AB-Gallbladder and Biliary System Flashcards Preview

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Flashcards in AB-Gallbladder and Biliary System Deck (15)
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1

The biliary ducts

Right and left hepatic ducts
Common hepatic duct
Common bile duct
Cystic duct

2

Hepatic Ducts

Right and left hepatic ducts emerge from the right lobe of liver in the porta hepatis and unite to form the common hepatic duct, which passes caudally and medially.
Run parallel with the portal vein
Each duct is formed by the union of bile canaliculi from the liver lobules

3

Common Hepatic Duct

Approximately 4mm in diameter
Descends within the edge of the lesser omentum
Joined by the cystic duct to form the common bile duct

4

Common Bile Duct

Normal measurement is <6mm for people 60 years or younger. 1mm per decade after age 60
Proximal portion lies lateral to the hepatic artery and anterior to the portal vein (left ear of Mickey Mouse)
Ends by piercing into the wall of the duodenum where is joins the main pancreatic duct and together, they open into the duodenum through a small opening called the ampulla of Vater

5

Cystic Duct

Approx. 4 cm long
Connects the neck of the gallbladder to the CHD to form the CBD
Normally not seen by ultrasound

6

Function of the Gallbladder

Stores bile produced by the liver; can hold approx 50 ml
Concentrates bile when the body is in a fasting state

7

Anatomic variations of the gallbladder

Bilobed gallbladder-Hourglass appearance
Septated gallbladder-Appear as thin separations within the gallbladder
Phrygian cap-Gallbladder fundus is folded onto itself
Hartmann pouch-Outpouching of gallbladder neck
Junctional fold-Prominent fold located at the junction of the gallbladder neck

8

Courvoisier's sign

Indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder

9

Common causes of thickening of the gallbladder wall ( >3 mm)

Intrinsic
Cholecystitis
Gallbladder perforation
Sepsis
Hyperplastic cholecystosis
Gallbladder carcinoma
AIDS cholangiography
Sclerosing cholangitis
Extrinsic
Hepatitis/cirrhosis
Hypoalbuminemia
Ascites
Right heart failure
Renal failure
Multiple myeloma
Portal node lymphatic obstruction

10

Sonographic findings for gallbladder carcinoma

Nonmobile mass within the gallbladder lumen that measures >2cm
Gallstones seen in approx 90%
Diffuse or focal gallbladder wall thickening  Irregular mass that may completely fill the
gallbladder fossa
Invasion of the mass into surrounding liver
tissue

11

Gallbladder carcinoma

Rare, although most common cancer of the
biliary tract
Caused by chronic irritation of the gallbladder wall by gallstones
Size > 2cm , suspicous for carcinoma vs polyps
Color doppler can reveal vessels within the
malignancy

12

Porcelain gallbladder

Results from the calcification of the gallbladder wall
Occurs mainly in older female patients
May appear sonographically similar to WES
sign
Has been associated with the potential
development of gallbladder carcinoma (25%)

13

Gallbladder perforation is seen in which disease?

Acute cholecystitis

14

Malignant melanoma

Most common metastatic disease of the
gallbladder

15

Cholangiocarcinoma

Dilated intrahepatic ducts that abruptly terminate at the level of the tumor
A solid mass may be noted within the liver or ducts