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