Biliary System - Part 2

Question 1

What are 3 anatomical variants of the GB?

Answer 1

1. Hartmann pouch
2. Junctional fold
3. Phrygian cap

Question 2

Hartmann pouch

Answer 2

Small posterior pouch near the GB neck

Question 3

Junctional fold

Answer 3

Fold or septation of the GB at the junction of the neck and body

Question 4

Phrygian cap

Answer 4

Fold in the gallbladder fundus

Question 5

What are 5 congenital anomalies of the GB?

Answer 5

1. Agenesis
   - rare
2. Duplication
3. Hypoplasia
4. Intrahepatic or ectopic
5. Multiseptated

Question 6

What is hypoplasia of the GB associated with?

Answer 6

Cystic fibrosis

Question 7

What is the normal length and diameter of the GB in fasting adult?

Answer 7

1. Length = 8=10cm

2. Diameter = 3-5cm

Question 8

What is the normal length and width of the GB in a fasting in a pediactric patient?

Answer 8

1. Length = 1.5-3cm

2. Width = 1.2cm

Question 9

What is the normal length and diameter of the GB in a fasting in a patient between the ages of 2-16 years old?

Answer 9

1. Length = 3-7cm

2. Diameter = 1-3cm

Question 10

What is the US appearance of a fasting GB? (2)

Answer 10

1. An ellipsoid anechoic structure located in the GB fossa demonstrating posterior acoustic enhancement
2. Smooth hyper echoic walls
   - measuring 3mm or less in thickness

Question 11

Where is the GB located compared to the liver?

Answer 11

Inferior medial aspect of the liver

Question 12

What are 6 reasons on why you wouldn’t see a GB?

Answer 12

1. Non-fasting patient
2. Surgically absent
3. Obliteration of the GB lumen by intestinal air or gallstones
4. Patient body habitus
5. Ectopic location
6. Agenesis

Question 13

What are 6 non-inflammatory causes of GB wall thickening?

Answer 13

1. Non-fasting patient
2. Ascites
3. Cirrhosis
4. Congestive heart failure
5. Hypoalbuminemia
6. Acute hepatitis

Question 14

What can be used to decrease artifactual echoes in the GB? (2)

Answer 14

1. Harmonics
2. Dynamic range
   - compression

Question 15

How can spatial compounding help?

Answer 15

It can help to visualize structures posterior to a highly attenuating structure

Question 16

If the patient is in a jaundice state, what part of the biliary system should be evaulated?

Answer 16

Intrahepatic ducts

Question 17

What are 7 indications for scanning the biliary system?

Answer 17

1. RUQ pain
   - may radiate to the upper back and chest
2. Increase in LFTs
3. Nausea/vomiting
4. Intolerance to fatty foods
5. Postprandial pain
6. Positive Murphy sign
7. Jaundice.

Question 18

Alkaline phosphatase

Answer 18

An enzyme produced primarily by the liver, bone and placenta and excreted
through the bile ducts

Question 19

What is the normal range of alkaline phosphatase?

Answer 19

35-150 U/L

Question 20

What does an increase in alkaline phosphatase indicate?

Answer 20

Obstructive jaundice

Question 21

ALT

Answer 21

Alanine aminotransferase

Question 22

Alanine aminotransferase

Answer 22

An enzyme found in high concentration in the liver and in lower concentrations in the heart, muscle, and kidney

Question 23

What is the normal range of ALT?

Answer 23

1-45U/L

Question 24

Does ALT or AST remain elevated longer?

Answer 24

ALT

Question 25

What does an elevation of ALT associated with? (3)

Answer 25

1. Cirrhosis 2. Hepatitis 3. Biliary obstruction

Question 26

What does a mild elevation of ALT associated with?

Answer 26

Liver metastasis

Question 27

AST

Answer 27

Aspartate Aminotransferase

Question 28

Aspartate Aminotransferase

Answer 28

An enzyme present in many types of tissue that is released when cells are injured or damaged - levels will be proportional to amount of damage and the time between cell injury and testing

Question 29

What is the normal range for AST?

Answer 29

1-36U/L

Question 30

What does an elevation of AST associated with? (3)

Answer 30

1. Cirrhosis 2. Hepatitis 3. Mononucleosis

Question 31

Bilirubin

Answer 31

A product from the break down of Hb in old RBCs - a disruption in the process may cause abnormal levels - leakage into tissues gives the skin a yellow appearance

Question 32

What is the normal range of total bilirubin?

Answer 32

0.3-1.1mg/dL

Question 33

What is the normal range of direct bilirubin?

Answer 33

0.1-0.4mg/dL

Question 34

What does bilirubin reflect on?

Answer 34

The balance between production and excretion of bile

Question 35

What is an elevation of direct on conjugated bilirubin associated with? (4)

Answer 35

1. Obstruction 2. Hepatitis 3. Cirrhosis 4. Liver metastasis

Question 36

What is an elevation of indirect on unconjugated bilirubin associated with?

Answer 36

Non-obstructive conditions