Gallbladder- lab values, indications, technique

1.

______________ _______________ is the end product of natural breakdown of the RBC's.

Explanation
Serum bilirubin is the end product of the natural breakdown of red blood cells (RBCs). When RBCs reach the end of their lifespan, they are broken down in the liver, spleen, and bone marrow. This breakdown process releases bilirubin, which is then transported in the bloodstream and eventually processed by the liver for excretion. Therefore, serum bilirubin is the correct answer as it is the final product of RBC breakdown in the body.

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2.

Serum bilirubin is the measurement of concentration of bilirubin, which is the predominant pigment in _______.

Explanation
Serum bilirubin is the measurement of concentration of bilirubin, which is the predominant pigment in bile. Bile is a digestive fluid produced by the liver and stored in the gallbladder. It is released into the small intestine to aid in the digestion and absorption of fats. Bilirubin is a yellowish pigment that is formed from the breakdown of red blood cells. It is then transported to the liver where it is conjugated and excreted into the bile. Therefore, the correct answer is bile.

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3.

Direct bilirubin is increased in
- A.
  
  Extrahepatic Obstruction
- B.
  
  Bile Duct Obstruction
- C.
  
  Intrahepatic Disruption
Correct Answer(s)
A. Extrahepatic Obstruction
B. Bile Duct Obstruction
C. Intrahepatic Disruption

Explanation
Direct bilirubin is increased in conditions such as extrahepatic obstruction, bile duct obstruction, and intrahepatic disruption. In these conditions, there is a blockage or disruption in the flow of bile, which leads to the accumulation of bilirubin in the bloodstream. Direct bilirubin is a form of bilirubin that is conjugated in the liver and excreted in bile. When there is a blockage or disruption in the biliary system, bilirubin cannot be properly excreted, resulting in its increased levels in the blood.

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4.

Serum bilirubin is elevated in __________ hepatic and ______________ jaundice

Correct Answer(s)
post, obstructive

Explanation
Serum bilirubin is elevated in post-hepatic and obstructive jaundice. Post-hepatic jaundice, also known as extrahepatic or obstructive jaundice, occurs when there is a blockage in the bile ducts, preventing the flow of bile from the liver to the intestines. This leads to an accumulation of bilirubin in the bloodstream, causing elevated levels of serum bilirubin. Obstructive jaundice can be caused by various conditions such as gallstones, tumors, or strictures in the bile ducts. Therefore, both post-hepatic and obstructive jaundice can result in elevated serum bilirubin levels.

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5.

Leukocytosis in cases of infection such as _____________ or _______________.

Correct Answer(s)
cholecystitis, cholangitis

Explanation
Leukocytosis is an increase in the number of white blood cells, which is a common response to infection. In cases of cholecystitis and cholangitis, both of which are infections of the gallbladder and bile ducts, leukocytosis can occur. This is because the body's immune system recognizes the presence of bacteria or other pathogens in these infections and responds by producing more white blood cells to fight off the infection. Therefore, leukocytosis can be seen as a diagnostic marker for these types of infections.

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6.

PT-The clotting time is ____________ in patients with acute cholecystitis, cancer of the gallbladder, and prolonged CBD obstruction.

Correct Answer(s)
longer

Explanation
Patients with acute cholecystitis, cancer of the gallbladder, and prolonged CBD obstruction experience a longer clotting time. This could be due to various factors such as inflammation, impaired liver function, or obstruction in the bile ducts. These conditions can affect the normal clotting process, leading to a prolonged clotting time.

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7.

Indications for gallbladder sono-
- A.
  
  Pain, RUQ or right shoulder pain with inflammation
- B.
  
  Positive Murphy's sign
- C.
  
  Numbness in extremities
- D.
  
  Vomiting
- E.
  
  Intolerance to fatty foods and dairy products
- F.
  
  Migraines
- G.
  
  Nausea
- H.
  
  Jaundice
Correct Answer(s)
A. Pain, RUQ or right shoulder pain with inflammation
B. Positive Murphy's sign
D. Vomiting
E. Intolerance to fatty foods and dairy products
G. Nausea
H. Jaundice

Explanation
The indications for gallbladder sono include pain in the right upper quadrant (RUQ) or right shoulder, inflammation, a positive Murphy's sign, vomiting, intolerance to fatty foods and dairy products, nausea, and jaundice. These symptoms suggest possible gallbladder inflammation or obstruction, which can be evaluated using ultrasound imaging.

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8.

A ________(#) - ________(#) MHz transducer should be used. A thin patient may require a ______(#) MHz probe for optimal resolution.

Correct Answer(s)
3.5, 5, 7.5

Explanation
Different frequencies of transducers are used in medical imaging to optimize resolution based on the patient's body type. The lower frequency transducer (3.5 MHz) is used for imaging deeper structures, such as abdominal organs, because it has a longer wavelength and can penetrate deeper into the body. The higher frequency transducer (7.5 MHz) is used for imaging superficial structures, such as the thyroid or breast, because it has a shorter wavelength and provides better resolution. The middle frequency transducer (5 MHz) is a compromise between depth and resolution and can be used for a variety of imaging purposes. A thin patient may require the higher frequency (7.5 MHz) probe to achieve the best resolution due to the shallow depth of the structures being imaged.

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9.

The patient must be NPO for ____(#) - ____(#) hours prior to the exam to decrease gas and assure gallbladder distention.

Correct Answer(s)
8, 10

Explanation
The patient needs to be NPO (nothing by mouth) for 8 to 10 hours before the exam to reduce the presence of gas in the digestive system and ensure proper distention of the gallbladder. This is important for obtaining clear and accurate images during the examination.

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10.

It is important to explain the procedure to the patient, this reduces patient anxiety and allows the sonographer to obtain ____________ _____________.

Correct Answer(s)
patient history

Explanation
Explaining the procedure to the patient is important because it helps to reduce their anxiety and allows the sonographer to obtain accurate patient history. By explaining the procedure, the patient will have a better understanding of what to expect, which can help to alleviate any fears or concerns they may have. This, in turn, creates a more relaxed environment for the patient, making it easier for the sonographer to gather important information about their medical history.

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11.

Check all that apply when performing a gallbladder exam
- A.
  
  Check for lab values
- B.
  
  Look for surgical scars or jaundice
- C.
  
  Pinpoint location of maximum tenderness
- D.
  
  Check for Murphy's sign
- E.
  
  Adjust TGC and overall gains
- F.
  
  Obtain images in longitudinal and transverse planes with patient supine and left lateral decubitus. Also right lateral decubitus or even erect if necessary.
Correct Answer(s)
A. Check for lab values
B. Look for surgical scars or jaundice
C. Pinpoint location of maximum tenderness
D. Check for Murphy's sign
E. Adjust TGC and overall gains
F. Obtain images in longitudinal and transverse planes with patient supine and left lateral decubitus. Also right lateral decubitus or even erect if necessary.

Explanation
When performing a gallbladder exam, it is important to check for lab values to assess any abnormalities in liver function. Looking for surgical scars or jaundice can provide information about the patient's medical history and potential liver issues. Pinpointing the location of maximum tenderness can help identify any inflammation or infection in the gallbladder. Checking for Murphy's sign, which is pain upon deep inspiration while palpating the right upper quadrant, can indicate gallbladder inflammation. Adjusting TGC (time gain compensation) and overall gains can optimize the image quality. Obtaining images in different positions (supine, left lateral decubitus, right lateral decubitus, or erect) can help visualize the gallbladder from different angles.

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12.

The gallbladder is not routinely measured, however, if a hydropic gallbladder is of concern, the gallbladder would be measured ______________.

Correct Answer(s)
transversely

Explanation
The gallbladder is not routinely measured because it is not a standard practice. However, if there is a concern about a hydropic gallbladder (a condition where the gallbladder is enlarged due to excessive fluid accumulation), then the gallbladder would be measured transversely. This means that the measurement would be taken from side to side, horizontally, to assess the size and dimensions of the gallbladder.

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13.

The gallbladder wall should be measured in the ________________ plane on its __________ wall with the sound beam perpendicular to the wall of the gallbladder.

Correct Answer(s)
longitudinal, anterior

Explanation
The gallbladder wall should be measured in the longitudinal plane on its anterior wall with the sound beam perpendicular to the wall of the gallbladder. This means that the ultrasound probe should be placed on the anterior surface of the abdomen, and the sound waves should be directed towards the gallbladder in a longitudinal orientation. This allows for a clear visualization and accurate measurement of the gallbladder wall thickness.

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14.

Minor angulation may result in ________________ of the gallbladder wall

Correct Answer(s)
pseudo-thickening

Explanation
Minor angulation of the gallbladder wall can lead to pseudo-thickening. Pseudo-thickening refers to the appearance of thickening in the gallbladder wall on imaging studies, such as ultrasound or CT scan, when there is no actual inflammation or pathology present. This can occur due to the compression or folding of the gallbladder wall, causing it to appear thicker than it actually is. It is important to differentiate pseudo-thickening from true thickening, as true thickening may indicate inflammation or other underlying conditions of the gallbladder.

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15.

A ___________ meal may be administered to assess gallbladder contractility or biliary obstruction. A non-obstructed bile duct should decrease in size after this meal.

Correct Answer(s)
fatty

Explanation
A fatty meal may be administered to assess gallbladder contractility or biliary obstruction. This is because a non-obstructed bile duct should decrease in size after consuming a fatty meal. The presence of biliary obstruction can be determined by the lack of decrease in the size of the bile duct after the meal.

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16.

A fatty meal is a liquid, usually ____________, given to a patient to stimulate their gallbladder to contract. Fatty meals are usually done in nuclear medicine with a _________ scan.

Correct Answer(s)
lipomul, HIDA

Explanation
A fatty meal, usually lipomul, is given to a patient to stimulate their gallbladder to contract. This is done in nuclear medicine with a HIDA scan. The HIDA scan is used to evaluate the function of the gallbladder and the bile ducts. By administering a fatty meal, the gallbladder is stimulated to contract, allowing the HIDA scan to assess the flow of bile from the liver to the gallbladder and then to the small intestine.

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4

Gallbladder- Lab Values, Indications, Technique

_ is the end product of natural breakdown of the RBC's.

Serum bilirubin is the measurement of concentration of bilirubin, which is the predominant pigment in _______.

Direct bilirubin is increased in

Serum bilirubin is elevated in hepatic and ____ jaundice

Leukocytosis in cases of infection such as _ or ___.

PT-The clotting time is ____________ in patients with acute cholecystitis, cancer of the gallbladder, and prolonged CBD obstruction.

Indications for gallbladder sono-

A __(#) - (#) MHz transducer should be used. A thin patient may require a (#) MHz probe for optimal resolution.

The patient must be NPO for (#) - (#) hours prior to the exam to decrease gas and assure gallbladder distention.

It is important to explain the procedure to the patient, this reduces patient anxiety and allows the sonographer to obtain _.

Check all that apply when performing a gallbladder exam

The gallbladder is not routinely measured, however, if a hydropic gallbladder is of concern, the gallbladder would be measured ______________.

The gallbladder wall should be measured in the ______ plane on its wall with the sound beam perpendicular to the wall of the gallbladder.

Minor angulation may result in ________________ of the gallbladder wall

A ___________ meal may be administered to assess gallbladder contractility or biliary obstruction. A non-obstructed bile duct should decrease in size after this meal.

A fatty meal is a liquid, usually ____, given to a patient to stimulate their gallbladder to contract. Fatty meals are usually done in nuclear medicine with a _ scan.

Gallbladder- Lab Values, Indications, Technique

______________ _______________ is the end product of natural breakdown of the RBC's.

Serum bilirubin is the measurement of concentration of bilirubin, which is the predominant pigment in _______.

Direct bilirubin is increased in

Serum bilirubin is elevated in __________ hepatic and ______________ jaundice

Leukocytosis in cases of infection such as _____________ or _______________.

PT-The clotting time is ____________ in patients with acute cholecystitis, cancer of the gallbladder, and prolonged CBD obstruction.

Indications for gallbladder sono-

A ________(#) - ________(#) MHz transducer should be used. A thin patient may require a ______(#) MHz probe for optimal resolution.

The patient must be NPO for ____(#) - ____(#) hours prior to the exam to decrease gas and assure gallbladder distention.

It is important to explain the procedure to the patient, this reduces patient anxiety and allows the sonographer to obtain ____________ _____________.

Check all that apply when performing a gallbladder exam

The gallbladder is not routinely measured, however, if a hydropic gallbladder is of concern, the gallbladder would be measured ______________.

The gallbladder wall should be measured in the ________________ plane on its __________ wall with the sound beam perpendicular to the wall of the gallbladder.

Minor angulation may result in ________________ of the gallbladder wall

A ___________ meal may be administered to assess gallbladder contractility or biliary obstruction. A non-obstructed bile duct should decrease in size after this meal.

A fatty meal is a liquid, usually ____________, given to a patient to stimulate their gallbladder to contract. Fatty meals are usually done in nuclear medicine with a _________ scan.

_ is the end product of natural breakdown of the RBC's.

Serum bilirubin is elevated in hepatic and ____ jaundice

Leukocytosis in cases of infection such as _ or ___.

A __(#) - (#) MHz transducer should be used. A thin patient may require a (#) MHz probe for optimal resolution.

The patient must be NPO for (#) - (#) hours prior to the exam to decrease gas and assure gallbladder distention.

It is important to explain the procedure to the patient, this reduces patient anxiety and allows the sonographer to obtain _.

The gallbladder wall should be measured in the ______ plane on its wall with the sound beam perpendicular to the wall of the gallbladder.

A fatty meal is a liquid, usually ____, given to a patient to stimulate their gallbladder to contract. Fatty meals are usually done in nuclear medicine with a _ scan.