Gallbladder Ultrasound Examination

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Questions and Answers

Which of the following is a common indication for performing an ultrasound of the gallbladder?

Right lower quadrant pain

Chronic cough

Suspected gallstones (correct)

Severe headaches

What is required prior to studying the gallbladder?

Only solid food is restricted.

Dietary changes are not needed for any scans.

No dietary restrictions are necessary.

Fasting or clear fluid restriction is necessary. (correct)

What symptom could suggest a need for gallbladder ultrasound due to possible obstruction?

Back pain

Jaundice (correct)

Nasal congestion

Increased appetite

Which condition is not typically assessed with an ultrasound of the gallbladder?

Chronic fatigue syndrome Signup and view all the answers

What frequency range of the transducer is typically used for gallbladder studies?

3–5 MHz Signup and view all the answers

In which situation would you assess gallbladder function using an ultrasound?

To evaluate gallbladder function Signup and view all the answers

Which of the following is NOT part of the patient preparation for gallbladder examination?

Consumption of solid food prior to the study. Signup and view all the answers

Which of the following is a clinical scenario that warrants an ultrasound of the gallbladder?

Fever of unknown origin Signup and view all the answers

What role does contact gel play in the examination process?

It improves the quality of the ultrasound images. Signup and view all the answers

Which statement correctly reflects preparation guidelines for a gallbladder study?

Fasting is required if the gallbladder is examined. Signup and view all the answers

What is the maximum normal thickness of the gallbladder wall?

3 mm Signup and view all the answers

Which of the following measurements is NOT used to assess fasting gallbladder volume?

Circumferential diameter Signup and view all the answers

Why is it important to assess the thickness of the gallbladder wall?

To assess for potential pathology Signup and view all the answers

Which technique can be utilized to measure the dimensions of the gallbladder?

Ultrasound imaging Signup and view all the answers

Which of the following statements is true regarding gallbladder function assessment?

It includes assessing various diameters. Signup and view all the answers

What appearance do dilated ducts exhibit?

Beaded branching Signup and view all the answers

In which position is the patient typically placed for examining extrahepatic bile ducts?

Supine or lateral Signup and view all the answers

What characteristic is NOT typical of dilated ducts?

Normal width Signup and view all the answers

Which of the following statements accurately reflects the condition of extrahepatic bile ducts?

They can be dilated in the presence of obstruction. Signup and view all the answers

Which of the following is a common feature observed in dilated ducts?

Branching pattern Signup and view all the answers

What indicates that intrahepatic ducts are dilated?

Their diameter is more than 40% of the accompanying portal vein branch. Signup and view all the answers

What is typically observed posterior to dilated intrahepatic ducts?

Acoustic enhancement. Signup and view all the answers

Which statement is true regarding the relationship between intrahepatic ducts and portal veins?

Dilated ducts will show acoustic enhancement while portal veins will not. Signup and view all the answers

If the diameter of intrahepatic ducts is equal to the accompanying portal vein branch, how would they be classified?

Non-dilated. Signup and view all the answers

What is a critical percentage used to assess the dilation of intrahepatic ducts?

40% of the portal vein diameter. Signup and view all the answers

What is the normal diameter of the common bile duct?

6 mm or less Signup and view all the answers

Which duct's junction is essential for distinguishing the common hepatic duct from the common bile duct?

Cystic duct Signup and view all the answers

Why is it often difficult to distinguish the common hepatic duct from the common bile duct using ultrasound?

Identification of the cystic duct junction is usually not possible Signup and view all the answers

What measurement would indicate a potential abnormality in the common bile duct?

10 mm Signup and view all the answers

Which of the following statements is true regarding the common bile duct?

It is typically 6 mm or less in diameter Signup and view all the answers

Study Notes

Ultrasound of the Liver

Indications: Suspected focal or diffuse liver lesions, jaundice, abnormal liver function tests, right upper quadrant pain or mass, hepatomegaly, suspected portal hypertension, staging of known extrahepatic malignancy (though superseded by CT for patients over 30), pyrexia of unknown origin (though superseded by CT), real-time image guidance for biopsy needle placement, assessment of portal vein, hepatic artery, or hepatic veins, assessment of patients with surgical shunts or TIPS procedures, and follow-up after surgical resection or liver transplant
Contraindications: None
Patient Preparation: Fasting or restriction to clear fluids, if gallbladder also being studied
Equipment: 3-5 MHz transducer, contact gel. Appropriate preset protocol selection depending on machine type, manufacturer, and patient factors
Technique: Patient supine, time-gain compensation for uniform reflectivity throughout the right lobe, suspended inspiration, longitudinal scans from epigastrium or left subcostal to right subcostal regions (transducer angled cephalad), transverse scans subcostally to visualize entire liver; additional scans (intercostal, longitudinal, transverse, oblique) if necessary when visualization is incomplete; quiet respiration or real-time scanning during quiet respiration if breath-holding is not possible for visualization, or left lateral decubitus if incomplete visualization still occurs, contrast agents for contrast-enhanced ultrasound to characterize focal liver lesions (similar to contrast-enhanced CT or MRI) using specialized ultrasound machine software and low mechanical index scanning for quick contrast bubble bursting prevention. Images recorded after bolus injection of contrast agent with saline flush
Advantages: Feasible even in presence of impaired renal function.
Disadvantages: Limited to single lesion visualization per pass

Additional Views

Hepatic Veins: Best visualized using transverse intercostal or epigastric approach during inspiration; real time, hepatic vein walls do not have increased reflectivity compared to normal liver parenchyma; normal hepatic vein waveform is triphasic, reflecting right atrial pressures; Power Doppler may be used to examine flow within hepatic IVC segment.
Portal Vein: Longitudinal view using oblique subcostal or intercostal approach; normal portal vein walls have increased reflectivity compared to liver parenchyma; normal portal vein blood flow is towards liver; usually continuous flow, but velocity may vary with respiration.
Hepatic Artery: Traced from the celiac axis (recognizable by "seagull" appearance of the origins of common hepatic and splenic arteries) with normally forward flow throughout systole and diastole, with a sharp systolic peak

Common Bile Duct and Spleen

Spleen Size: Measure in all cases of suspected liver disease or portal hypertension; normal adult spleens usually measure 12cm or less in length, and less than 7 cm × 5 cm in thickness, "eyeballing" (measurement of longest diameter) is common method. Children: splenomegaly suspected if spleen is over 1.25 times the length of the adjacent kidney
Common Bile Duct: Patients suspected of having gallstones or right upper quadrant pain, jaundice, fever of unknown origin, acute pancreatitis, assessing gallbladder function, guided percutaneous procedures should be evaluated
Contraindications: None
Patient Preparation: Fasting for at least 6 hours, preferably overnight, water is permitted
Equipment: 3-5 MHz transducer, contact gel, appropriate preset protocol, factors including machine type, manufacturer, patient habitus, and positioning, or ultrasound stand for anterior gallbladder
Technique: supine positioning; gallbladder location by tracing from the right portal vein to the gallbladder fossa; visualization around the long axis and transversely from the fundus to the cystic duct; rescanning in left lateral decubitus or erect positions for improved stone identification; head-down tilt may aid neck and cystic duct visualization; normal gallbladder wall thickness should not exceed 3 mm

Ultrasound of the Gallbladder and Biliary System

Indications: suspected gallstones, right upper quadrant pain, jaundice, fever of unknown origin, acute pancreatitis assessing gallbladder function; guided percutaneous procedures
Contraindications: None
Patient Preparation: fasting for at least six hours, preferably overnight, water is permitted
Equipment: 3-5 MHz transducer, contact gel, appropriate protocol, factors including machine type, manufacturer, patient habitus, and positioning, or stand-off for anterior gallbladder,

Ultrasound of the Pancreas

Indications: suspected pancreatic tumor, pancreatitis or its complications, epigastric mass, epigastric pain, jaundice, facilitate guided biopsy and/or drainage
Contraindications: None
Patient Preparation Nil by mouth, preferably overnight
Equipment 3-5 MHz transducer, contact gel, appropriate protocol, factors including machine type, manufacturer, patient habitus, and positioning (or stand-off for thin patients).
Technique: Patient supine; pancreas located anterior to splenic vein in transverse epigastric scan; transducer angled transversely and obliquely to visualize head and tail; tail visualization using spleen as acoustic window; longitudinal epigastric scans may be useful; pancreatic parenchyma reflectivity increases with age, equaling liver reflectivity in young adults

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Description

This quiz tests your knowledge on the indications, preparation, and procedures for gallbladder ultrasounds. You will encounter questions about common symptoms requiring examinations, appropriate transducer frequencies, and patient preparation guidelines. Assess your understanding of clinical scenarios and measurement criteria related to gallbladder evaluation.