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
    • 1. Rt hepatic duct
    • 2. Lt hepatic duct
    • 3. Common hepatic duct
    • 4. Cystic duct
    • 5. Common bile duct
    • 6. Distal CBD
    • 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
  8. What are the 3 portions of the gallbladder?
    • fundus
    • body
    • neck
  9. What is the normal size of the gallbladder?
    • length 7-10 cm
    • transverse 3 cm
    • wall thickness < 3 mm
  10. What are the folds along the inner border of the gallbladder?
    Rokitansky-Aschoff sinuses
  11. What helps prevent kinking of the duct in the neck of the gallbladder?
    Heister's Valves
  12. What is the outpouching called located near the junction of the cystic duct and the gallbladder neck?
    Hartmann's Pouch or infundibulum
    • 1. Heister's Valve
    • 2. GB Neck
    • 3. Hartmann's Pouch
    • 4. Cystic Duct
    • 5. GB Body
    • 6. GB Fundus
  13. The gallbladder is between what lobes of the liver?
    Rt & Lt lobes
  14. 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

  15. The gallbladder is typically located on the inferoposterior surface of the liver and can be _______ or ________.
    extrahepatic or intrahepatic
  16. 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
    • 1. Portal Vein
    • 2. Main Lobar Fissure
    • 3. Gallbladder
  17. Where are junctional folds typically located?
    near the gallbladder neck
  18. What is it called when a junctional fold occurs at the fundus?
    Phrygian Cap
  19. Name 4 gallbladder variants.
    • 1. junctional fold
    • 2. Phrygian cap
    • 3. pear shaped
    • 4. oval
  20. Name 4 congenital gallbladder variants.
    • 1. septations
    • 2. bilobed
    • 3. duplication
    • 4. absence or agenesis (rare)
  21. Phrygian cap
  22. Septation & duplicated GB
  23. Bile is the principle route of execretion for what 4 things?
    • 1. bilirubin
    • 2. cholesterol
    • 3. steroids
    • 4. drugs & other toxins
  24. What are the tiny spiral valves found within the cystic duct called?
    Heister's Valves
  25. The lumen of the cystic duct contains ______ folds.
  26. What is the normal diameter of the common bile duct?
    up to 6mm
  27. What is name of the area where the common bile duct and the pancreatic duct merge?
    Ampulla of Vater aka hepatopancreatic duct
  28. What is the name of the small muscle that guards the ampulla of vater?
    sphincter of oddi
  29. What structures comprise the portal (hepatic) triad?
    • common bile duct
    • hepatic artery
    • portal vein
  30. What is the name given to the portal triad when viewed sonographically in transverse?
    mickey mouse sign
    • 1. common bile duct
    • 2. hepatic artery
    • 3. portal vein
  31. What is the normal sonographic appearance of the gallbladder?
    • anechoic lumen
    • thin well-defined walls
  32. How long should the patient be NPO for examining the gallbladder?
    8-12 hours
  33. How should the patient be positioned for examining the gallbladder?
    supine or decubitus
  34. T/F
    You should always scan the patient in 2 positions when imaging the gallbladder.
    • 1. Hepatic artery
    • 2. GB Neck
    • 3. Portal Vein
    • 4. IVC
    • 1. common hepatic duct
    • 2. portal vein
    • 3. diaphragm
    • 4. IVC
    • 1. Portal Vein
    • 2. IVC
    • 3. Right Renal Artery
  35. What is the disease process called where pancreatic juices reflux into the common bile duct causing focal or diffuse dilation?
    Choledochal cysts
  36. T/F
    Choledochal cysts occur more frequently in infants, women, and people of East Asia.
  37. What are the symptoms of choledochal cysts?
    • intermittent jaundice
    • palpable RUQ mass
    • colicky pain
  38. What are the sonographic findings associated with choledochal cysts?
    • cyst in the portal hepatis
    • dilated CBD
  39. 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
  40. Which type of choledochal cyst is very rare and has a true diverticulum of the CBD?
    Type 2
  41. Which type of choledochal cyst is confined to a intraduodenal portion of the CBD (choledochoceles)?
    Type 3
  42. 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
  43. Which type of choledochal cyst involves multiple dilations with the extrahepatic biliary tract ONLY?
    Type 4 B
  44. What pathology is a rare congenital disorder with malformation of the intrahepatic biliary tree causing biliary stasis?
    Caroli's Disease
  45. Biliary stasis caused from Caroli's disease can cause what 3 pathologies?
    • stone formation
    • cholangitis
    • sepsis
  46. What are the two types of Caroli's disease?
    • simple, classic form
    • periportal hepatic fibrosis (most common)
  47. Which type of Caroli's disease is most common?
    periportal hepatic fibrosis
  48. What is the sonographic appearance of Caroli's disease?
    • saccular dilation of the intrahepatic ducts
    • converge toward portal hepatis
    • appears as many cysts
  49. What causes ductal dilation/obstruction?
    • choledocholithiasis
    • masses
  50. Which type of choledocholithiasis is cause by etiologic factors often related to disease causing strictures or dilation of the bile ducts leading to stasis?
  51. Sclerosing cholangitis, Caroli’s disease, sickle cell disease, prior biliary surgery are all causes of which type of choledocholithiasis?
    primary choledocholithiasis
  52. Which type of choledocholithiasis is caused by migration of stones from the GB into the CBD?
    secondary choledocholithiasis
  53. What are the clinical symptoms associated with choledocholithiasis?
    • painless jaundice or
    • painful jaundice - acute obstruction or infection of the biliary tree
  54. Why are choledocholithiasis difficult to diagnose?
    because of limited visualization of the CBD due to bowel gas
  55. What is the sonographic appearance of choledocholithiasis?
    • round echogenic foci
    • posterior shadowing
  56. choledocholithiasis
  57. What is the name of the pathology where the biliary tract hemorrhages due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasm?
  58. What is the name of the pathology where air is found within the biliary tree?
  59. Inflammation of the bile ducts.
  60. 50% of patients with Sclerosing cholangitis will also have what pathology?
    ulcerative colitis
  61. What is the sonographic appearance of cholangitis?
    • walls- smooth or irregular thickening of the intrahepatic ducts
    • sludge
    • hepatic abcess
  62. What is the most common disease of the GB?
    cholelithiasis aka gallstones
  63. Gallstones are formed by precipitated crystals of _______ or _______.
    bile salts or cholesterol
  64. 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
  65. Cholelithiasis aka Gallstones
  66. 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
  67. 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)
  68. What should you always do to the patient when checking for gallstones?
    check for mobility (move the patient into a LLD)
  69. What lab values are associated with cholelithiasis?
    • Bilirubin
    • Amylase
    • Abnormal LFT's (liver function tests)
  70. Gallstones
  71. Gallstones
  72. excessive bile accumulation in the tissues resulting in yellowing in the skin and whites of the eyes
  73. What are 2 other names for sludge?
    biliary sand or microlithiasis
  74. low-level echoes found along the posterior margin of the gallbladder; move with change in position
  75. Name given when sludge has a liver echotexture.
  76. 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
  77. sludge
  78. Acute cholecystitis is associated 90-95% with what patient pathology?
  79. Which GB pathology is caused by persistent obstruction of the GB neck or cystic duct resulting in inflammation of the GB wall?
    Acute Cholecystitis
  80. What is the name of the sign when the probe is pressed directly over the GB causing maximum pain?
    Murphy's Sign
  81. What lab values would you find in a patient with acute cholecystitis?
    • increased serum amylase
    • abnormal liver function test
  82. What are the sonographic findings of acute cholecystitis?
    • dilation of the GB
    • Murphy's sign
    • thick wall
    • stones
    • pericholecystic fluid
  83. 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
  84. What lab test is associated with Chronic cholecystitis?
    abnormal LFT's
  85. What is the sonographic findings associated with chronic cholecystitis?
    • coarse GB wall thickening
    • contracted GB
    • WES sign
    • no Murphy's sign
  86. What is the pathology with an acute inflammation of the gallbladder in the absence of gallstones?
    Acalculous Cholecystitis
  87. What additional study is used to diagnose acalculous cholecystitis?
    Nuc Med study with CCK stimulation
  88. What are the sonographic signs of Acalculous cholecystitis?
    • thick GB wall
    • sludge
    • pericholecystic fluid
  89. 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
  90. Emphysematous cholecystitis is fatal in what percent of patients?
  91. What pathlogy is a complication of acute cholecystitis; it can lead to perforation, ulcerations, pericholecystic fluid, or peritonitis?
    Gangrenous cholecystitis
  92. Gangrenous cholecystitis
  93. What is the sonographic appearance of GB perforation?
    • deflation of GB
    • pericholecystic fluid
    • abscess
  94. GB perforation
  95. What is the rare GB pathology defined as calcium incrustation of the GB wall?
    Porcelain GB
  96. What is Porcelain GB often associated with?
  97. What is the sonographic appearance of porcelain GB?
    • echogenic line
    • hyperechoic line with posterior acoustic shadowing
  98. What percentage of porcelain GBs develop into cancer?
  99. What is the mortality rate for GB carcinoma?
    near 100%
  100. 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
  101. What pathology is associated 80-90% with GB carcinoma?
  102. 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
  103. Name a clinical symptom of Klatskin's Tumor.
    slowly worsening jaundice
  104. What is the sonographic appearance of Klatskin's tumor?
    • no CBD dilatation
    • dilatation may be seen elsewhere in the biliary tract
  105. What are benign, small, well-defined, soft tissue projections from the GB wall?
  106. Polyps can look like small stones but they will not be _____ or _____.
    mobile or shadow
  107. What type of GB adenoma is the most common?
  108. What is the sonographic appearance of GB adenomas?
    • stalk
    • hyperechoic
    • occur with GB disease
    • flat elevation located in the body near the fundus
  109. What pathology is an accumulation of cholesterol deposits on the mucosa of the GB?
  110. What is the name given to cholesterolosis because it's mucosal surface resembles a fruit?
    Strawberry GB
  111. What pathology has a hyperplastic change in the GB wall that does not move when patient changes orientation?
  112. What is the name of the artifacts associated with adenomyomatosis?
    "comet tail" and "ring down" artifact
  113. Polyps
  114. adenomyomatosis

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Test 3 Abdomen Sonography
2011-09-27 21:11:21
Biliary System

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