Test 3 Abdomen Sonography

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  1. What is the function of the biliary system?
    drains bile from the liver and stores it in the gallbladder to be realeased later during digestion
  2. What is the function of the gallbladder?
    serves as a reservoir storing bile produced by the liver
  3. How much bile can the gallbladder store?
    50 mL capacity
  4. When does the gallbladder fill?
    during fasting
  5. What hormone produced by the stomach stimulates the gallbladder to contract releasing the bile?
    CCK- Cholecystokinin
  6. Where is bile produced?
  7. What is the composition of bile?
    • water
    • bile salts
    • bilirubin (a bile pigment)
    • cholesterol
    • electrolytes
  8. Image Upload
    • 1. Rt hepatic duct
    • 2. Lt hepatic duct
    • 3. Common hepatic duct
    • 4. Cystic duct
    • 5. Common bile duct
    • 6. Distal CBD
  9. Image Upload
    • 1. Liver
    • 2. Intrahepatic ducts
    • 3. Rt & Lt hepatic ducts
    • 4. Common hepatic duct
    • 5. Common bile duct
    • 6. Gallstones
    • 7. Pancreatic duct
    • 8. Pancreas
    • 9. Duodenum
  10. What are the 3 portions of the gallbladder?
    • fundus
    • body
    • neck
  11. What is the normal size of the gallbladder?
    • length 7-10 cm
    • transverse 3 cm
    • wall thickness < 3 mm
  12. What are the folds along the inner border of the gallbladder?
    Rokitansky-Aschoff sinuses
  13. What helps prevent kinking of the duct in the neck of the gallbladder?
    Heister's Valves
  14. What is the outpouching called located near the junction of the cystic duct and the gallbladder neck?
    Hartmann's Pouch or infundibulum
  15. Image Upload
    • 1. Heister's Valve
    • 2. GB Neck
    • 3. Hartmann's Pouch
    • 4. Cystic Duct
    • 5. GB Body
    • 6. GB Fundus
  16. The gallbladder is between what lobes of the liver?
    Rt & Lt lobes
  17. Where is the gallbladder located when the patient is supine?

    When the patient is on their left side?
    along the inferior border of the Rt lobe of the liver

  18. The gallbladder is typically located on the inferoposterior surface of the liver and can be _______ or ________.
    extrahepatic or intrahepatic
  19. What is the boundary between the right & left lobes of the liver; seen as a hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder?
    Main Lobar Fissure
  20. Image Upload
    • 1. Portal Vein
    • 2. Main Lobar Fissure
    • 3. Gallbladder
  21. Where are junctional folds typically located?
    near the gallbladder neck
  22. What is it called when a junctional fold occurs at the fundus?
    Phrygian Cap
  23. Name 4 gallbladder variants.
    • 1. junctional fold
    • 2. Phrygian cap
    • 3. pear shaped
    • 4. oval
  24. Name 4 congenital gallbladder variants.
    • 1. septations
    • 2. bilobed
    • 3. duplication
    • 4. absence or agenesis (rare)
  25. Image Upload
    Phrygian cap
  26. Image Upload
    Septation & duplicated GB
  27. Bile is the principle route of execretion for what 4 things?
    • 1. bilirubin
    • 2. cholesterol
    • 3. steroids
    • 4. drugs & other toxins
  28. What are the tiny spiral valves found within the cystic duct called?
    Heister's Valves
  29. The lumen of the cystic duct contains ______ folds.
  30. What is the normal diameter of the common bile duct?
    up to 6mm
  31. What is name of the area where the common bile duct and the pancreatic duct merge?
    Ampulla of Vater aka hepatopancreatic duct
  32. What is the name of the small muscle that guards the ampulla of vater?
    sphincter of oddi
  33. What structures comprise the portal (hepatic) triad?
    • common bile duct
    • hepatic artery
    • portal vein
  34. What is the name given to the portal triad when viewed sonographically in transverse?
    mickey mouse sign
  35. Image Upload
    • 1. common bile duct
    • 2. hepatic artery
    • 3. portal vein
  36. What is the normal sonographic appearance of the gallbladder?
    • anechoic lumen
    • thin well-defined walls
  37. How long should the patient be NPO for examining the gallbladder?
    8-12 hours
  38. How should the patient be positioned for examining the gallbladder?
    supine or decubitus
  39. T/F
    You should always scan the patient in 2 positions when imaging the gallbladder.
  40. Image Upload
    • 1. Hepatic artery
    • 2. GB Neck
    • 3. Portal Vein
    • 4. IVC
  41. Image Upload
    • 1. common hepatic duct
    • 2. portal vein
    • 3. diaphragm
    • 4. IVC
  42. Image Upload
    • 1. Portal Vein
    • 2. IVC
    • 3. Right Renal Artery
  43. What is the disease process called where pancreatic juices reflux into the common bile duct causing focal or diffuse dilation?
    Choledochal cysts
  44. T/F
    Choledochal cysts occur more frequently in infants, women, and people of East Asia.
  45. What are the symptoms of choledochal cysts?
    • intermittent jaundice
    • palpable RUQ mass
    • colicky pain
  46. What are the sonographic findings associated with choledochal cysts?
    • cyst in the portal hepatis
    • dilated CBD
  47. Which type of choledochal cyst occurs 80% of the time, is associated with an abnormally long duct, and has a fusiform dilatation of the CBD?
    Type 1
  48. Which type of choledochal cyst is very rare and has a true diverticulum of the CBD?
    Type 2
  49. Which type of choledochal cyst is confined to a intraduodenal portion of the CBD (choledochoceles)?
    Type 3
  50. Which type of choledochal cyst involves multiple dilatations of the intra & extrahepatic biliary tract and is associated with an abnormally long duct?
    Type 4 A
  51. Which type of choledochal cyst involves multiple dilations with the extrahepatic biliary tract ONLY?
    Type 4 B
  52. What pathology is a rare congenital disorder with malformation of the intrahepatic biliary tree causing biliary stasis?
    Caroli's Disease
  53. Biliary stasis caused from Caroli's disease can cause what 3 pathologies?
    • stone formation
    • cholangitis
    • sepsis
  54. What are the two types of Caroli's disease?
    • simple, classic form
    • periportal hepatic fibrosis (most common)
  55. Which type of Caroli's disease is most common?
    periportal hepatic fibrosis
  56. What is the sonographic appearance of Caroli's disease?
    • saccular dilation of the intrahepatic ducts
    • converge toward portal hepatis
    • appears as many cysts
  57. What causes ductal dilation/obstruction?
    • choledocholithiasis
    • masses
  58. Which type of choledocholithiasis is cause by etiologic factors often related to disease causing strictures or dilation of the bile ducts leading to stasis?
  59. Sclerosing cholangitis, Caroli’s disease, sickle cell disease, prior biliary surgery are all causes of which type of choledocholithiasis?
    primary choledocholithiasis
  60. Which type of choledocholithiasis is caused by migration of stones from the GB into the CBD?
    secondary choledocholithiasis
  61. What are the clinical symptoms associated with choledocholithiasis?
    • painless jaundice or
    • painful jaundice - acute obstruction or infection of the biliary tree
  62. Why are choledocholithiasis difficult to diagnose?
    because of limited visualization of the CBD due to bowel gas
  63. What is the sonographic appearance of choledocholithiasis?
    • round echogenic foci
    • posterior shadowing
  64. Image Upload
  65. What is the name of the pathology where the biliary tract hemorrhages due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasm?
  66. What is the name of the pathology where air is found within the biliary tree?
  67. Inflammation of the bile ducts.
  68. 50% of patients with Sclerosing cholangitis will also have what pathology?
    ulcerative colitis
  69. What is the sonographic appearance of cholangitis?
    • walls- smooth or irregular thickening of the intrahepatic ducts
    • sludge
    • hepatic abcess
  70. What is the most common disease of the GB?
    cholelithiasis aka gallstones
  71. Gallstones are formed by precipitated crystals of _______ or _______.
    bile salts or cholesterol
  72. What is the sonographic appearance of cholelithiasis?
    • rounded
    • multiple or single
    • large or small
    • mobile or non-mobile
    • highly reflective echo in GB
    • posterior acoustic shadowing
  73. Image Upload
    Cholelithiasis aka Gallstones
  74. Name the 5 F's for most common patients with cholelithiasis.
    • fat
    • female
    • forty
    • fertile (women of child bearing age)
    • fair (fair complected)
    • and 6 fertilized! (oh snap what now!)
    • Diabetes melitus is also a cause
  75. What is the name of the sonographic sign when the GB is completely packed with stones you only see the anterior border?
    Wall echo shadowing (WES sign)
  76. What should you always do to the patient when checking for gallstones?
    check for mobility (move the patient into a LLD)
  77. What lab values are associated with cholelithiasis?
    • Bilirubin
    • Amylase
    • Abnormal LFT's (liver function tests)
  78. Image Upload
  79. Image Upload
  80. excessive bile accumulation in the tissues resulting in yellowing in the skin and whites of the eyes
  81. What are 2 other names for sludge?
    biliary sand or microlithiasis
  82. low-level echoes found along the posterior margin of the gallbladder; move with change in position
  83. Name given when sludge has a liver echotexture.
  84. Why is it important to watch the gain settings when viewing the gallbladder?
    if the GB is not anechoic in appearance it can look like sludge
  85. Image Upload
  86. Acute cholecystitis is associated 90-95% with what patient pathology?
  87. Which GB pathology is caused by persistent obstruction of the GB neck or cystic duct resulting in inflammation of the GB wall?
    Acute Cholecystitis
  88. What is the name of the sign when the probe is pressed directly over the GB causing maximum pain?
    Murphy's Sign
  89. What lab values would you find in a patient with acute cholecystitis?
    • increased serum amylase
    • abnormal liver function test
  90. What are the sonographic findings of acute cholecystitis?
    • dilation of the GB
    • Murphy's sign
    • thick wall
    • stones
    • pericholecystic fluid
  91. What is the name of the fluid that results from extended inflammation along the hepatoduodenal ligament into the main lobar fissure resting adjacent to the GB?
    Pericholecystic fluid
  92. What lab test is associated with Chronic cholecystitis?
    abnormal LFT's
  93. What is the sonographic findings associated with chronic cholecystitis?
    • coarse GB wall thickening
    • contracted GB
    • WES sign
    • no Murphy's sign
  94. What is the pathology with an acute inflammation of the gallbladder in the absence of gallstones?
    Acalculous Cholecystitis
  95. What additional study is used to diagnose acalculous cholecystitis?
    Nuc Med study with CCK stimulation
  96. What are the sonographic signs of Acalculous cholecystitis?
    • thick GB wall
    • sludge
    • pericholecystic fluid
  97. What rare pathology involves infection of the GB with a gas forming bacteria which fills the lumen of the GB wall with gas?
    Emphysematous cholecystitis
  98. Emphysematous cholecystitis is fatal in what percent of patients?
  99. What pathlogy is a complication of acute cholecystitis; it can lead to perforation, ulcerations, pericholecystic fluid, or peritonitis?
    Gangrenous cholecystitis
  100. Image Upload
    Gangrenous cholecystitis
  101. What is the sonographic appearance of GB perforation?
    • deflation of GB
    • pericholecystic fluid
    • abscess
  102. Image Upload
    GB perforation
  103. What is the rare GB pathology defined as calcium incrustation of the GB wall?
    Porcelain GB
  104. What is Porcelain GB often associated with?
  105. What is the sonographic appearance of porcelain GB?
    • echogenic line
    • hyperechoic line with posterior acoustic shadowing
  106. What percentage of porcelain GBs develop into cancer?
  107. What is the mortality rate for GB carcinoma?
    near 100%
  108. What type of cancer is rare, rapidly progressive, affects elderly women, arises in the body of the GB and can obstruct the cystic ducts?
    gallbladder carcinoma
  109. What pathology is associated 80-90% with GB carcinoma?
  110. What is type of carcinoma is rare, affects the bile duct, and originates at the junction of the RT and LT hepatic ducts?
    Klatskin's Tumor
  111. Name a clinical symptom of Klatskin's Tumor.
    slowly worsening jaundice
  112. What is the sonographic appearance of Klatskin's tumor?
    • no CBD dilatation
    • dilatation may be seen elsewhere in the biliary tract
  113. What are benign, small, well-defined, soft tissue projections from the GB wall?
  114. Polyps can look like small stones but they will not be _____ or _____.
    mobile or shadow
  115. What type of GB adenoma is the most common?
  116. What is the sonographic appearance of GB adenomas?
    • stalk
    • hyperechoic
    • occur with GB disease
    • flat elevation located in the body near the fundus
  117. What pathology is an accumulation of cholesterol deposits on the mucosa of the GB?
  118. What is the name given to cholesterolosis because it's mucosal surface resembles a fruit?
    Strawberry GB
  119. What pathology has a hyperplastic change in the GB wall that does not move when patient changes orientation?
  120. What is the name of the artifacts associated with adenomyomatosis?
    "comet tail" and "ring down" artifact
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Card Set:
Test 3 Abdomen Sonography
2011-09-27 21:11:21
Biliary System

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