The GB and Biliary System (Hagen-Ansert) 11-12
Terms in this set (94)
hepatic ducts, common hepatic duct
________ _______- the right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the _________ ______ _______
4 mm, common hepatic duct
The common hepatic duct is approx __ ___ in diameter and descends within the edge of the lesser omentum. The _________ _________ ________ is the bile duct system that drains the liver into the common bile duct.
The normal common bile duct has a diameter of up to ___ ___.
ampulla of vater
The common bile duct is joined by the main pancreatic duct, and together they open through a small ampulla (the _______ ___ _______) into the duodenal wall.
sphincter of Oddi
The end parts of both ducts (common bile duct and main pancreatic duct) and the ampulla are surrounded by circular muscle fibers known as the __________ ___ ___________.
The proximal portion of the common bile duct is _______ to the hepatic artery and _______ to the portal vein.
cystic duct, 4 cm,
The ______ _____ is about __ ___ long and connects the neck of the gallbladder with the common hepatic duct to form the common bile duct.
The ____________ is a pear-shaped sac in the anterior aspect of the right upper quandrant, closely related to the visceral surface of the liver. It is divided into a neck, body, and fundus.
2.5-4 cm, 7-10 cm, 3 mm
The size and shape of the GB are variable. Generally the normal GB measures ______ ____ diameter and ______ ___ in length. The walls are less than __ ___ thick.
Dilation of the GB is known as ______.
hartmann's pouch, phrygian cap
The GB may fold back on itself at the neck, forming _______ ___________. Other anomalies include partial septation, complete septation (double GB), and folding of the fundus (_________ _______).
The GB can store __ ___ of bile. It stores and concentrates it.
Mucous membrane folds that unite with each other, giving the surface a honeycomb appearance. ________ _______ in the neck of the GB helps to prevent kinking of the duct.
cystic artery, cystic vein
The arterial supply of the GB is from the ______ ________, which is a branch of the right hepatic artery. The ______ _______ drains directly into the portal vein.
transportation, regulation, 1-2
The primary functions of the extrahepatic biliary tract are (1) the ______________ of bile from the liver to the intestine. (2) the _____________ of its flow. The liver secretes approx ___ liters of bile per day.
The __________ _______ appears as a thick-walled structure with a slit for bile.
Dilation of the extrahepatic bile ducts (usually less than __ ____) occurs after cholecystectomy.
bile salt dependent
Bile secretion is largely caused by a ______ _____-________ mechanism, and ductal flow is controlled by secretion.
Bile is the principle medium for excretion of _________ and cholesterol.
kidney, pancreas, duodenum
The GB may be identified as a sonolucent oblong structure located anterior to the right ______, lateral to the head of the ______, and _______.
Sagittal scans shows the GB __________ to the right kidney.
The fundus is slightly more ________ than the neck.
________ ________- a small echogenic fold that can occur along the posterior wall of the GB at the junction of the body and infundibulum. It can be very small (3-5 mm) but may give rise to an acoustic shadow in the supine position. It doesn't duplicate in an oblique position.
fatty meal, pancreatic
If a GB appears too large, a _____ ____ may be administered and further sonographic evaluation made to detect whether the enlargement is abnormal or normal. If the GB fails to contract during examination, the ________ area should be investigated further.
________ ________ indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder. The liver should be examined for dilated bile ducts.
In a well-contracted GB, the wall changes from a single to a __________ __________ structure with a following three components: (1) a strongly reflective outer contour. (2) a poorly reflective inner contour. (3) a sonolucent area between both reflecting structures.
The small cystic duct is generally not identified. Because this landmark is necessary to distinguish the common hepatic duct from the common bile duct, the more general term is ___________ =________ is used to refer to these structures.
The most classic symptom of GB disease is RUQ _____, usually after a greasy food. Nausea and vomiting sometimes occur and may indicate the presence of a _____ in the common bile duct.
___________ is the presence of bile in the tissues with resulting yellow-green color of the skin. It may develop when a tiny gallstone blocks the bile ducts between the gallbladder and the intestines, producing pressure on the liver and forcing bile into the blood.
______ , or thickened bile, occurs from bile stasis. It is gravity dependent. It should be considered abnormal because it indicates either a functional or a pathologic abnormality exists when calcium bilirubin or cholesterol precipitates in bile. The viscosity of the sludge is irrelevant.
A thickened wall is a nonspecific ____ and is not necessarily related to GB disease. A thickened GB should be measured when the transducer is perpendicular to the anterior GB wall. Usually taken in the transverse plane. It is measured from outer to outer wall.
Sonographically the GB wall may be underestimated when the wall has extensive _________ or is surrounded by fat.
______________ is an inflammation of the GB that may have one of several forms: acute or chronic, acalculous, emphysematous, or gangrenous
____________ ____________- the most common cause is gallstones. When stones become impacted in the cystic duct or in the neck of the GB, it results in obstruction with distention of the lumen, ischemia, and infection with eventual necrosis of the GB.
In the majority of patients obstructed with an impacted stone, the stone will spontaneously _________.
If a thickened GB wall is ________ and irregular, an abscess cholecystosis, or carcinoma of the GB should be considered.
__________- is the most common disease of the GB. There may be a single large stone or hundreds of tiny ones. The tiny stones are the most dangerous because they can block stones.
fat, female, forty, fertile, fair
The five F's of cholelithiasis is _______, ____, ________, _________, and _________.
Right upper quandrant pain with radiation to the should after a high-fat meal is a typical presentation for _____________.
GB stones that are less than ______ may be difficult to separate from one another by ultrasound evaluation and thus are reported as just gallstones without a specific number.
wall echo shadow (WES) sign
If the GB is completely packed with stones, the sonographer will only be able to image the anterior border of the gallbladder, with stones casting a distinct acoustic shadow known as the ______ ____ _____ ___ _____.
GB stones greater than ___ _____ always cast a shadow. The shadow is highly dependent on the relationship between the stone and the acoustic beam. If the central beam is aligned with a stone than the shadow can be seen.
Some stones are seen to float ("floating gallstones") when _________ material from an oral cholecystogram is present because the contrast material has a higher specific gravity than the bile.
________ _______ is rare form of acute cholecystitis and is assocaited with the presence of gas-forming bacteria in the GB wall and lumen with extension into the biliary ducts. Look for the ring-down, comet tail, or WES sign.
__________ _____________ associated with acute cholecystitis and occurs after a prolonged infection, which causes the GB to undergo necrosis. The common appearance are the presence of diffuse medium to coarse echogenic densities filling the GB lumen in the absence of bile duct obstruction.
shadowing, gravity, layering
Gangrenous cholecystitis has three distinct sonographic appearances (1) it does not cause ___________. (2) it is not _______ dependent, and (3) it does not show a __________ effect. The wall also becomes irregular.
_____________ _______________ is most likely caused by decreased blood flow through the cystic artery.
4-5 mm, pericholecystic
Acalculous cholecystitis appearance the GB wall is extremely thickened (greater than _______ ___), and echogenic sludge is seen within a dilated GB. Look for the presence of ____________ fluid within ascites or subserosal edema.
Torsion of the GB is a rare condition that is found more in elderly females and is associated with a mobile GB and a long ____________ __________.
With _________ the GB becomes massively inflamed and distended. If the GB becomes more than 180 degrees , the risk of gangrene may develop.
_________ __________- is the most common form of GB inflammation. It is the result of numerous acute attacks and subsequent fibrosis of the GB wall.
A ___________ GB is rare and is defined as calcium incrustation of the GB wall. It is associated with gallstones in the majority of patients. Sonographically it appears as a bright echogenic echo is seen in the region of the GB with shadowing posterior.
___________ ________ is represented by a variety of degenerative and proliferative changes of the GB characterized by hyperconcentration, hyperexcitability, and hyperexcretion. Two types cholesterolosis and adenomyomatosis
The __________ polyp may be multiple and small in size (less than 10 mm). It does not change size when followed serially.
_______ polyps are singular and measures greater than 10 mm and a rapid change in size upon follow-up sonography.
____________ is a condition in which cholesterol is deposited within the lamina propria of the GB. It is associated with cholesterol stones. It is often referred to as a "strawberry gallbladder" because the mucosa resembles the surface of a strawberry.
_________ of the GB are small, well defined soft tissue projections from the GB wall.
_________ polyp is the most common pseudotumor of the GB. Sonographically they appear as smooth ovoid projections seen to arise from the GB wall. Usually are multiple, do not shadow, and remain fixed to the wall with change in patient position. The comet tail artifact may be present.
adenoma, smaller, larger
___________ are benign neoplasms of the GB with a premalignant potential much lower than colonic adenomas. the _____ lesions are pedunculated, whereas the ____ lesions may contain foci of malignant transformation. They tend to be homogenously hyperechoic but become more heterogeneous as they grow. IF the GB wall is thickened adjacent to the adenoma then malignancy should be suspected.
___________ is a hyperplastic change in the GB wall. Papillomas may occur alone or in groups and may be scattered over a large part of the mucosal surface of the GB. These papillomas are not precursors to cancer.
lumen, comet tail
Benign tumors appear as small elevations in the GB ______. These elevations maintain their intial location during positional changes and are the cause for _____ _____.
Primary ____________ of the GB is rare and is nearly always rapidly progressive disease, with mortality approaching 100%. Most often associated with cholelithiasis and porcelain GB.
malignant GB masses
The global shape of __________ ______ ______ is similar to that of the GB. The mass has a heterogeneous solid or semisolid echo texture. The GB wall is markedly abnormal and thickened. The adjacent liver tissue, in the hilar area, if often heterogeneous because of direct tumoral spread.
________ _______ are an unusual, diverse group of diseases that may manifest as congenital, focal, or diffuse cystic dilation of the biliary tree. Can be caused from a reflux of bile. The patient presents with an abdominal mass, pain, feverm or jaundice. The diagnosis can be confirmed with a nuclear medicine hepatobiliary scan.
__________ _________ is most likely inherited in an autosomal recessive fashion. This condition is a communicating cavernous ectasia of intrahepatic ducts characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts. Often found in younger adults or pediatric population.
medullary spongy kidney
Cystic disease of the kidney (_________ ____________ __________) is strongly associated with Caroli's disease.
Caroli's disease appears on ultrasound as multiple cystic structures in the area of the ductal system converge toward the _______ _______.
4 mm, 4 mm
The small size of the intrahepatic bile ducts implies that sonography cannot image the ducts routinely until their size dilates to greater than ___ ____. The Common hepatic duct has an internal diameter of less than ___ ____.
The most common cause of biliary ductal system obstruction is the presence of a ______ or ______ within the ductal system. This is confirmed sonographically by shotgun or many ductal tubes visualized.
Bile ducts expand ____________ from the point of obstruction. Therefore, extrahepatic dilation occurs before intrahepatic dilation
extrahepatic biliary obstruction
__________ _________ _________ can occur in three places (1) intrapancreatic (2) suprapancreatic (3) porta hepatic.
_________ __________ can be caused by (1) pancreatic carcinoma (2) choledocholithiasis (3) chronic pancreatitis with stricture formation.
____________ _____ originates between the pancreas and the porta hepatitis. The most common cause for this is malignancy or adenopathy at this level.
porta hepatic obstruction
_________ _______ ___________ is usually caused by a neoplasm.
A _________ _________ is a specific type of cholangiocarcinoma that can occur at the bifurcation of the common hepatic duct, with involvement of both the central left and right duct. The most suggestive sonographic findings is isolated intrahepatic duct dilation. A nonunion of the right and left ducts is a characteristic.
________ ______ is an uncommon cause for extrahepatic biliary obstruction resulting from an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the common hepatic duct.
__________ is classified into primary and secondary. Primary stones originate in the ducts. The secondary travels from the GB.
Another cause of shadowing in the right upper quadrant is gas in the biliary tree. This is a spontaneous occurrence resulting from the formation of a biliary enteric ________ in chronic GB disease.
Biliary trauma secondary to percutaneous biliary procedures or liver biopsies accounts for the majority of __________ cases.
__________ is air within the biliary tree secondary to biliary intervention, biliary-enteric anastomoses, or common bile duct stents. Sonographically it presents as bright echogenic linear structures that follow the portal triads. The posterior dirty shadow and reverberating artifact is seen. You should look for bubble movement.
__________ is an inflammation of the bile ducts. It is a medical emergency. And more than half of people who have this have ulcerative colitis.
________ is a parasitic roundworm that uses a fecal-oral route of transmission. The worm may be 20-30 cm long and 6 cm in diameter. It grows in the small bowel before entering the biliary tree through the ampulla of vater. Sonographically appears as a moving tube.
Intrahepatic biliary tumors are rare and are primarily limited to __________ and __________. Usually sonographically appear as cystic mass with multiple septa and papillary excrescences.
primary scelerosing cholangitis, nodular
Cholangiocarcinomas most common risk factor in the Western world is __________ ___________ ___________. Most cholangiocarcinomas are adenocarcinomas. There are three types sclerosing, nodular, and papillary. __________ sclerosing tumors are the most common.
______________ cholangiocarcinomas are found in the distal common bile duct.
_____________ _____________ is the least common location for cholangiocarcinomas, it represents the second most common primary malignancy of the liver.
___________ ___________ presents with a patient being jaundice, pruritus, and elevated cholestatic liver parameters.Usually begins in the right and left bile duct and then extendds into the proximal duct and distally into the common hepatic duct. Chronic obstruction leads to atrophy of the involved lobe.
_________ _____________ this tumor is difficult to distinguish from hilar cholangiocarcinomas, although progressive jaundice is seen in the majority of paients.
breast, colon, melanoma
The most common tumor sites that can spread to the biliary system are from the _____, _____, or _________.
cholesterol, bilirubin, calcium
The majority of stones contain a mixture of ___________, ______________, and ___________.
____________ pigment stones result from the presence of excessive deconjugated bilirubin and are associated with hemolytic diseases, cirrhosis, and TPN.
____________ pigment stones are more common in Asian countries and are associated with biliary tract infections.
__________ or suppurative cholecystitis, pus in the GB, typically occurs in diabetic patients. Resembles sludge.
GB _______________ typically occurs in the fundus due to chronic inflammation and low amount of blood flow to this area. With a small leak it will cause peritonitis. A larger leak will cause an abscess.
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