Upgrade to remove ads
Biliary/ GallBladder Ultrasound
Terms in this set (70)
The right and left hepatic duct join to make the..
Common hepatic duct
The GB neck tapers to form the cystic duct which joins with the CHD to form the?
Common Bile Duct
At the Porta Hepatis, the "Mickey Mouse" sign consists of?
Portal triad: Main PV, CHD, Proper HA.
With the Mickey Mouse sign,, the CHD is located (____) to the HA?
The pancreatic duct (Duct of Wirsung) and the CBD join to form the?
Ampulla of Vater
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 (sphincter of ampulla)
Tumor that may be located in an intrahepatic or extrahepatic bile duct is known as ?
(Scirrhous, Polypoid, Klatskin tumor)
Pt with jaundice, pain, nausea, vomiting and hx of cholecystectomy will most likely have?
(gallstone in the ductal system)
Gallstones in the duct system
Inflammation of the Gallbladder
Most common cause for Gb wall thickening?
Sludge consists of
Calcium Bilirubinate granules and cholesterol crystal
Sludge balls is also known as ?
Cholelithiasis composition varies, what are the 3 primary types?
Cholesterol, Calcium Bilirubinate,
What "double arc' sign will be present with a GB filled with stones?
WES sign (wall-echo-shadow)
Extra-hepatic obstruction: stone impacting in cystic duct or gallbladder neck causes extrinsic compression or obstruction of CHD, causing jaundice
Usually seen in chronic cholecystitis
Inflammation of the GB wall with decreased GB function
What are the usual causes of Acute Cholecystitis?
1) Cystic duct obstruction
2) Bacterial infection in biliary system
3) Pancreatic enzyme reflux
Which "elevated" lab suggests obstruction at the level of the Ampulla of Vater?
Calcification of the GB wall is known as ? What is the sonographic appearance?
A solid reflective line with distal shadowing of the GB fossa (not to be mistaken for Cholelithiasis which has 2 lines together)
Porcelain Gb is usually associated with chronic cholecystitis but can also be associated with?
Which lab test would best indicate presence of bile duct obstruction?
Serum direct bilirubin
A hormone that is released into the blood by the ingestion of fatty foods: causes GB contraction
A non-tender dilation of the GB is associated with obstruction of which organ?
usually a mass in the head of the pancreas
Associated with pancreatic disease
Air in the bile ducts is also known as? What procedure is associated with this?
ERCP (Endoscopic Retrograde Cholangiopancreatogram)
Pericholecystic fluid seen in conjunction with gallstones and a thickened GB wall, is most consistent with?
Acute cholecystitis complicated by GB wall perforation
A severe form of acute gangrenous cholecystitis: has air/gas-forming bacteria in the GB wall with bright echoes and comet-tail reverberation artifact, casts a "noisy" less shadow than stones; usually seen in older men with diabetes
Diverticular disease of the GB: has thick GB wall causing overgrowth of the mucosa (interior epithelial surface with folds), and formation of diverticula (outpouching/pockets) into or through the muscular GB wall.
what is the sonographic appearance of Adenomyomatosis?
Hyperechoic (echogenic) foci within the a thickened GB wall, with comet tail or V-shaped comet tail artifacts
Which artery feeds the GB and branches off the right hepatic artery
GB wall thickening may be a result of inflammation due to: (6)
Cholecystitis, Hepatic dysfunction, Renal disease, CHF, and AIDS
A tumor that may be located in an intrahepatic or extrahepatic bile duct is know as?
AKA- Bile Duct Carcinoma
Cystic dilation of the CBD into the pancreatic duct, which causes reflux of pancreatic juice into ducts. Leads to dilation and cholangitis
seen mostly in asia/japan
This type of cholangiocarcinoma is located at the hepatic hilum/confluence of the rt and lt hepatic duct resulting in a intrahepatic (not extrahepatic) biliary obstruction
With Adenomyomatosis, The extended Diverticula (small mucosal herniations/pockets) within the muscular layer of the GB that can accumulate stones or sludge, what are these sinuses/diverticula known as?
seen with comet-tail artifact, hypoechoic (fluid filled) pouches along the GB wall.
If you see echogenic foci in the GB but no shadowing, What changes will improve the detectability of stone shadowing?
Increase Transducer frequency and increase transducer focusing (focal carrots)
A stone lodged in the distal CBD can cause what complication?
How can you differentiate dilated bile ducts from intrahepatic veins?
Ducts have tortuous walls and will not show color flow with doppler
What are the ultrasound findings of Pneumobilia?
Variable length echogenic foci in the intrahepatic bile ducts with comet tail or reverberation artifacts
What are the sonographic features of acute choecystitis?
Cholelithiasis, Murphys sign, Diffuse wall thickening, GB dilation, sludge
This type of cholecystitis has tissue loss due to decreased blood supply.
may show asymmetric wall thickening
A Pus material within the GB due to bacteria-containing bile associated with acute cholecystitis:
Initiated with obstruction of the cystic duct
Empyema of the GB
A cholecystitis with no stones, that us usually associated with trauma, post-opt, sepsis, IV nutrition, AIDS and men
Sludge like material with a high concentration of calcium: Associated with chronic cholecystitis and GB obstruction of the cystic duct
Milk of calcium bile (Limy bile)
AKA- mucocele of the GB
A round distended, non-inflamed GB due to obstruction of the cystic duct.
Hydrops of the GB
AKA- Strawberry GB
Lipids (triglycerides & cholesterol) are deposited in the GB wall, appear as polyps as large as 1 cm.
Mostly, biliary obstruction is due to pathology in the distal CBD. What are the 2 most common lesions/pathologies?
Cholelithiasis and Carcinoma of the Head of Pancreas
This is the most common cause of extrahepatic obstructive jaundice:
It is a formation of calculi in the bile ducts
Common symptoms of Choledocolithiasis are (2)
Biliary colic (RUQ shoulder pain)
Infection and inflammation of the biliary ducts resulting in wall thickening that compromises the lumen of the bile duct
Congenital condition in newborns where the biliary ducts are either blocked or absent
What congenital disease in newborns is associated with Polyspenia syndrome and abdominal heterotaxia (Abnorm position)
What drainage procedure is the most successful in the treatment of biliary atresia if performed w/in 90 days of life
Congenital abnormality of the biliary tract with multifocal segmental dilation of the intrahepatic bile ducts. Its a specific type of Choledochal cyst
Most common cause of malignant neoplasm obstructing the biliary tree.
Pancreatic Adenocarcinoma -
at the head of the pancreas, this cancer typically causes "Courvoisier GB", a non-diseased enlarged GB.
What biliary abnormality has elevated conjugated bilirubin , ALP and biliary colic (shoulder) pain?
THis type of GB usually results from a GB mucocele (caused by Mirizzi's): the stasis bile is replaced by watery fluid, wall becomes fibrotic & thickened and ultimately calcifies. This type of GB is known as ?
This type of GB disease resembles the sonographic appearance of Adenomyomatosis, but does not have a comet-tail artifact.
AKA- Strawberry GB
Common findings of acute cholecystitis are? 5
Murphy sign, Gallstones, GB dilation, GB wall thickening, sludge
Which lab elevates that suggest an obstruction at the level of the Ampulla of Vater?
What landmark separates the Intrahepatic ducts from the Extrahepatic ducts?
At the junction of the Lt/Rt hepatic ducts and CHD
This artery feeds the wall of the GB and is a branch of the Rt Hepatic Artery
This vessel (AKA-Lt Gastric Vein) drains into the splenic vein at the level of Portal/Splenic confluence, via the esophageal veins.
The accessory pancreatic duct is AKA as?
It opens into the 2nd portion of duodenum at the minor papilla, 2cm prox t Ampulla of vater
Duct of Santorini
The CBD and Duct of Wirsung join to become the hepaticopancreatic ampulla, This is also know as?
The Ampulla of vaster
It opens at the 2nd portion of the duodenum at the major papilla
The SMV courses ___ to the Uncinate process of the pancreas and ___ to the SMA
Anterior and to the Right
Pancreatic transplant is done to decrease insulin dependency & microvascular complications in Pts that have which type of disease?
Type I diabetes
Form of Acute Cholecystitis due to GB wall ischemia & infection. Shows as gas-forming bacteria in the wall/lumen of GB and in Diabetics
THIS SET IS OFTEN IN FOLDERS WITH...
gallbladder pathology ultrasound images
Abd Ultrasound - Liver Pathology
YOU MIGHT ALSO LIKE...
Examination Review for Ultrasound : Chapter 3 The…
Pathology -Week 4