Gallbladder/Biliary System Worksheet PDF

Gallbladder/Biliary System Worksheet *Key* 1. The gallbladder is divided into what 3 parts? Neck, Body, and Fundus 2. What is the name of the valve that controls the bile flow in the cystic duct? Heister’s 3. Whe...

Gallbladder/Biliary System Worksheet *Key* 1. The gallbladder is divided into what 3 parts? Neck, Body, and Fundus 2. What is the name of the valve that controls the bile flow in the cystic duct? Heister’s 3. When Performing a Gallbladder ultrasound you must evaluate what 4 areas of anatomy? Liver, Pancreas, Gallbladder, CBD 4. The portal vein and hepatic artery flow is toward the liver and the flow in the bile ducts is away from the liver. 5. The cystic Duct is the connection from the gallbladder to the bile ducts. 6. The Cystic duct and the Common Hepatic duct converge to form the common bile duct, which carries bile from the liver to the duodenum. 7. The CBD and the Main Pancreatic duct , also known as Wirsung’s duct join and enter the duodenum at the Ampulla of Vater. 8. The Sphincter of Oddi is a muscular “gatekeeper” that relaxes to allow bile/pancreatic enzymes from the ampulla of Vater to the duodenum. 9. Name 3 types of folds of the gallbladder and where they occur: Hartman’s Pouch-Neck, Phrygian cap-fundus, Junctional-between the body and infundibulum (fundus) 10. What is the term for removal of the Gallbladder? Cholecystectomy …Is there any expected change in size of the CBD after the gallbladder is removed? YES, How? Dialation 11. What is the appearance of the gallbladder if the patient is not NPO? Small (contracted) and thick walled. 12. The purpose of changing the patient’s position during the exam is to demonstrate mobility of gallstones and to make sure that no stones are lodged in the neck or cystic duct 13. The gallbladder should be less than 5cm in the anterior/posterior dimension from the transverse plane and the gallbladder wall should measure less than 3mm. 14. Where is the CBD routinely measured? Where the rt. Hepatic artery courses between the portal vein and the bile duct 15. Typically the CBD should be 5-6 mm or less. 16. The CBD diameter increases with age. After age 60 the normal CBD diameter increases 1mm per decade. 17. Findings of Hydrops/mucocele of the gallbladder is a round distended, non-inflamed GB due to obstruction of the cystic duct. 18. Murphy’s sign is demonstrated when a pt. Indicates exquisite tenderness of the rt. Costal margin over the area of the gallbladder. Is an indication of gb disease. 19. Name 4 appearances (signs) associated with dialated intrahepatic ducts: double barrel shotgun, parallel channel, stallate confluence, too many tubes 20. Cholecystokinin is a “fatty” hormone that may be administered which causes the gallbladder to contract. 21. If a patient was positive for obstruction the gallbladder would appear distended (fat) 22. What are the 5 F’s of gallbladder disease? Fat, Forty, Female, Fair, (flatulent), Fertile 23. Name 4 (primary) causes of Gallbladder wall thickening: (12 Possible): cholecystitis, Adenomyomatosis, cancer, AIDS, cholangitis, cholangiopathy 24. GB Sludge is a gravity dependent, non-shadowing, echogenic material, made up of calcium bilirubinate granules and cholesterol crystals. 25. Cholecystitis is the term for inflammation of the gallbladder. 26. The symptoms of Cholecystitis include: RUQ pain, murphy’s sign, possible fever, high WBC count, diffuse GB wall thickening, gallstones 27. An elevation of amylase suggests obstruction at the ampulla of Vater. 28. Empyema of the gallbladder involves purulent material(pus) within the gallbladder,due to bacteria-containing bile. 29. What is the technical term for gallstones? Cholelithiasis 30. What are the 3 diagnostic criteria for gallstones? Echogenic, mobile, shadowing 31. What is the WES sign short for? Wall, Echo, Shadow. what is another name that could be used for that sonographic appearance?double arc. What pathology is the term referring to?a gallbladder full of stones. 32. What is the technical term for gas in the biliary tree? pneumobilia 33. What condition is also known as strawberry gallbladder? cholesterolosis 34. The mortality rate for Gallbladder Carcinoma is near 100%. 35. 80-90% of patients with GB Carcinoma will also have cholelithiasis (gallstones). 36. Name the 3 sonographic appearances of GB carcinoma: Focal thickening of the gb wall, intraluminal mass, gb replaced by mass 37. Biliary atresia is absence of the extrahepatic biliary tree and is suspected in infants with jaundice. 38. Cholangitis is inflammation of the bile ducts, usually due to infection secondary to intestinal infection. 39. What are the symptoms of Cholangitis? Fever, jaundice, RUQ pain 40. Mirizzi Syndrome is extrahepatic biliary obstruction due to an impacted stone in the cystic duct, causing mechanical compression of the common hepatic duct. 41. Klatskin/Cholangiocarcinoma is a tumor that occurs at the bifurcation of the common hepatic duct into right and left (hepatic hilum). It results in intra-hepatic but not extra-hepatic duct dilation. 42. The 2 most common lesions causing biliary obstruction are: Gallstones and Carcinoma of the head of the pancreas 43. What labs are typically elevated with biliary obstruction? Serum alkaline Phosphatase, GGT, and Conjugated bilirubin 44. An obstruction in the distal portion of the CBD will result in dilation of: Both the Extra and Intrahepatic ducts 45. What does the term Choledocolithiasis mean? Stones in the bile duct 46. Choledocolithiasis is the most common cause of extra-hepatic obstructive jaundice. 47. What diagnostic tests may be performed if choledocolithiasis is suspected? ERCP, CT, PTC, ultrasound 48. Choledochal cyst is a rare condition caused by weakness in the bile duct wall, causing cystic dilatation of the intra and extrahepatic bile ducts. 49. What is the sonographic appearance of Choledochal cyst? 2 cystic structures in the RUQ (GB and dialated intrahepatic ducts. 50. In what part of the world are choledochal cyst prevalent? Asia 51. _Pancreatic Adenocarcinoma is the most common cause of malignant neoplasm obstructing the biliary tree.