Term
| In 4th to 5th week of life, a 4mm, human embryo develops a bud from the foregut that grows _________ and the cranial portion becomes the ________ and ________ _______ ________ |
|
Definition
| cephalad / liver and hepatic bile ducts |
|
|
Term
| In the caudal portion of the growing bud, there develops a second bud, or diverticulum, and this is destinated to become the _____ _______ and _________ ________ |
|
Definition
| gall bladder and cystic duct |
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|
Term
| _________ _________ is a rare condition that results from the failure of the cystic bud to develop in the 4th week of intrauterine life |
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Definition
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|
Term
| What is the treatment for a person with isolated agenesis of gallbladder? |
|
Definition
| The person with isolated agensis of the gallbladder is healthy. No treatment is needed. The prognosis is excellent |
|
|
Term
| What is the main function of the gallbladder? |
|
Definition
| The gallbladder's main function is to store bile |
|
|
Term
|
Definition
| Bile is a bitter dark yellow/green digestive liquid produced by the liver |
|
|
Term
| What happens to the bile when stored in the gallbladder? |
|
Definition
| When stored in the gallbladder, bile becomes more concentrated and therefore more powerful in its ability to do its work |
|
|
Term
| Why does the gallbladder stores the bile? |
|
Definition
| to have it available in larger quantities for secretion when a meal is eaten |
|
|
Term
| Which hormone is released when food is ingested especially fats? |
|
Definition
|
|
Term
| What does the hormone cholecystokinin do? |
|
Definition
| cholecystokinin turn signals the relaxation of the valve at the end of the common bile duct (the sphincter of Oddi) which lets the bile enter the small intestine |
|
|
Term
| What else does the CCK do? |
|
Definition
| It also signals the contraction of the gallbladder which squirts the concentrated liquid bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal |
|
|
Term
| What is the muscular valve that controls the flow of digestive juices (bile and pancreatic juice)? |
|
Definition
|
|
Term
| Through where does the digestive juice flow and where does it enter? |
|
Definition
| flows through the ampulla of vater and inters into the second part of the duodenum |
|
|
Term
| What does the CCK do to the Sphincter of Oddi? |
|
Definition
|
|
Term
| What does bile consist of? |
|
Definition
| cholesterol, lecithin, calcium, bile salts, acids and waste materials among other things |
|
|
Term
| What happens when bile salts and cholesterol get out of balance with each other? |
|
Definition
|
|
Term
| what does the liver continuously make and secrete into the bile ducts in varying amount? and where does it go? |
|
Definition
bile
and some of it goes directly into the small intesting and some into the gallbladder |
|
|
Term
| What does the GB act when there is excess bile? |
|
Definition
| GB acts as a reservoir that uptakes excess bile when there is pressure in the bile ducts |
|
|
Term
| What is the function of bile? |
|
Definition
it breaks down the fats that you eat so that your body can utilize them
bile is a very powerful antioxidant which helps to remove toxins from the liver |
|
|
Term
| Where does the GB lie and what shape does it have? |
|
Definition
| GB is a pear shaped organ lying in the inferior margin of the liver, between the right and left lobes |
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|
Term
| What else lie in the same plane of the GB that can be used to help find the GB fossa? |
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Definition
|
|
Term
| What is the origin of the RPV to the GB fossa? |
|
Definition
|
|
Term
| what is the landmark for the GB fossa? |
|
Definition
|
|
Term
| From where does the GB derives its blood supply from? and where does it arise from? |
|
Definition
| the cystic artery which arises from the right hepatic artery |
|
|
Term
| Where does the cystic vein drain into? |
|
Definition
| directly into the portal vein |
|
|
Term
| What are the parts of GB? |
|
Definition
Neck (which terminates in the narrow infundibulum)
Body
Fundus |
|
|
Term
| What is the angulated portion of the neck region called? what happens to that region? |
|
Definition
infundibulum or hartmann's pouch
common location for impaction of gallstones |
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|
Term
| Why is there failure to identify the GB on an ultrasound exam? |
|
Definition
| due to a previous cholecystectomy |
|
|
Term
| What leads to a collapsed and fibrosed GB making it difficult to detect? |
|
Definition
|
|
Term
| What can be an other reson for the GB to be difficult to locate? |
|
Definition
| it may lie in an ectopic position |
|
|
Term
| What is it called when the GB fundus fold onto the body? |
|
Definition
|
|
Term
|
Definition
| composed of 2 or more intercommunicating compartments divided by thin septa |
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|
Term
| What is the hourglass GB? |
|
Definition
| has thick septa seperating the components |
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|
Term
| The intrahepatic bile ducts converge to form the - |
|
Definition
| right and left hepatic ducts |
|
|
Term
| the right and left hepatic duct join to form the - |
|
Definition
|
|
Term
| The GB neck tapers to form the ___________ which joins with the _______ to form the ___________ |
|
Definition
| cystic duct - CHD - common bile duct |
|
|
Term
| the common bile duct and main pancreatic duct join to form the |
|
Definition
|
|
Term
| main pancreatic duct is also known as |
|
Definition
|
|
Term
| what is the small mucosal folds that forms within the cystic duct and sometimes in the GB neck? |
|
Definition
|
|
Term
| what does the spiral valves of heister control? |
|
Definition
| bile flow in the cystic duct |
|
|
Term
| How does the GB appear sonographically? |
|
Definition
| sonolucent oblong structure |
|
|
Term
| Where does the GB lie to the right kidney |
|
Definition
|
|
Term
| where does the gb lie to the head of pancreas and duodenum |
|
Definition
|
|
Term
| what does the GB indent to? |
|
Definition
| the inferior to medial aspect of the right lobe of the liver |
|
|
Term
| What is the size of the GB? |
|
Definition
less than 4 cm transverse
less than 10 cm sagittal |
|
|
Term
| What is the wall thickness of the GB? |
|
Definition
|
|
Term
| How does the lumen look sonographically? |
|
Definition
|
|
Term
| what is the location of the GB? |
|
Definition
| RUQ - between RT & LT lobes of the liver |
|
|
Term
| What within the liver connects the GB and the RPV or MPV? |
|
Definition
| bright linear reflector - main lobar fissure |
|
|
Term
| When is a prominent GB be normal? |
|
Definition
| in some individuals because of their fasting state |
|
|
Term
| If the GB appears too large what can be done? |
|
Definition
| administration of a fatty meal and further evaluation may differentiate between normal and abnormal |
|
|
Term
| if no contraction of the GB occurs what must be evaluated? |
|
Definition
| the pancreatic area for suspicious masses must be evaluated |
|
|
Term
| when must the exam of a GB be performed? |
|
Definition
| after a minimum of 6 hours fasting |
|
|
Term
| How does a well contracted GB change? |
|
Definition
a strongly reflective outer contour
a poorly reflective inner contour
a sonolucent area between both reflecting structures |
|
|
Term
| How must the GB be evaluated? |
|
Definition
| evaluation of the GB is usually easily performed with routine sagittal and transverse ultrasounds but must be imaged in at least 2 patient position |
|
|
Term
| what must be done if the gb is not visualized? |
|
Definition
| maneuvers to evaluate the gb fossa are essential to avoid missing gb pathology |
|
|
Term
| Within the liver parenchyma the bile duct follow the same course as the - |
|
Definition
| portal veins and hepatic artery branches |
|
|
Term
| The common hepatic duct, portal vein and hepatic artery are encased in a common collagenous sheath that forms the ____________ |
|
Definition
|
|
Term
| the proximal portion of the CBD is ________ to the proper hepatic artery and __________ to the main portal vein |
|
Definition
|
|
Term
| The CBD becomes more posterior after it descends behind the - |
|
Definition
| duodenal bulb and enters the pancreas |
|
|
Term
| The distal CBD lies ________ to the anterior wall of the IVC |
|
Definition
|
|
Term
| What are the common risk factors for GB stone (5 F's)? |
|
Definition
Forty something
Female
Fat
Fertile
Fair Skinned
(Fair Female who are 40 years and fat are fertile) |
|
|
Term
| What are the symptoms of GB stones? |
|
Definition
| most patients are asymptomatic but some may show biliary colic (recurrent episodes of abd pain) |
|
|
Term
| What is highly sensitive in the detection of stones within the GB? |
|
Definition
|
|
Term
| What results in an echogenic appearance with strong posterior acoustic shadowing in a GB? |
|
Definition
| the large difference in the acoustic impedance of stones and adjacent bile makes them highly reflective |
|
|
Term
| What is the key feature for looking for gb stones? |
|
Definition
|
|
Term
| what differencitates the polyps or other entities in gb? |
|
Definition
|
|
Term
| In case of gall stones how is it visualized? |
|
Definition
| the gb wall is first visualized in the near field followed by the bright echo of the stone, followed by the acoustic shadowing |
|
|
Term
| what is the acoustic shadowing of the gall stones called? what is it AKA? |
|
Definition
WES (Wall Echo Shadowing)
AKA double arc |
|
|
Term
| What is the presence of a gallstone in the common bile duct? |
|
Definition
|
|
Term
| What is the rare condition in which the gb becomes filled with a pasty semi solid substance made mostly of calcium carbonate? |
|
Definition
milk of calcium bile
AKA limey bile |
|
|
Term
| how does milk of calcium bile in the gb appear sonographically? |
|
Definition
| highly echogenic material with posterior acoustic shadowing |
|
|
Term
|
Definition
| biliary sludge, biliary sand or microlithiasis |
|
|
Term
| What is gallbladder sludge made up of? |
|
Definition
| residual particles that remain in the gb after it sends bile from the liver to the intestines to further break down food. |
|
|
Term
| What happens if the gb doesn't empty correctly? |
|
Definition
| protiens can be left behind, resulting in sludge in the gb. gb sludge can solidify forming gallstones |
|
|
Term
| what are the predisposing factors for gb sludge? |
|
Definition
pregnancy
rapid weight loss
prolonged fasting
critical illness
bone marrow transplantation
biliary stasis
cystic duct obstruction
cholecystitis |
|
|
Term
| What are the complications for gb sludge? |
|
Definition
stone formation
biliary colic
acalculous cholecystitis
pancreatitis |
|
|
Term
| How does gb sludge look sonographically? |
|
Definition
| amorphous, low level echoes within the gb in the dependent position with no shadowing |
|
|
Term
| what happens to the gb sludge with a change in position? |
|
Definition
| sludge may slowly resettle in the most dependent location |
|
|
Term
| When sludge mimicpolypoid tumors what is the sludge then called? |
|
Definition
| tumefactive sludge or sludge balls |
|
|
Term
| What is hepatization of the gb? |
|
Definition
| occasionally sludge has the same echotexture as the liver leading to camouflage of the gb |
|
|
Term
| what is caused by gallstones in more than 90% of the cases? |
|
Definition
|
|
Term
| What happens when there is impaction of the stones in the cystic duct or the gb neck? |
|
Definition
| it results in obstruction with luminal distention, ischemia, superinfection and eventually, necrosis of the gb |
|
|
Term
| what is acute cholecystitis associated with? |
|
Definition
| RUQ pain, fever and leukocytosis (elev. wbc's) |
|
|
Term
| What is the complications of acute cholecystitis? |
|
Definition
empyema
gangrenous cholecystitis
gb perforation
pericholecystic abscess |
|
|
Term
| What are the sonographic finding of acute cholecystitis? |
|
Definition
thickened gb wall (>3mm)
distention of the gb lumen (>4cm)
gallstones
impacted stone in cystic duct or gb neck
pericholecystic fluid collecions
positive murphy's sign
hyperemic gb wall with doppler |
|
|
Term
| what lab value suggests obstruction at the level of the ampulla of vater? |
|
Definition
|
|
Term
| What is the complications of acute cholecystitis? |
|
Definition
gangrenous cholecystitis
emphysematous cholecystitis
empyema
gb perforation
acalculous cholecystitis
torsion (volvulus) of the gb
|
|
|
Term
| what is the finding for gangrenous cholecystitis? |
|
Definition
| loss of tissue due to decreased blood supply there are no specific ultrasound findings to define this |
|
|
Term
| What are the signs for gangrenous cholecystitis? |
|
Definition
asymmetric wall thickening
wall striations
intraluminal membranes
pericholecystic fluid
the gb wall is necrosing |
|
|
Term
| Emphysematous cholecystitis of the gb due to - |
|
Definition
| gb wall ischemia and infection |
|
|
Term
| what ultrasound findings of emphysematous cholecystitis? |
|
Definition
comet tail (reverberation) artifacts are seen due to the presence of gas within the wall/lumen of the gb due to gas forming bacteria
occurs more commonly in diabetic men |
|
|
Term
| What is the purulent material within the GB due to bacteria-containing bile associated with acute cholecystitis |
|
Definition
|
|
Term
| Empyema is initiated with obstruction of the _________ |
|
Definition
|
|
Term
| Where does GB perforation occur? |
|
Definition
| localized fluid collection in the GB fossa |
|
|
Term
| What does the complications include for GB perforation? |
|
Definition
peritonitis
pericholecystic abscess
biliary fistula |
|
|
Term
| Which acute cholecystitis is without the presence of gallstones |
|
Definition
|
|
Term
| Acalculous cholecystitis exists with conditions like |
|
Definition
prolonged use of TPN
abd surgery
trauma
severe burns
sepsis
AIDS |
|
|
Term
| What is the rare acute cholecystitis but patients present with symptoms of acute cholecystitis? |
|
Definition
| Torsion (Volvulus) of the GB |
|
|
Term
| How does Torsion of the gb look like? |
|
Definition
| massively distended and inflamed gb lying in an unusual horizontal postion |
|
|
Term
| What happens if torsion is >180 degrees? |
|
Definition
|
|
Term
| Recurring symptoms of biliary colic due to multiple previous episodes of acute cholecystitis is called - |
|
Definition
|
|
Term
| How does chronic cholecystitis look sonographically? |
|
Definition
| doesn't appear different from acute cholecystitis |
|
|
Term
| What does chronic cholecystitis finding include? |
|
Definition
| thick-walled fibrotic contracted gb. sludge and an obsructing cystic duct stone may be present |
|
|
Term
| what is an unusual variant of chronic cholecystitis? |
|
Definition
| xanthogranulomatous cholecystitis |
|
|
Term
| How does xanthogranulomatous cholecystitis look like? |
|
Definition
| the gb is thickened and irregular with extension of yellow xanthogranulomatous inflammation to adjacent organs |
|
|
Term
| When is the gb wall thickned? |
|
Definition
| when it is greater than 3mm |
|
|
Term
| what is the common cause of gb wall thickness? |
|
Definition
|
|
Term
| what are the causes for gb wall thickening? |
|
Definition
hypoalbuminemia
ascites
hepatitis
chf
pancreatitis |
|
|
Term
| what happens when the gb is removed? |
|
Definition
| when the gb is removed bile is no longer retained in the bile ducts but is free to flow into the duodenum during fasting and digestive phases |
|
|
Term
| what happens to the extrahepatic bile duct after the gb is removed? |
|
Definition
| dilation of the extrahepatic bile duct, which is usually less than 1cm, occurs after gb removal |
|
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