HA Ch. 10 - Gallbladder and Biliary system Exercises 4 - 7

The normal gallbladder wall thickness is less than _____mm

3

To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for at least _____ hours before the ultrasound examination

6

On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _________ sign

Mickey Mouse

An uncommon cause of extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct creating extrinsic mechanical compression of the common hepatic duct is ________ syndrome

Mirizzi

Describe the normal function of the gallbladder during digestion.

The GB releases bile into the duodenum as food product passes from the stomach into the duodenum. Bile has enzymes that aid in digestion

The _____ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones

WES

The differential for a porcelain gallbladder would include a packed bag or ____ sign

WES

The gallbladder serves as a reservoir for ______ that is drained from the hepatic ducts in the liver.

bile

The majority of stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______ cholecystitis

calculous

On ultrasound, multiple cystic structures that converge towards the porta hepatis, are seen in ________ disease

caroli's

List the six biliary causes of gallbladder wall thickening

cholecystitis, adenomyomatosis, cancer, acquired immunodeficiency syndrome, cholangiopathy, and sclerosing cholangitis

Bile is the principle medium for excretion of bilirubin __________

cholesterol

The common hepatic duct is joined by the cystic duct to form the _________ duct

common bile

when the right subcostal approach is used, the _________ is seen as a tubular structure anterior to the portal vein. the right branch of the __________ artery can be seen between the duct and the portal vein.

common hepatic duct, hepatic

The arterial supply of the gallbladder is from the _______ artery, which is a branch of the right hepatic artery.

cystic

The patient should also be rolled into a steep ________ or upright position (to ensure there are no stones within the gallbladder) in an attempt to separate small stones from the gallbladder wall or cystic duct.

decubitus

A small _______ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum

echogenic

Because _____ tissue within the main lobar fissure of the liver (which lies between the gallbladder and the right portal vein), this bright linear reflector is a reliable indicator of the location of the gallbladder.

fat

Clinically the patient falls under the five "F"s:

fat, female, forty, fertile, and fair

The gallbladder commonly resides in a(n) _____ on the medial aspect of the liver

fossa

The patient is initially examined with ultrasound in full

inspiration

The bile salts from the small intestine stimulate the liver to make more bile, which activates ________ and ________ enzymes

intestinal, pancreatic

The job of the sonographer is to localize the level and cause of the obstruction. List the three primary areas where obstruction occurs.

intrahepatic obstruction, suprahepatic obstruction, and porta hepatic obstruction

To obtain a cross section of the portal triad, the transducer must be directed in a slightly _____ path from the left shoulder to the right hip

oblique

On sagittal scans, the right branch of the hepatic artery usually passes ________ to the common duct

posterior

_________ causes increasing pressure in the biliary tree with pus accumulation

Cholangitis

_________ cysts may be the result of pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and outpouching of the ductal walls.

Choledochal

The sign that indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder, is called __________

Courvoisier's

A fairly rare complication of actue cholecystitis associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts is called _______ cholecystitis

Emphysematous

The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the sphincter of ______

Oddi

The most classic symptom of gallbladder disease is _______ pain, usually occurring after ingestion of greasy foods

RUQ

Describe the factors that produce a shadow in the gallbladder

acoustic impedance of gallstones, refraction through them or diffraction around them, size, location, position, in relation to the beam, and the intensity of the beam

Clinically the patient with acute cholecystitis presents with these symptoms:

acute RUQ pain, fever, and leukocytosis

A hyperplastic change in the gallbladder wall is ________

adenomyomatosis

_______ within the duodenum may also give rise to a dirty shadow in the right upper quadrant.

air

The common duct is seen just _____ to the portal vein before it dips posteriorly to enter the head of the pancreas.

anterior

The hepatic artery lies ________ and to the ______ of the portal vein.

anterior, left

Sonographically, the common duct lies _____ and to the _______ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.

anterior, right

A gallbladder attack may cause pain in the ______ shoulder

right

The gallbladder may be identified as a(n) _______ oblong structure located anterior to the right kidney, lateral to the head of the pancreas and duodenum.

sonolucent

What is the most notable sonographic finding with carcinoma of the gallbladder?

thickened, abnormal GB wall

The most common cause of biliary ductal system obstruction is the presence of a(n) ______ or ______ within the ductal system

thrombus or tumor

Explain why the patient's position should be shifted during the ultrasound exam

to demonstrate movement of stones. Patients should be scanned in RLD, LLD, or erect

List two primary functions of the extrahepatic biliary tract

transportation of bile from the liver to the intestine and regulation of its flow

The main pancreatic duct joins the common bile duct, and together they open through a small ampulla (the ampulla of _______) into the duodenal wall.

vater