Flashcards in GB Deck (148):
The 4/5-week embryo develops a bud from the foregut that grows _____ (direction); the cranial portion becomes the _____ and the _____.
Hepatic bile ducts
In the _____ portion of the growing bud, a second bud develops, also called the _____, and this becomes the gall bladder and cystic duct.
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
This condition often occurs with duplication of the cystic duct and may be diagnosed prenatally.
duplication of the GB
The GB's main function is to
T or F? When stored in the GB, bile becomes less concentrated and therefore more powerful in its ability to do its work.
MORE concentrated = MORE powerful
This organ is often also removed automatically with gastric bypass surgery.
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.
What does the release of cholecystokinin signal (2)
the relaxation of the sphincter of Oddi
the contraction of the GB
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.
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
This is relaxed by the release of cholecystokinin (CCK).
Sphincter of Oddi
What 2 vessels merge at the Ampula of Vater?
CBD and Pancreatic Duct
This consists of cholesterol, lecithin, calcium, bile salts, acids and waste materials among other things.
What happens within bile that is a cause of gallstones?
the bile salts and cholesterol become umbalanced
T or F? Bile is continually being made and secreted by the liver in varying amounts into bile ducts.
Some of the bile that is made and secreted go directly into the _____ and some into the _____.
This also acts as a reservoir that uptakes excess bile when there is pressure in the bile ducts.
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
The GB lies in the _____ margin of the liver, between the RLL and LLL.
This vessel may be used to help find the GB fossa, which is in the same anatomic plane.
Most hepatic ultrasounds will see and use this as a landmark for the GB fossa.
The GB derives its blood supply from the _____.
The cystic artery arrises from the _____ and supplies the GB with blood.
T or F? You can't see the cystic artery or cystic vein on U/S.
Sometimes the proper hepatic artery skips the RHA and connects directly to the _____.
The GB is divided into _____ (#) parts, which are
The GB neck terminates in the _____.
This area of the GB is a common location for impaction of gallstones.
infundibulum (Hartmann's Pouch)
This is a region of the GB neck that may be angulated in some people.
Failure to identify the GB on an exam is most often due to
a previous cholecystectomy
Occasionally it is hard to find the GB in an exam because of this condition, which leads to a collapsed and fibrosed GB.
The GB may lie in _____ positions and be difficult to locate.
The GB may fold onto itself, the body onto the _____ or the _____ onto the body.
When the GB fundus folds onto the body, this is known as a _____ and has no clicial significance.
This is a GB composed of 2 or more intercommunicating compartments divided by a THIN septa.
This is an GB composed of 2 or more intercommunicating compartments divided by a THICK septa.
The GB is located at the _____ end of the MLF in the area we call the GB _____.
The _____ (vessels) converge to form the RHD and LHD.
intrahepatic bile ducts
The _____ (vessels) converge to form the CHD.
RHD and LHD
The GB neck tapers to form the _____ which joins with the CHD to form the CBD.
The _____ and _____ join to form the Ampulla of Vater.
Main Pancreatic Duct
Within the cystic duct and sometimes the GB neck, small mucosal folds exist called
Spiral Valves of Heister
T or F? Sometimes you will see the Spiral Valves of Heister on U/S.
The Spiral Valves of Heister control the bile flow in the _____ (vessel).
Spiral Valves of Heister are problematic at times because _____ can get stuck in them.
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.
The GB size should be less than _____ transversely and less than _____ sagitally.
The wall thickness of the GB should be less than _____ and measured at the _____ portion.
The GB is located in the _____ (quadrant), between the _____ and _____.
The bright linear reflector within the liver that connects the GB and the RPV or MPV is the
T or F? A prominent GB may be normal in some people because of their fasting state.
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.
The contracted GB wall appears thick and may obscure _____ or _____ abnormalities.
The exam of a GB should be performed after a minimum of _____ hours of fasting.
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
T or F? A GB ultrasound MUST be performed in at least 2 different patient positions.
If the GB is not visualized, what should be done?
Maneuvers to evaluate the GB fossa are essential to avoid missing GB pathology
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 _____.
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 _____ _____.
common collagenous sheath
The proximal portion of the CBD is _____ to the PHA and _____ to the MPV.
The CBD becomes more posterior after it descends behind the _____ bulb and enters the _____.
The distal CBD lies _____ to the anterior wall of the IVC .
The 5 common risk factors for gallstone disease are
1) Forty something
5) Fair skinned
Although most patients are asymptomatic of gallstone disease, some develop a complication that is most often
Biliary colic is
recurrent episodes of abdominal pain
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
The reason gallstones are highly reflective is because of the
large difference in the acoustic impedance of stones and adjacent bile
The high reflective gallstones appear _____ (echogenicity) with strong _____ _____ _____ .
posterior acoustic shadowing
Stones smaller than _____ may not shadow but will still appear _____.
This is the key feature of stones that allows differentiation from polyps or other entities.
Do small stones or large stones cause more complications and pain usually? Why?
because they can travel out of the GB and get lodged in the ducts
List 4 possible positions to demonstrate mobility of stones during scanning.
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 stands for
wall echo shadowing
WES is also known as
gallstones in the CBD
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.
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
Milk of Calcium Bile is also called
Milk of Calcium bile involves a semi-solid substance made mostly of
Milk of Calcium Bile or Limey Bile is often associated with (caused by) _____.
T or F? Milk of Calcium Bile or Limey Bile often causes acute cholecystitis.
False (it rarely does)
The appearance of Milk of Calcium Bile/Limey Bile is
high echogenic material with posterior acoustic enhancement
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.
This can solidify in the GB, causing gallstones.
3 other terms for GB sludge are
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.
The kinds of people with a higher risk for sludge are/have experienced (7)
Rapid weight loss
Prolonged fasting/critically ill
Bone marrow transplant
Cystic duct obstruction
Why is the GB often removed automatically during gastric bypass surgery?
Because the rapid weight loss can result in sludge filling the entire GB
Complications of sludge are (4)
2) biliary colic (pain)
3) acalculous cholecystitis ("no stone inflammation")
Amorphous, low level echoes within the GB in the dependent position with no shadowing is probably
If sludge mimics polypoid tumors, it is called either _____ or _____.
sludge balls (organization of the sludge)
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
Camouflage of the GB =
hepatization of the GB
What are GB polyps?
Tumor or tumor-like projections arising from the GB mucosa.
T or F? Although most polyps are benign, some early GB carcinomas present as polypoid lesions.
Polyps need to be followed up for a(n) _____ in size and changes which may suggest _____ _____.
The most common kind of polyp is a _____ polyp.
What size polyp requires follow-up?
Inflammation of the GB is called
A relatively common disease accounting for some patients in the ER with abdominal pain is
Acute cholecystitis is caused by _____ in more than 90% of cases.
With cholecystitis, impaction of stones in the cystic duct or the GB neck results in obstruction with _____ distention, _____, superinfection, and eventually _____ of the GB.
This is associated with RUQ pain, fever, and leukocytosis
Can you tell the difference between acute and chronic cholecystitis on an ultrasound?
Sonographic findings of cholecystitis are (7)
1) Thickened GB wall
2) distention of the GB lumen
4) impacted stone in cystic duct or gb neck
5) pericholecystic fluid collections
6) positive Murphy's sign
7) hypermic GB wall with doppler
_____ (hormone) elevation suggests obstruction at the level of the Ampula of Vater (with cholecystitis).
7 complications of acute cholecystitis are
1) gangrenous cholecystitis
2) emphysematous cholecystitis
4) GB perforation
5) acalculous cholecystitis
6) torsion of the GB
7) pericholecystic abscess
This is loss of tissue due to decreased blood supply (with cholecystitis).
3 signs of gangrenous cholecystitis are
1) wall striations
2) intraluminal membranes
3) pericholecystic fluid
This condition means the GB wall is necrosing
This is acute cholecystitis due to GB wall ischemia and infection. This condition occurs most often in _____ men.
This complication of cholecystitis may result in a fever because of infection involved with this condition.
Pus from bacteria-containing bile within the GB is
This complication of cholecystitis is initiated with obstruction of the cystic duct.
Localized fluid collection in the GB fossa is
If the fluid leaks from GB perforation, these complications can occur (3)
2) pericholecystic abcess
3) biliary fistula
This is acute cholecystitis without gallstones.
Acalculous cholecystitis is associated with existing conditions such as (6)
1) prolonged use of TPN
2) abdominal surgery
4) severe burns
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
GB in unusual HORIZONTAL postion =
torsion of the GB
Another word for torsion is
If torsion of the GB is >180 degrees, _____ sets in.
With torsion of the GB, a twist of the _____ (vessel) and _____ (vessel) may be visible.
T or F? GB torsion is rarely diagnosed preoperatively.
This is characterized by recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis.
Do acute and chronic cholecystitis appear different sonographically?
Findings with chronic cholecystitis may include (3)
1) thick fibrotic GB wall
3) obstruction of the cystic duct by a stone
An unusual variant of chronic cholecystitis is
Xanthogranulomatous cholecystitis causes spreading to _____.
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
CBD should be less than _____, unless over the age of _____, in which it will often increase an extra mm a year.
Although the CBD should be less than 6mm below the age of 60, if the GB is removed it can be up to _____.
When is GB removal usually necessary?
when gallstones begin causing problems
GB wall thickness should be less than _____ and the most common cause of GB wall thickening is _____.
Other causes, besides cholecystitis, of GB wall thickening are
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
The origin of the RPV to the GB fossa is the
Normal GB wall thickness can be up to _____ thick after eating.
What is hyperplastic cholecystitis?
Will benign ascites thicken the GB wall?
Will malignant ascites thicken GB wall?
The most common anatomic variants of the GB are