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Flashcards in GB Deck (148):
1

The 4/5-week embryo develops a bud from the foregut that grows _____ (direction); the cranial portion becomes the _____ and the _____.

Cephalad
Liver
Hepatic bile ducts

2

In the _____ portion of the growing bud, a second bud develops, also called the _____, and this becomes the gall bladder and cystic duct.

caudal
diverticulum

3

This is a rare condition that results from the failure of the cystic bud to develop in the 4th week of intrauterine life.

agenesis of the GB

4

This condition often occurs with duplication of the cystic duct and may be diagnosed prenatally.

duplication of the GB

5

The GB's main function is to

store bile

6

T or F? When stored in the GB, bile becomes less concentrated and therefore more powerful in its ability to do its work.

Why?

False

MORE concentrated = MORE powerful

7

This organ is often also removed automatically with gastric bypass surgery.

GB

8

What hormone is released with the ingestion of food (especially fats), that signals the relaxtion of the valve at the end of the CBD (the sphincter of _____) which lets the bile enter the small intestine.

cholecystokinin
Oddi

9

What does the release of cholecystokinin signal (2)

the relaxation of the sphincter of Oddi
the contraction of the GB

10

When the GB contracts, what happens?

It squirts the concentrated bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal.

11

This is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the Ampulla of Vater into the second part of the duodenum.

Sphincter of Oddi

12

This is relaxed by the release of cholecystokinin (CCK).

Sphincter of Oddi

13

What 2 vessels merge at the Ampula of Vater?

CBD and Pancreatic Duct

14

This consists of cholesterol, lecithin, calcium, bile salts, acids and waste materials among other things.

Bile

15

What happens within bile that is a cause of gallstones?

the bile salts and cholesterol become umbalanced

16

T or F? Bile is continually being made and secreted by the liver in varying amounts into bile ducts.

true

17

Some of the bile that is made and secreted go directly into the _____ and some into the _____.

small intestines
GB

18

This also acts as a reservoir that uptakes excess bile when there is pressure in the bile ducts.

GB

19

The 2 major functions of bile are

1) emulsifies fats so that the body can use them
2) acts as an antioxident to help remove toxins from the liver

20

The GB lies in the _____ margin of the liver, between the RLL and LLL.

inferior

21

This vessel may be used to help find the GB fossa, which is in the same anatomic plane.

MHV

22

Most hepatic ultrasounds will see and use this as a landmark for the GB fossa.

MLF

23

The GB derives its blood supply from the _____.

cystic artery

24

The cystic artery arrises from the _____ and supplies the GB with blood.

RHA

25

T or F? You can't see the cystic artery or cystic vein on U/S.

True

26

Sometimes the proper hepatic artery skips the RHA and connects directly to the _____.

cystic artery

27

The GB is divided into _____ (#) parts, which are

3
neck
body
fundus

28

The GB neck terminates in the _____.

narrow infundibulum

29

This area of the GB is a common location for impaction of gallstones.

infundibulum (Hartmann's Pouch)

30

This is a region of the GB neck that may be angulated in some people.

infundibulum
Hartmann's Pouch

31

Failure to identify the GB on an exam is most often due to

a previous cholecystectomy

32

Occasionally it is hard to find the GB in an exam because of this condition, which leads to a collapsed and fibrosed GB.

chronic cholecystitis

33

The GB may lie in _____ positions and be difficult to locate.

ectopic

34

The GB may fold onto itself, the body onto the _____ or the _____ onto the body.

neck
fundus

35

When the GB fundus folds onto the body, this is known as a _____ and has no clicial significance.

phrygian cap

36

This is a GB composed of 2 or more intercommunicating compartments divided by a THIN septa.

Septate GB

37

This is an GB composed of 2 or more intercommunicating compartments divided by a THICK septa.

Hourglass GB

38

The GB is located at the _____ end of the MLF in the area we call the GB _____.

inferior
fossa

39

The _____ (vessels) converge to form the RHD and LHD.

intrahepatic bile ducts

40

The _____ (vessels) converge to form the CHD.

RHD and LHD

41

The GB neck tapers to form the _____ which joins with the CHD to form the CBD.

cystic duct

42

The _____ and _____ join to form the Ampulla of Vater.

CBD
Main Pancreatic Duct

43

Within the cystic duct and sometimes the GB neck, small mucosal folds exist called

Spiral Valves of Heister

44

T or F? Sometimes you will see the Spiral Valves of Heister on U/S.

True

45

The Spiral Valves of Heister control the bile flow in the _____ (vessel).

cystic duct

46

Spiral Valves of Heister are problematic at times because _____ can get stuck in them.

gallstones

47

The GB appears as a _____ (echogenicity) oblong structure _____ (relationship/location) to the right kidney, _____ (relationship/location) to the head of the pancreas and duodenum, indenting the _____ to medial aspect of the RLL.

sonolucent
anterior
lateral
inferior

48

The GB size should be less than _____ transversely and less than _____ sagitally.

4cm
10cm

49

The wall thickness of the GB should be less than _____ and measured at the _____ portion.

3mm
fundus

50

The GB is located in the _____ (quadrant), between the _____ and _____.

RUQ
RLL
LLL

51

The bright linear reflector within the liver that connects the GB and the RPV or MPV is the

MLF

52

T or F? A prominent GB may be normal in some people because of their fasting state.

True

53

If the GB appears too large, administration of a _____ _____ and further evaluation may differentiate between normal and abnormal. If contraction does not occur, the _____ area should be studied for suspicious masses.

fatty meal
pancreatic

54

The contracted GB wall appears thick and may obscure _____ or _____ abnormalities.

luminal
wall

55

The exam of a GB should be performed after a minimum of _____ hours of fasting.

6

56

A well contracted GB changes in the following ways (3):

1) strong, reflective outer contour
2) poorly reflective inner contour
3) sonolucent area between both reflecting structures

57

T or F? A GB ultrasound MUST be performed in at least 2 different patient positions.

True

58

If the GB is not visualized, what should be done?

Maneuvers to evaluate the GB fossa are essential to avoid missing GB pathology

59

The rule of thumb for measuring the GB is to compare it to the _____ in the _____ plane. The width of the GB should always less than _____.

right kidney
transverse
5cm

60

Within the liver parenchyma, the bile ducts follow the same course as the _____ and the _____. All of these vessels are contained in a _____ _____ _____ that forms the _____ _____.

portal veins
hepatic artery
common collagenous sheath
portal triad

61

The proximal portion of the CBD is _____ to the PHA and _____ to the MPV.

lateral
anterior

62

The CBD becomes more posterior after it descends behind the _____ bulb and enters the _____.

duodenal
pancreas

63

The distal CBD lies _____ to the anterior wall of the IVC .

parallel

64

The 5 common risk factors for gallstone disease are

1) Forty something
2) Female
3) Fat
4) Fertile
5) Fair skinned

65

Although most patients are asymptomatic of gallstone disease, some develop a complication that is most often

biliary colic

66

Biliary colic is

recurrent episodes of abdominal pain

67

Sonography is considered highly sensitive in the detection of gallstones because

the variable size and number of stones within the GB give them different appearances on ultrasound

68

The reason gallstones are highly reflective is because of the

large difference in the acoustic impedance of stones and adjacent bile

69

The high reflective gallstones appear _____ (echogenicity) with strong _____ _____ _____ .

echogenic
posterior acoustic shadowing

70

Stones smaller than _____ may not shadow but will still appear _____.

5mm
echogenic

71

This is the key feature of stones that allows differentiation from polyps or other entities.

mobility

72

Do small stones or large stones cause more complications and pain usually? Why?

small
because they can travel out of the GB and get lodged in the ducts

73

List 4 possible positions to demonstrate mobility of stones during scanning.

1) RLD
2) LLD
3) upright
4) standing

74

This appears as the GB wall in the near field, followed by a sliver of anechoic bile, then bright echo of a stone, followed by acoustic shadowing.

WES sign

75

WES stands for

wall echo shadowing

76

WES is also known as

double arc

77

Cholelithiasis is

gallstones

78

Choledocholithiasis is

gallstones in the CBD

79

T or F? Blockage and infection caused by stones in the biliary tract can be life threatening. However, with prompt diagnosis and treatment, the outcome is usually very good.

true

80

This is a rare condition in which the GB becomes filled with a pasty semi-solid substance made mostly of calcium carbonate.

Milk of Calcium Bile

81

Milk of Calcium Bile is also called

Limey Bile

82

Milk of Calcium bile involves a semi-solid substance made mostly of

calcium carbonate

83

Milk of Calcium Bile or Limey Bile is often associated with (caused by) _____.

GB stasis

84

T or F? Milk of Calcium Bile or Limey Bile often causes acute cholecystitis.

False (it rarely does)

85

The appearance of Milk of Calcium Bile/Limey Bile is

high echogenic material with posterior acoustic enhancement

86

This is made up of residual particles that remain in the GB after it sends bile from the liver to the intestines to further break down food. If the GB doesn't empty correctly, proteins can be left behind resulting in this.

sludge

87

This can solidify in the GB, causing gallstones.

sludge

88

3 other terms for GB sludge are

biliary sludge
biliary sand
microlithiasis

89

Why do people that have been fasting or are critically ill have problems with GB sludge?

Because since they aren't eating, cholecystichinin isn't being released, so the GB isn't contracting to release the stored bile from the GB.

90

The kinds of people with a higher risk for sludge are/have experienced (7)

Pregnant
Rapid weight loss
Prolonged fasting/critically ill
Bone marrow transplant
Biliary stasis
Cystic duct obstruction
Cholecystitis

91

Why is the GB often removed automatically during gastric bypass surgery?

Because the rapid weight loss can result in sludge filling the entire GB

92

Complications of sludge are (4)

1) gallstones
2) biliary colic (pain)
3) acalculous cholecystitis ("no stone inflammation")
4) pancreatitis

93

Amorphous, low level echoes within the GB in the dependent position with no shadowing is probably

sludge

94

If sludge mimics polypoid tumors, it is called either _____ or _____.

tumefactive sludge
sludge balls (organization of the sludge)

95

Occasionally, the sludge in the GB has the same echotexture as the liver, leading to camouflage of the GB, this is called

hepatization of the GB

96

Camouflage of the GB =

hepatization of the GB

97

What are GB polyps?

Tumor or tumor-like projections arising from the GB mucosa.

98

T or F? Although most polyps are benign, some early GB carcinomas present as polypoid lesions.

True

99

Polyps need to be followed up for a(n) _____ in size and changes which may suggest _____ _____.

increase
malignant transformation

100

The most common kind of polyp is a _____ polyp.

cholesterol

101

What size polyp requires follow-up?

5-10mm

102

Inflammation of the GB is called

cholecystitis

103

A relatively common disease accounting for some patients in the ER with abdominal pain is

acute cholecystitis

104

Acute cholecystitis is caused by _____ in more than 90% of cases.

gallstones

105

With cholecystitis, impaction of stones in the cystic duct or the GB neck results in obstruction with _____ distention, _____, superinfection, and eventually _____ of the GB.

luminal
ischemia
necrosis

106

This is associated with RUQ pain, fever, and leukocytosis

acute cholecystitis

107

Can you tell the difference between acute and chronic cholecystitis on an ultrasound?

No

108

Sonographic findings of cholecystitis are (7)

1) Thickened GB wall
2) distention of the GB lumen
3) gallstones
4) impacted stone in cystic duct or gb neck
5) pericholecystic fluid collections
6) positive Murphy's sign
7) hypermic GB wall with doppler

109

_____ (hormone) elevation suggests obstruction at the level of the Ampula of Vater (with cholecystitis).

amylase

110

7 complications of acute cholecystitis are

1) gangrenous cholecystitis
2) emphysematous cholecystitis
3) empyema
4) GB perforation
5) acalculous cholecystitis
6) torsion of the GB
7) pericholecystic abscess

111

This is loss of tissue due to decreased blood supply (with cholecystitis).

gangrenous cholecystitis

112

3 signs of gangrenous cholecystitis are

1) wall striations
2) intraluminal membranes
3) pericholecystic fluid

113

This condition means the GB wall is necrosing

gangrenous cholecystitis

114

This is acute cholecystitis due to GB wall ischemia and infection. This condition occurs most often in _____ men.

emphysematous cholecystitis
diabetic

115

This complication of cholecystitis may result in a fever because of infection involved with this condition.

emphysematous cholecystitis

116

Pus from bacteria-containing bile within the GB is

empyema

117

Purulent =

pus

118

This complication of cholecystitis is initiated with obstruction of the cystic duct.

empyema

119

Localized fluid collection in the GB fossa is

GB perforation

120

If the fluid leaks from GB perforation, these complications can occur (3)

1) peritonitis
2) pericholecystic abcess
3) biliary fistula

121

This is acute cholecystitis without gallstones.

acalculous cholecystitis

122

Acalculous cholecystitis is associated with existing conditions such as (6)

1) prolonged use of TPN
2) abdominal surgery
3) trauma
4) severe burns
5) sepsis
6) AIDS

123

This is rare but patients may present with symptoms of acute cholecystitis. This is seen most often in females and sonographically looks like a massively distended and inflamed GB lying in an unusual horizontal position.

torsion of the GB

124

GB in unusual HORIZONTAL postion =

torsion of the GB

125

Another word for torsion is

volvulus

126

If torsion of the GB is >180 degrees, _____ sets in.

gangrene

127

With torsion of the GB, a twist of the _____ (vessel) and _____ (vessel) may be visible.

cystic artery
cystic duct

128

T or F? GB torsion is rarely diagnosed preoperatively.

True

129

This is characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis.

chronic cholecystitis

130

Do acute and chronic cholecystitis appear different sonographically?

No

131

Findings with chronic cholecystitis may include (3)

1) thick fibrotic GB wall
2) sludge
3) obstruction of the cystic duct by a stone

132

An unusual variant of chronic cholecystitis is

xanthogranulomatous cholecystitis

133

Xanthogranulomatous cholecystitis causes spreading to _____.

adjacent organs

134

The GB is thickened and irregular with extension of yellow inflammation to adjacent organs. This condition is extremely difficult to suspect preoperatively as it macroscopically resembles carcinoma of the GB. This is

Xanthogranulomatous cholecystitis

135

CBD should be less than _____, unless over the age of _____, in which it will often increase an extra mm a year.

6mm
60

136

Although the CBD should be less than 6mm below the age of 60, if the GB is removed it can be up to _____.

1 cm

137

When is GB removal usually necessary?

when gallstones begin causing problems

138

GB wall thickness should be less than _____ and the most common cause of GB wall thickening is _____.

3mm
cholecystitis

139

Other causes, besides cholecystitis, of GB wall thickening are

hypoalbuminemia
ascites
hepatitis
CHF
pancreatitis

140

There are many causes of GB wall thickening, but with acute cholecystitis, a difference can sometimes be that

marked thickening of the wall with visible stratification, as seen in general edmatous states, is not present

141

The origin of the RPV to the GB fossa is the

MLF

142

Normal GB wall thickness can be up to _____ thick after eating.

5mm

143

Postprandial means

after eating

144

What is hyperplastic cholecystitis?

polyps

145

Will benign ascites thicken the GB wall?

Yes

146

Will malignant ascites thicken GB wall?

No

147

The most common anatomic variants of the GB are

junctional folds

148

The term for after you eat is

Postprandial