Chapter 11 - The Gallbladder and the BIliary System Fill In The Blanks

Question 1

The gallbladder serves as a reservoir for _______________ that is drained from the hepatic ducts in the liver.

Answer 1

bile

Question 2

The common hepatic duct is joined by the cystic duct to form the ______________ duct.

Answer 2

common bile duct

Question 3

The main pancreatic duct joins the common bile duct, and together they open through a small ampulla (the ampulla of _______________) into the duodenal wall.

Answer 3

Vater

Question 4

The end parts of the common bile duct and main pancreatic duct and the ampulla are surrounded by circular muscle fibers known as the _______________

Answer 4

Sphincter of Oddi

Question 5

The arterial supply of the gallbladder is from the _______________ artery, which is a branch of the right hepatic artery.

Answer 5

cystic

Question 6

List the two primary functions of the extrahepatic biliary tract.

Answer 6

1. transportation of bile from the liver to the intestines

2. regulation of its flow

Question 7

Bile is the principal medium for excretion of bilirubin _______________.

Answer 7

cholesterol

Question 8

The _______________ from the small intestine stimulate the liver to make more bile. This activates intestinal and pancreatic enzymes.

Answer 8

bile salts

Question 9

The sign that indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder, is called _______________.

Answer 9

Courvoisier’s sign

Question 10

Sonographically, the common duct lies _______________ and to the _______________ of the portal vein in the region of the porta hepatis and gastrohepatic ligament.

Answer 10

anterior; right

Question 11

The hepatic artery lies _______________ and to the _______________ of the portal vein.

Answer 11

anterior; left

Question 12

To ensure maximum dilation of the gallbladder, the patient should be given nothing to eat for a least _______________ hours before the ultrasound examination.

Answer 12

8 to 12

Question 13

The patient is initially examined with ultrasound in full _______________.

Answer 13

inspiration

Question 14

The patient should also be rolled into a steep _______________ or upright position (to ensure there are no stones within the gallbladder) in an attempt to separate small stones from the gallbladder wall or cystic duct.

Answer 14

decubitus

Question 15

The gallbladder may be identified as a(n) _______________ oblong structure located anterior to the right kidney, lateral to the head of the pancreas and duodenum.

Answer 15

sonolucent

Question 16

The gallbladder commonly resides in a(n) _______________ on the medial aspect of the liver.

Answer 16

fossa

Question 17

Because of ________________ tissue within the main lobar fissure of the liver (which lies between the gallbladder and the right portal vein), this bright linear reflector is a reliable indicator of the location of the gallbladder

Answer 17

fat or fibrous

Question 18

A small ________________ fold has been reported to occur along the posterior wall of the gallbladder at the junction of the body and infundibulum.

Answer 18

echogenic

Question 19

On a transverse scan, the common duct, hepatic artery, and portal vein have been referred to as the _______________ sign.

Answer 19

Mickey Mouse

Question 20

To obtain a cross section of the portal triad, the transducer must be directed in a slightly _______________ path from the left shoulder to the right hip.

Answer 20

oblique

Question 21

On sagittal scans, the right branch of the hepatic artery usually passes _______________ to the common duct.

Answer 21

posterior

Question 22

The common duct is seen just _______________ to the portal vein before it dips posteriorly to enter the head of the pancreas.

Answer 22

anterior

Question 23

When the right subcostal approach is used, the common hepatic duct is seen as a tubular structure anterior to the portal vein. The right branch of the _______________ artery can be seen between the duct and the portal vein as a small circular structure.

Answer 23

hepatic

Question 24

The most classic symptom of gallbladder disease is _______________ pain, usually occuring after ingestion of greasy foods.

Answer 24

RUQ

Question 25

A gallbladder attack may cause pain in the _______________ shoulder.

Answer 25

right

Question 26

The normal wall thickness of the gallbladder is less than _______________ mm.

Answer 26

3

Question 27

List the six biliary causes of gallbladder wall thickening.

Answer 27

1. cholecystitis
2. adenomyomatosis
3. cancer
4. acquired immunodeficiency syndrome
5. cholangiopathy
6. sclerosing cholangitis

Question 28

Clinically the patient with acute cholecystitis presents with these symptoms.

Answer 28

acute RUQ pain, positive Murphy’s sign, fever, and leukocytosis (increased white blood cell count)

Question 29

The ________________ sign is described as a contracted bright gallbladder with posterior shadowing caused by a packed bag of stones.

Answer 29

WES (wall echo shadow) sign

Question 30

A fairly rare complication of acute cholecystitis associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts is called ________________.

Answer 30

emphysematous cholecystitis

Question 31

Clinically the patient falls under the five “F”s.

Answer 31

fat, forty, female, fertile, fair

Question 32

Explain why the patient’s position should be shifted during ultrasound examination.

Answer 32

To demonstrate the movement of stones

Question 33

Describe the factors that produce a shadow in the gallbladder.

Answer 33

acoustic impedance of gallstones; refraction through them or around them; their size, centra, or peripheral location, and position in relation to the focus of the beam; intensity of the beam

Question 34

_______________ may be the result of the pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct into the distal common bile duct, causing duct wall abnormality, weakness, and outpouching of the ductal walls.

Answer 34

choledochal cycts

Question 35

A hyperplastic change in the gallbladder wall is _______________.

Answer 35

adenomyomatosis

Question 36

The differential for a porcelain gallbladder would include a packed bag or _______________ sign.

Answer 36

WES (wall echo shadow)

Question 37

What is the most notable sonographic finding with carcinoma of the gallbladder?

Answer 37

gallbladder wall is markedly abnormal and thickened

Question 38

The most common cause of biliary ductal system obstruction is the presence of a(n) ________________ or ________________ within the ductal system.

Answer 38

tumor or thrombus

Question 39

The job of the sonographer is to localize the level and cause of the obstruction. List the three primary areas where obstruction occurs.

Answer 39

1. intrapancreatic obstruction
2. suprapancreatic obstruction
3. porta hepatis obstruction

Question 40

An uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct creating extrinsic mechanical compression of the common hepatic duct is _______________ syndrome.

Answer 40

Mirizzi

Question 41

_______________ causes increasing pressure in the biliary tree with pus accumulation.

Answer 41

cholangitis

Question 42

The majority of stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______________.

Answer 42

Calculous cholecystitis

Question 43

______________ within the duodenum may also give rise to a dirty shadow in the right upper quadrant.

Answer 43

Air or gas

Question 44

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in _______________ disease.

Answer 44

Caroli’s

Question 45

What maneuvers may be performed to be sure the sludge in the gallbladder is not a tumor?

Answer 45

Change the patient’s position to see if the sludge moves.

Question 46

The majority of the stones in the common bile duct have migrated from the gallbladder. Common duct stones are usually associated with _______________.

Answer 46

calculous cholecysitis

Question 47

_______________ within the duodenum may also give rise to a dirty shadow in the right upper quadrant.

Answer 47

Air or gas

Question 48

On ultrasound, multiple cystic structures that converge toward the porta hepatis are seen in ______________ disease.

Answer 48

Caroli’s