallbladder that is completely filled with gallstones
wall-echo-shadow sign
53
The sonographic sign of gallbladder torsion when color Doppler is applied to the spiraled, twisted cystic artery
whirlpool sign
54
rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells, noted sonographically as asymmetrical thickening of the gallbladder wall and intraluminal echogenic debris
xanthogranulomatous cholecystitis
55
hourglass appearance of the gallbladder
bilobed gallbladder
56
appears as thin separations within the gallbladder
septate gallbladder
57
gallbladder is folded onto itself
phyrgian cap
58
most common gallbladder variany
phyrygian cap
59
outpouching of the gallbladder neck
hartmann pouch
60
prominent fold located at the junction of the gallbladder neck
junctional fold
61
Sources of diffuse gallbladder wall thickening
postprandial
acute cholecystitis
chronic cholecystitis
adenomyomatosis
hepatic dysfunction
benign ascites
hypoalbuninemia
AIDS cholangiopathy
congestive heart failure
gallbladder carcinoma
62
sources of focal gallbladder wall thickening
gallbladder polyp
adenomyomatosis
gallbladder carcinoma
adhered gallstone
63
risk factors and predisposing conditions for cholelithiasis
obesity
pregnancy
increased parity
gestational diabetes
estrogen therapy
oral contraceptive use
rapid weight loss programs
hemolytic disorder
Chron's disease
total parenteral nutrition
64
Clinical findings of cholithiasis
asymptomatic
biliary colic
abdominal pain after fatty meals
epigastric pain
nausea and vomiting
pain that radiates to the shoulders
65
echogenic, mobile, shadowing structure(s) with the lumen of the gallbladder, stones that lodge within the cystic duct or neck of the gallbladder may not move; WES sign may be present
sonographic findings of cholelithiasis
66
A collection of low-level, nonshadowing, dependent, echoes within the gallbladder lumen
sonographic findings of gallbladder sludge
67
hyperechoic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen
sonographic findings of gallbladder polyps
68
focal or diffuse thickening of the gallbladder wall; comet-tail artifact that projects from the gallbladder wall into the lumen of the gallbladder
sonographic findings of Adenomyomatosis
69
RUQ tenderness
epigastic or abdominal pain
leukocytosis
possible elevation in ALP, ALP, GGT, and bilirubin (with obstruction)
fever
paid that radiates to the shoulders
nausea and vomiting
jaundice if there is an obstruction
clinical findings of acute cholecystitis
70
gallstones, positive sonographic Murphy sign, gallbladder wall thickening, gallbladder enlargement, pericholecystic fluid, sludge
sonographic findings of acute cholecystitis
71
RUQ pain, epigastric or abdominal pain, leukocystosis, possible elevation in ALP, ALT, GGT, and bilirubin, fever, pain that radiates to the shoulders, nausea and vomiting
clinical findings of gangrenous cholecystitis and Gallbladder perforation
72
galls stones, loss of the sonographic Murphy sign, gallbladder wall thickening with a possible perceptible wall tear, focal wall necrosis, bulges of the gallbladder wall, sloughed membranes, and ulcerative craters, gallbladder typically loses its shape, pericholecystic fluid, sludge
sonographic findings of gangrenous cholecystitis and gallbladder perforation
73
diabetic patient
RUQ pain, possible without Murphy sign
fever
can progress to sepsis
clinical findings of emphysematous cholecystitis
74
dirty shadowing reverberation, or ring-down artifact emanating from the gallbladder wall or gallbladder lumen consistent with air, champagne sign
sonographic findings of emphysematous cholecystitis
75
gas bubbles within the gallbladder wall may rise to the nondependent wall of the gallbladder
Champagne sign
76
intolerance to fatty foods because of subsequent abdominal pain; nontender gallbladder
clinical findings of chronic cholecystitis
77
contracted gallbladder; WES sign; gallstones; wall thickening
sonographic findings of chronic cholecystitis
78
RUQ tenderness, epigastric or abdominal pain, leukocytosis
clinical findings of acalculus cholecystitis
79
positive sonographic Murphy sign, gallbladder wall thickening, pericholecystic fluid, sludge
sonographic findings of alcalculous cholecystitis
80
palpable gallbladder, could suffer from painless jaundice, possible elevation in ALP, ALT, GGR, and bilirubin
clinical findings of gallbladder enlargement
81
gallbladder measures greater than 4-5 cm in diameter or greater than 8-10 cm in length
sonographic signs of gallbladder enlargement
82
calcification of the gallbladder wall recognized by an echogenic curvilinear structure within the gallbladder fossa with shadowing; the identification of the calcified posterior wall of the gallbladder is helpful to differentiate from the WES sign, signs of chronic cholecystitis may be present
sonographic findings of porcelain gallbladder
83
weight loss; RUQ pain; jaundice; nausea and vomiting; hepatomegaly; possible elevation in ALP, AST, GGT, and bilirubin
clinical findings of gallbladder carcinoma
84
nonmobile mass within the gallbladder lumen that measures greater than 1 cm; diffuse or focal gallbladder wall thickening; irregular mass that may completely fill the gallbladder fossa; invasion of the mass into surrounding liver tissue
sonographic findings of gallbladder carcinoma
85
Where is the gallbladder located/
posterior to the right lobe of the liver within the gallbladder fossa
86
The gallbladder is an ____peritoneal organ
intra
87
pear shaped sac, used to store and concentrate bile that is produced by liver
main lobar fissure
88
3 distinct layers to main lobar fissue
mucusal layer (innermost layer, consists of multiple folds and rugae)
fibromuscular layer (middle layer)
serosal layer (outer layer)
89
The gallbladder consists of the ____, ____, and _____.
neck
body
fundus
90
contiguous with cystic duct, connects gallbladder to rest of biliary system as level of common hepatic duct
neck
91
portion of biliary tree that lies distal to union of the cystic duct with hepatic duct
common bile duct
92
most dependent portion of the gallbladder
fundus
93
Blood supply to the gallbladder is via:
cystic artery
94
The cystic artery is a small branch of the _____
right hepatic artery
95
The hormone _____, causes the gallbladder to contract
cholecystokinin
96
twisting of the blood supply of the gallbladder
gallbladder torsion
97
gallbladder torsion is also known as:
gallbladder volvulus
98
the "whirlpool" sign is associated with:
gallbladder torsion
99
spiral appearance of cystic artery with color Doppler
"whirlpool" sign
100
gallbladder totally surrounded by hepatic parenchyma
intrahepatic gallbladder
101
The normal gallbladder is __-__ cm in length.
8-10
102
The normal gallbladder is __-__ cm in diameter.
4-5
103
Gallbladder volume equation
v= 0.523(LxWxH)
104
The gallbladder normally holds __ mL of bile.
40
105
The gallbladder should measure no more than __mm
3
106
Helpful labs for gallbladder
ALP
AST
bilirubin
GGT
LDH
WBC
107
biliary stones that form within the gallbladder
cholelithiasis
108
Gallstones usually consist of:
cholesterol
calcium bilrubinate
calcium carbonate
109
6Fs associated with cholelithiasis
fat
female
fertile
flatulent
fair
forty
110
mobile, echogenic structure within gallbladder lumen that produces an acoustic shadow; WES sign, twinkle artifact
cholelithiasis
111
WES sign
wall echo shadow sign
112
occurs posterior to a strong, granular, and irregular surface
twinkle artifact
113
viscid bile, most often associated with biliary stasis
gallbladder sludge
114
collection of low-level, nonshadowing, dependent echoes within gallbladder lumen
gallbladder sludge
115
thick sludge that can mimic an intraluminal gallbladder mass
tumefactive sludge
116
gallbladder completely fills with tumefactive sludge; isoechoic to liver parenchyma
hepatization of gallbladder
117
projection of tissue from gallbladder wall that protrudes into the lumen of the gallbladder
gallbladder polyps
118
most common type of gallbladder polyp
cholesterol polyps
119
cholesterol polyps measure less than __ mm
10
120
result of accumulation of cholesterol and triglycerides within gallbladder wall
cholesterol polyps
121
round object stuck to gallbladder wall
"ball-on-the-wall" sign
122
results from disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the gallbladder wall
cholesterol polyps
123
diffuse polypoid appearance of gallbladder filled with polyps
strawberry gallbladder
124
dissemination of glands within the muscle
adenomyomatosis
125
luminal epithelium hyperplastic; muscular layer becomes thickened; produces diverticuli or tiny pockets
adenomyomatosis
126
sinuses may contain cholesterol crystals that produce comet tail artifact; most often seen protruding into gallbladder lumen from anterior wall
Rokitansky Aschoff sinuses
127
sudden onset of gallbladder inflammation
acute cholecystitis
128
most common cause of acute cholecystitis is
gallstone that has become lodged in cystic duct or neck of gallbladder
129
laboratory findings of acute cholecystitis
elevation in ALP and ALT
leukocytosis
elevation of bilirubin
130
focal tenderness over gallbladder
Positive Murphy sign
131
sonographic findings of acute cholecystitis
gallstones
pericholecystic fluid
sludge
thickened gallbladder wall that may contain edematous fluid
132
can be a direct evolution of acute cholecystitis; focal wall necrosis; buldges of gallbladder wall; sloughed membranes; ulcerative craters
gangrenous cholecystitis
133
most often discovered in diabetic patients; form of acute cholecystitis; caused by gas-forming infection invading gallbladder lumen or wall or both
emphysematous cholecystitis
134
gas or gas bubbles produced by bacteria within gallbladder wall will lead to manifestation of _____, ______, or _____
dirty shadowing
reverberation
ring-down artifact
135
gas bubbles rise to nondependent portion of gallbladder wall
champagne sign
136
results from intermittent obstruction of cystic duct by gallstones, resulting in multiple bouts of acute cholecystitis
chronic cholecystitis
137
presents with all symptoms and sonographic findings of cholecystitis but no gallstones are present
chronic cholecystitis
138
chronic cholecystitis is most often found in:
children; recently hospitalized patients; immunocompromised
139
also referred to as suppurative cholecystitis
empyema of the gallbladder
140
gallbladder filled with purulent material (pus)
empyema of the gallbladder
141
chronic infection of the gallbladder; characterized by intramural accumulation of inflammatory cells
xanthogranulomatous cholecystitis
142
sonographic findings of xanthogranulomatous choelcystitis
asymmetrical thickening of the gallbladder wall; intraluminal echogenic debris
143
The gallbladder should not exceed ____in diameter
4-5 cm
144
The gallbladder should not exceed ____ in length
8-10
145
also referred to hydropic gallbladder or mucocele of the gallbladder
Gallbladder enlargement
146
clinical detection of an enlarged, palpable gallbladder caused by a pancreatic head mass, painless jaundice
courvoiser gallbladder
147
Courveisier gallbladder may be associated with _____ disease
Kawasaki
148
results from the calcification of the gallbladder
porcelain gallbladder
149
echogenic curvilinear structure within the gallbladder fossa with shadowing; gallstones and chronic inflammation present
porcelain gallbladder
150
most common cancer of the biliary tract
gallbladder carcinoma
151
through to be caused by chronic irritation of the gallbladder wall by stones; almost always associated with gallstones; increased risk in patients with gallstones
gallbladder carcinoma
152
distinct, nonmobile, hypoechoic mass with lumen, diffuse gallbladder wall thickening, irregulary polypoid mass that completely fills gallbladder fossa
sonographic findings of gallbladder carcinoma
153
Gallbladder carcinoma is suspected if a polyp or mass more than __ cm
1
154
most common metastatic disease of the gallbladder
malignant melanoma
155
The most common location of gallstones is in the _____ because it is the most dependent part of the gallbladder
fundus
156
_______, produced by the entero-endocrine cells of the duodenum, causes gallbladder to contract
cholecystokinin
157
___, ___, and _____ may be most beneficial for determining evidence of gallbladder and bile duct disease
AST
ALP
bilirubin
158
The ______ can be used to identify small gallstones
twinkle artifact
159
_______, which is a group of proliferative and degenerative gallbladder disorders includes both adenomyomatosis and cholesterolosis
hyperplastic cholecystoris
160
______ is associated with comet-tail artifact
adenomyomatosis
161
The presence of gallstones and a positive sonographic Murphy sign is a strong indicator of _____
acute cholecystitis
162
________ is most often discovered in diabetic patients
emphysematous cholecystitis
163
The identifaction of the calcified posterior wall of the gallbladder is helpful to differentiate porcelain gallbladder from _____
WES sign
164
Hepatization of the gallbladder occurs when the gallbladder:
fills with sludge
165
A 71 year old patient presents to the emergncy department with painless jaundice and an enlarged palpable gallbladder. These findings are highly suspicious for:
Courvosier gallbladder
166
The innermost layer of the gallbladder wall is the:
mucosal layer
167
Which of the following would not be a laboratory finding typically analyzed with suspected gallbladder disease?
a. ALP
b. ALT
c. Bilirubin
d. Alpha-fetoprotein
d
168
The cystic artery is most often a direct branch of the:
right hepatic artery
169
The middle layer of the gallbladder wall is:
fibromuscular layer
170
Which structure is a useful landmark for identifying the gallbladder?
main lobar fissure
171
What of the following would be least likely to cause focal gallbladder wall thickening?
a. gallbladder polyp
b. adenomyomatosis
c. ascites
d. adhered gallstone
c
172
What hormone causes the gallbaldder to contract?
cholecystokinin
173
The gallbladder wall should measure no more than:
3mm
174
Which of the following is associated with cholelithiasis and is characteristically found in Africans or people of African descent?
a. Sickle cell disease
b. gallbladder torsion
c. cholesterolosis
d. Arland-Berlin syndrome
a
175
The direct blood supply to the gallbladder is the:
cystic artery
176
The outermost layer of the gallbladder wall is the:
serosal layer
177
Which part of the gallbladder is involved in Hartmann pouch?
Neck
178
The gallbladder is connected biliary tree by the:
cystic duct
179
At which layer of the gallbladder is the junctional fold found?
neck
180
Empyema of the gallbladder denotes:
gallbladder filled with pus
181
What is/are cholelithiasis?
gallstones
182
The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with:
cholesterolosis
183
The most common variant of gallbladder shape is the:
phyrgian cap
184
The diameter of the gallbladder should not exceed:
5 cm
185
Patients who suffer from acute cholecystitis that leads to perforation and rupture have a high mortality and morbidity rate secondary to:
peritonitis
186
All of the following are sources of diffuse gallbladder wall thickening except:
a. acute cholecystitis
b. AIDS
c. hepatitis
d. gallbladder polyp
d
187
Which statement is not true of cholelithiasis?
a. Men have an increased likelihood of developing cholelithiasis compared to women
b. Patients who have been or are pregnant have an increased occurence of cholelithiasis
c. A rapid weight loss may increase the likelihood of developing cholelithiasis
d. patients who have hemolytic disorders have an increased occurrence of cholelithiasis
a
188
WES sign denotes:
a gallbladder filled with cholelithiasis
189
Which of the following is most likely clinical finding of adenomyomatosis?
a. Murphy sign
b. Hepatitis
c. congestive heart failure
d. asymptomatic
d
190
Tumefactive sludge can resemble the sonographic appearance of:
gallbladder carcinoma
191
The champagne sign is associated with:
emphysematous cholecystitis
192
The sequela of acute cholecystitis that is associated with a tear in the gallbladder wall is:
gallbladder perforation
193
A 32 year old female patient presents to the sonography department with vague abdominal pain. The sonographic investigation of the gallbladder reveals a focal area of gallbladder wall thickening that produces comet-tail artifact. These findings are consistent with:
adenomyomatosis
194
Which of the following would not be a finding of alcalculous cholecystitis?
a. gallbladder wall thickening
b. pericholecystic fluid
c. cholelithiasis
d. Positive Murphy sign
c
195
Intermittent obstruction of the cystic duct by a gallstone results in:
chronic cholecystitis
196
Which of the following is not a risk factor for the development of gallstones?
a. phrygian cap
b. pregnancy
c. total parenteral nutrition
d. oral contraceptive use
a
197
A nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represents:
gallbladder polyp
198
Focal tenderness over the gallbladder with probe pressure describes:
Murphy sign
199
Diabetic patients suffering from acute cholecystitis havfe an increased risk for developing:
emphysematous cholecystitis
200
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found within:
adenomyomatosis
201
The spiral valves of Heister are found within:
cystic duct
202
Which of the following would yield a gallbladder with an hourglass appearance?
a. Hartmann pouch
b. Phyrgian cap
c. Junctional fold
d. Bilobed
d
203
With which of the following is Courvoisier gallbladder associated?
a. a pancreatic head mass
b. a stone in the cystic duct
c. cholecystitis
d. chronic diverticulitis
a
204
Calcification of the gallbladder wall is termed:
porcelain gallbladder
205
What produces the hormone cholecystokinin?
duodenum
206
What is the artifact associated with adenomyomatosis?
comet tail
207
Which of the following is a condition associated with vasculitis and gallbladder hydrops?
a. Kawasaki disease
b. Beckwith-Wiedemann syndrome
c. sickle cell disease
d. multiple hepatic hemangioma
a
208
Unconjugated bilirubin may also be referred to as:
indirect bilirubin
209
Which of the following may not be a clinical or sonographic finding in patients with emphysematous cholecystitis?
a. diabetes
b. gas formation in the wall of the gallbladder
c. fever
d. Murphy sign
d
210
Which of the following is a rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells?
a. gallbladder perforation
b. adenomyomatosis
c. xanthogranulomatous gallbladder
d. emphysematous cholecystitis
c
211
Which of the following would most likely be associated with gallstones or biliary tree obstruction?
a. elevated direct bilirubin
b. elevated indirect bilirubin
c. decreased conjugated bilirubin
d. decreased unconjugated bilirubin
a
212
Which of the following is associated with focal wall necrosis, bulges in the gallbladder wall, sloughing membranes, and ulcerative craters?
a. porcelain gallbladder
b. adenomyomatosis
c. gangrenous cholecystitis
d. emphysematous cholecystitis
c
213
What condition may increase the likelihood of developing gallbladder carcinoma?
chronic cholecystitis
214
Gallbladder carcinoma may be suspected when a gallbladder polyp exceeds:
1 cm
215
Which of the following would increase the likelihood of suffering from gallbladder torsion?
a. floating gallbladder
b. gallstones
c. acalculous cholecystitis
d. AIDS cholangiopathy
a
216
Which of the following is a result of an accumulation of cholesterol and triglycerides within the gallbladder wall?
a. gallstones
b. gallbladder carcinoma
c. gallbladder polyp
d. xanthogranulomatous cholecystitis
c
217
Which of the following is not a section of the gallbladder?
a. neck
b. body
c. fundus
d. head
d
218
What is another name for empyema of the gallbladder?
suppurative cholecystitis
219
Which of the following could be a likely cause of a hydropic gallbladder?
a. multiple gallbladder polyps
b. gallstone in the cystic duct
c. phyrgian cap
d. hartman pouch
b
220
What clinical finding is not typically associated with gallbladder carcinoma?
a. weight gain
b. hepatomegaly
c. jaundice
d. elevation in ALP
a
221
