GB

Question 1

What shape is a normal gallbladder?

Answer 1

pear-shaped hollow organ

Question 2

What are the parts of the GB?

Answer 2

neck, body, fundus

Question 3

What is the size of the GB?

Answer 3

7-10 cm in length 2.5-4 cm in width

Question 4

An increase in size of a GB is called what?

Answer 4

hydrops

Question 5

What keeps the cystic duct of the neck of the GB from kinking?

Answer 5

Heister’s valves

Question 6

What is the vascular supply of the GB?

Answer 6

cystic artery and cystic vein

Question 7

Where does the GB lie?

Answer 7

intrahepatic, migrating to the surface of the liver

Question 8

What is the GB covered by?

Answer 8

a peritonal layer on most of it and an adventicia layer on the covering the rest

Question 9

What does the GB store

Answer 9

approx. 50 mL of bile

Question 10

How does bile get into the GB?

Answer 10

Bile is forced into the GB due to an increased pressure within the CBD produced by the action of the Sphincter of Oddi

Question 11

How does bile get out of the GB?

Answer 11

As the stomach empties the food into the duodenum, the intestines secrete enzymes and bile salts that stimulate the GB to contract and push bile into the duodenum

Question 12

How does the GB concentrate bile?

Answer 12

folds within the mucous membrane of the wall (with honeycomb appearance) unite with each other

Question 13

What ducts are in the biliary system?

Answer 13

right and left hepatic duct, common hepatic duct, common bile duct, cystic duct and GB

Question 14

The right and left hepatic ducts come from the right lobe of the liver in the porta hepatis and unite to form what?

Answer 14

Common Hepatic Duct

Question 15

The common hepatic duct joins the ____ duct to form the ____ ____ ____ .

Answer 15

cystic; common bile duct

Question 16

The common bile duct ends by piercing into the wall of the duodenum to join the ____ _____ ____. Together they open into the duodenum through the ____ ____ ____.

Answer 16

Main Pancreatic Duct; Ampulla of Vater

Question 17

The CBD lies laterally to the ____ ____ and anterior to the ____ ____ .

Answer 17

Hepatic artery; portal vein

Question 18

WHat is the normal measurement of the CBD?

Answer 18

1 mm per decade; 6mm = 60 yrs

Question 19

The cystic duct connects the neck of the GB to the ___ ____ ____.

Answer 19

Common hepatic duct

Question 20

What is the med term for removal of the gallbladder?

Answer 20

cholecystectomy

Question 21

Where does bile goes when a patient has a cholecystectomy?

Answer 21

Bile is stored in the CBD, which makes it larger in diameter; it freely moves into the duodenum at fasting or non-fasting states

Question 22

hydropic gallbladder

Answer 22

enlargement of the gb

Question 23

Courvoisier gallbladder

Answer 23

An enlarged often palpable on physical exam

caused by a pancreatic head mass

Question 24

Cholelithiasis

Answer 24

Echogenic, mobile, shadowing structure(s)
within 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 (gallbladder
completely filled with stones)

Question 25

Asymptomatic  Biliary colic  Abdominal pain after fatty meals  Epigastric pain  Nausea and vomiting  Pain that radiates to shoulders

Answer 25

Cholelithiasis

Question 26

Echogenic, nonshadowing, and nonmobile masses that projects from the gallbladder wall into the gallbladder lumen  Also called adenoma

Answer 26

polyps

Question 27

polyps

Answer 27

Asympomatic  Caused by a disturbance in cholesterol metabolism and accumulation of cholesterol within the wall of the gallbladder  May be single or multiple  Most measure less than 5mm  Benign  If these adenomas grow rapidly or >2cm, worrisome for gallbladder carcinoma

Question 28

Adenomyomatosis

Answer 28

Benign hyperplasia of the gallbladder  Epithelium and muscular layers of the wall have tiny sinuses called Rokitansky-Aschoff sinuses. These contain cholesterol crystals that produce comet tail artifacts  May be focal or diffuse

Question 29

Acute cholecystitis

Answer 29

Sudden onset of gallbladder inflammation  Focal tenderness, caused by inflammation is termed a positive sonograghic Murphy’s sign  Murphy’s sign is local tenderness over the gallbladder with transducer pressure

Question 30

Chronic cholecystitis

Answer 30

Most common form of gallbladder | inflammation

Question 31

Gallbladder carcinoma

Answer 31

``` Rare, although most common cancer of the biliary tract  Caused by chronic irritation of the gallbladder wall by gallstones  Size > 2cm , suspicous for carcinoma vs poloyp  Color doppler can reveal vessels within the malignancy  Most common metastatic disease of the gallbladder is malignant melanoma ```

Question 32

RUQ tenderness  Epigastric or abdominal pain  Leukocytosis  Possible elevation in alkaline phosphatase, aminotransferase, and/or bilirubin  Fever  Pain that radiates to the shoulders  Nausea and vomitting

Answer 32

Acute cholecystitis

Question 33

Gallstones  Positive sonographic Murphy’s sign  Gallbladder wall thickening  Pericholecystic fluid  Sludge

Answer 33

Acute cholecystitis

Question 34

Acalculous cholecystitis

Answer 34

Presents with all the clinical and sonographic findings of cholecystitis except no gallstones are present  More commonly seen in children, recently hospitalized patitents , and those who are immunocompromised  Uncommon  Caused by decreased blood flow through the cystic artery  Can also be caused by extrinsic compression of the cystic duct by a mass or lymphadenopathy

Question 35

Rare  Seen mostly in elderly females

Answer 35

torsion of the gallbladder

Question 36

Porcelain gallbladder

Answer 36

Results from the calcification of the gallbladder wall  Occurs mainly in older female patients  May appear sonographically similar to WES sign  Has been associated with the potential development of gallbladder carcinoma (25%

Question 37

Weight loss  Right upper quadrant pain  Jaundice  Nausea and vomiting  Hepatomegaly

Answer 37

Gallbladder carcinoma

Question 38

Nonmobile mass within the gallbladder lumen that measures >2cm  Gallstones seen in approx 90%  Diffuse or focal gallbladder wall thickening  Irregular mass that may completely fill the gallbladder fossa  Invasion of the mass into surrounding liver tissue

Answer 38

Gallbladder carcinoma

Question 39

the opening that allows bile and pancreatic juices to flow into the duodenum

Answer 39

The spincter of Oddi

Question 40

Choledocholithiasis Primary –

Answer 40

formation of stones in the bile duct resulting from a disease that leads to stasis or dilation of the ducts

Question 41

Caroli’s disease

Answer 41

form of Primary Choledocholithiasis

Question 42

Choledocholithiasis Secondary

Answer 42

Stones found in the bile duct that has migrated down | from the gallbladder

Question 43

Cholangitis

Answer 43

Inflammation of the | biliary ducts >5mm

Question 44

Caroli’s disease

Answer 44

Congenital disorder  Found in younger adult or pediatric population  Characterized by segmental diliation of the intrahepatic ducts  May appear segmental, saccular, or berry shaped  Often seen in association with cystic renal disease and may precede the development of cholangiocarcinoma, a hepatic abscess, cholangitis and sepsis

Question 45

Dilated intrahepatic ducts that abruptly terminate at the level of the tumor A solid mass may be noted within the liver or ducts

Answer 45

Cholangiocarcinoma

Question 46

Biliary atresia and Choledochal Cyst

Answer 46

Congenital disease thought to be caused by a viral infection at birth, although some think it may be an inherited disorder A narrowing or obliteration of all or a portion of the biliary tree This leads infants to suffer from cirrhosis and portal hypertension

Question 47

Choledochal cyst

Answer 47

4 types Most common being described as the cystic dilatation of the Common bile duct Discovered in infancy or the first decade of life Jaundice Pain Fever

Question 48

Dilated intrahepatic ducts that abruptly terminate at the level of the tumor  A solid mass may be noted within the liver or ducts  Klatskin tumor- found at the junction of the left and right hepatic ducts

Answer 48

Cholangiocarcinoma

Question 49

Cholangiocarcinoma

Answer 49

Jaundice  Pruitis  Unexplained weight loss  Abdominal pain  Elevated bilirubin  Elevated alkaline phosphatase