• Releases bile into the duodenum during digestion (especially after fatty meals).

• Contraction is stimulated by

• Transportation of bile from the liver to the intestine.

• Regulation of bile flow into the duodenum.

• Normal bile flow is essential for fat __ and __ (via bile salts).

• Responds in a coordinated manner to different phases of digestion.

• = storage & concentration of bile.

• = transport & controlled release of bile

• Dark green to yellowish-brown fluid.

Bile is (a)   produced by the liver hepatocytes

• Collected and concentrated in the gallbladder

• Bile Released into the (a)   after eating, especially in response to fatty meals.

Bile is (a)   water --> solvent for bile components

Bile is (a)   bile salts --> essential for emulsification and absorption of dietary fats.

Bile is (a)   bilirubin

• a pigment formed from breakdown of red blood cells (gives bile its yellow-green color).

Bile is __ to __ fats --> cholesterol, fatty acids, lecithin.

(a)  

• electrolytes that maintain fluid balance and pH.

Helps with digestion and absorption of fats and fat-soluble vitamins in the small intestine

(a)  

• Helps to eliminate many waste products including bilirubin

• is an orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in the bile

• (a)   is a red protein responsible for transporting oxygen in the blood of vertebrates

• A peptide hormone and key hormonal regulator of digestion

• Secreted into the blood in response to the presence of fats and partially digested proteins in the small intestine after eating.

• Stimulates the gallbladder to contract and release stored bile into the duodenum.

• Essential for emulsification and digestion of dietary fats.

• Slows gastric emptying to allow adequate time for digestion and absorption in the small intestine.

• Acts on the hypothalamus to induce satiety (feeling of fullness), helping regulate food intake.

• Stimulates secretion of pancreatic enzymes.

• Enhances relaxation of the sphincter of Oddi to facilitate bile and pancreatic juice flow.

• CCK links (a)   in the small intestine to bile and enzyme release, while also helping regulate appetite.

• Elevated (leukocytosis) in acute cholecystitis due to inflammation/infection

• Normal total bilirubin

• Formed from breakdown of hemoglobin; normally bound to albumin. Serum Bilirubin

• Processed in the liver, water-soluble, excreted in bile

• Serum Bilirubin

• Marker of cholestasis (bile flow obstruction).

• Mild elevation in gallstone disease, but higher in hepatocellular injury.

• More specific to hepatocellular damage.

• May rise transiently in choledocholithiasis (stone in CBD).

• Prolonged if bile obstruction reduces absorption of vitamin K (needed for clotting factors).

• Non-specific marker; mild elevation can be seen in liver dysfunction or ischemic injury

• RUQ pain- may radiate to the upper back and chest

• Increase in liver function test

• Nausea/vomiting

• Intolerance to fatty foods

• Postprandial pain

• Positive Murphy’s sign-pain in area of gallbladder when pressure is applied by transducer

• Jaundice

• Intolerance to fatty food and dairy products

• NPO for  8-12 hrs prior to the exam

• Supine position of the patient

• Use the liver as a window to help displacing the bowel.

• Deep inspiration / expiration

• Sagittal, transverse and oblique scans are made over the upper abdomen (RUQ) to identify the gallbladder, liver , right kidney, and the head of the pancreas

• Roll the patient into a steep Lt Lateral decubitus or upright position to separate small stones from the gallbladder wall or cystic duct

Normal length of gallbladder in sag

(a)  

Normal gallbladder measurement in trans

(a)  

Gallbladder wall thickness

(a)  

• Measured in the transverse plane and at the level of the fundus

RUQ , between right and left lobes of liver, right kidney, main lobar fissure and portal vein

(a)  

• Thin, smooth, and uniform; ≤ 3 mm.

• Anechoic without internal echoes

• Length: 7–10 cm

• Transverse diameter: ≤ 4 cm

• Smooth echogenic line representing mucosa, with posterior acoustic enhancement.

• The (a)   is a hyperechoic (bright) line seen sonographically, running from the right portal vein to the gallbladder neck.

• It serves as a reliable anatomical guide to locate the gallbladder, especially when it is contracted or difficult to visualize

• A distended or “prominent” gallbladder is normal after (a)   , because bile accumulates while the patient has not eaten.

• After eating (particularly a fatty meal), (a)   (CCK) stimulates gallbladder contraction

• the gallbladder should (a)   as it ejects bile into the duodenum.

• if the gallbladder remains enlarged and does not contract, it may suggest (a)   (e.g., gallbladder dyskinesia, obstruction)

• In such cases, the (a)   should also be evaluated since pathology there (e.g., head of pancreas mass) can cause secondary biliary dilation

• Comes into contact with the anterior abdominal wall at the level of the 9th right costal cartilage.

• This is often the part palpated or seen in imaging when distended.

• Largest portion of the gallbladder.

• Lies in contact with the visceral surface of the liver.

• Directed upward, backward, and to the left.

• anterior landmark (9th costal cartilage).

• lies against liver surface.

• drains into cystic duct → common bile duct.

• Rounded appearance

• Images should be taken at the neck, mid and fundus of the gallbladder

• The __ __ refers to the three key structures that travel together within the hepatoduodenal ligament (part of the lesser omentum) at the porta hepatis of the liver

• brings nutrient-rich, deoxygenated blood from the gastrointestinal tract and spleen to the liver

• supplies oxygenated blood to the liver tissue.

• carries bile from the liver and gallbladder to the duodenum

The right and left hepatic ducts join to form the (a)   (CHD) at the porta hepatis

• The CHD then joins the cystic duct (from gallbladder) → forms the (a)  

• Measure inner wall to inner wall in longitudinal view.

• Dark (fluid-filled), pear-shaped sac.

• Near the duodenum and colon.

• The neck points toward the porta hepatis (where ducts join).

What is the normal measurement of a distended gallbladder long?

(a)  

Normal distended gallbladder AP

(a)  

the duct that carries bile from the cystic and hepatic ducts to the duodenum

(a)  

The duct of the gallbladder that joins with hepatic duct to form the CBD

(a)  

A pear shaped sac that lies on the undersurface of the liver; the gallbladder holds bile from the liver until releaed through cystic duct

(a)  

A fold within the gallbladder neck and body

(a)  

A fold within gallbladder fundus

(a)  

The normal gallbladder wall measures less than (a)   mm in thickness

The gallbladder is located within the (a)   between the RT and LT hepatic lobes

The gallbladder lies (a)   to the Rt kidney and transverse colon

The neck lies (a)   of the porta hepatic

May enter the advetita and serve as a pathway for infection from the liver

(a)  

The cystic duct arises from the (a)   aspect of the gallbladder neck and enters into the CBD

The valve of Hester are located in the (a)  

Which valves prevent collapse or overdistention during sudden changes in positions

(a)  

The cystic duct ends at the (a)  

The cystic duct joins the CHD to create the (a)  

CHD typically does not exceed

(a)  

The gallbladder__ and __ bile until needed and regulates biliary pressure

(a)  

CCK is produced by the (a)  

Small infundibulum at the neck of the gallbladder

(a)  

Fundus kinks or folds back on the body

(a)  

Tenderness to the transducer compression over the gallbladder

(a)  

Blood supply of the gallbladder comes from the

(a)  

Cholesterol, bilirubin, biliverdin, and bile acids

(a)  

Biliary radicles are the most (a)   segments of the biliary tract

(a)   reduce echoes or artifacts

on CT gallbladder appears a (a)   grayda