Abdo- GB Flashcards
(108 cards)
1
Q
what is the biliary system comprised of? (3)
A
- intrahepatic bile ducts
- GB
- common bile duct
2
Q
what are hepatocytes?
A
- produce bile
- transported though the rt and lt intrahepatic bile ducts to the porta hepatis where they converge to form the common hepatic duct
3
Q
function of the common hepatic duct?
A
- transports the bile into the GB through the cystic duct
4
Q
function of the valves of heister?
A
- in the cystic duct
- control the flow of bile
5
Q
location of the extrahepatic CBD?
A
- distal to the cystic duct and CHD
6
Q
function of GB?
A
- stores and concentrates bile in the GB
- transports bile through the CBD to the duodenum
7
Q
what hormone is released into the bloodstream and stimulates the release of bile into the CBD and duodenum?
A
cholecystokinen
8
Q
when is the hormone cholecystokinen released?
A
when fat enters the digestive system
9
Q
GB blood supply?
A
- the GB and cystic duct are supplied by the cystic artery
- it is a branch of the right hepatic artery
10
Q
when the GB is not working what other 2 organs are probably affected as well?
A
- liver and pancreas
11
Q
normal total bilirubin?
A
0.3 to 1.1 /dL
12
Q
normal direct bilirubin?
A
0.1 - 0.4/dL
13
Q
what is bilirubin?
A
- a product from the breakdown of hemoglobin in old RBC’s
14
Q
what is jaundice?
A
- Leakage of bilirubin into tissues that gives the skin a yellow appearance
- jaunice itself is not a disease but a sign
15
Q
jaunice is AKA?
A
icterus
16
Q
causes of Hyperbilirubinemia?
A
- increased levels of bilirubin in the blood
- bilirubin is usually excreated in bile and urine
17
Q
what is jaundice often seen in? (4)
A
- liver disease
- hepatitis and cirrhosis
- liver or pancreatic cancer
- may indicate an obstruction of the biliary tract (stones in CBD)
18
Q
symptoms of jaundice? (5)
A
- pruritis- itchiness
- fatigue
- abdominal pain
- weight loss
- vomiting
19
Q
signs of jaundice (3)?
A
- yellow discoloration of skin and eyes
- fever
- pale stools and dark urine
20
Q
Elevation of direct or conjugated bilirubin is associated with? (4)
A
- obstruction
- hepatitis
- cirrhosis
- liver mets
21
Q
Elevation of indirect or unconjugated bilirubin is associated with?
A
- nonobstructive conditions
- steatosis
22
Q
Alkaline Phosphatase (ALP)?
A
- Enzyme produced primarily by liver, bone, and placenta
- excreated through bile ducts
23
Q
ALP elevation is associated with?
A
- obstrictive jaundice
24
Q
what is Alanine Aminotransferase(ALT)?
A
- enzyme found in high concentration in the liver and lower concentrations in the heart, muscle, and kidneys
- remains elevated longer than AST
25
what is used to assess jaundice?
Alanine Aminotransferase(ALT)
26
elevation of Alanine Aminotransferase(ALT) is associated with? (3)
- cirrhosis
- hepatitis
- biliary obstruction
27
mild elevation of Alanine Aminotransferase(ALT) is associated with?
liver metastases
28
what is Aspartate Aminotransferase(AST)?
- enzyme present in many kinds of tissue that is released when cells are injured or damaged
levels will be proportional to the amount of damage and the time between cell injury and testing
- used to diagnose liver disease before jaundice occurs
29
elevation of Aspartate Aminotransferase(AST) is associated with?
- cirrhosis
- hepatitis
- mononucleosis
30
normal GB measurment?
TRV: <4cm
SAG: <8-12 cm
wall thickness: <3mm
31
dialation of GB is known as?
hydrops
32
what is milk of calcium bile?
- rare condition
| - GB filled with semisolid calcium carbonate
33
what is milk of calcium bile caused by?
- stasis
| - rarely causes acute cholecystitis
34
biliary sludge on u/s?
- appears as amorphous low-level echoes
- no acoustic shadowing
- lacks vascularity
- may move or chance position
- normal GB wall
- Tumefactive sludge (sludge balls) mimics polyps
35
biliary sludge predisposing factors? (6)
```
Pregnancy
Rapid weight loss
Prolonged fasting
Critical illness
Long term parental nutrition
Bone marrow transplant
```
36
Clinical Symptoms and Signs of Gallbladder Disease?
- RUQ abdominal pain develops after the ingestion of greasy foods
- Nausea and vomiting sometimes occur and may indicate the presence of a stone in the common bile duct
- A gallbladder attack may cause pain in the right shoulder.
- Jaundice is a clinical sign of gallbladder disease
37
what is cholecystitis?
- inflammation of the GB that may take one of several forms
38
Cholecystitis is an inflammation of the gallbladder that may take one of several forms- including? (4)
Acute or chronic
Acalculous
Emphysematous
Gangrenous
39
Most common cause of acute cholecystitis is?
gallstones
40
what is Acute Cholecystitis?
caused by stones being impacted in the cystic duct or in the neck of the gallbladder (Hartmann’s pouch)
41
clinical presentation of acute cholecystitis?
- RUQ pain
- positive murphy's sign
- inspiratory arrest upon palpitation of GB area
- fever
- leukocytosis
- increased bilirubin and alkaline phosphatase levels
42
acute cholecystitis complications?
May be serious and include:
- empyema
- emphysematous
- gangrenous cholecystitis
- perforation
43
Acute Cholecystitis sono findings?
```
Gallbladder wall >3 mm
Distended gallbladder lumen >4 cm
Gallstones
Impacted stone in Hartmann’s pouch or cystic duct
Positive Murphy’s sign
Increased color Doppler flow
Pericholecystic fluid collection
```
44
what is positive murphys sign?
- pain in GB area when slight pressure with probe is applied
45
acute cholecystitis
46
Complications of Acute Cholecystitis?
Emphysematous cholecystitis
47
what is Emphysematous cholecystitis?
- Rare complication of acute cholecystitis
- Rapidly progressive and fatal in 15% of patients
- Affects more men than women; 50% of
- patients are diabetic; gallstones may not be present in 30% to 50% of patients
48
Emphysematous cholecystitis is associated with?
- presence of gas-forming bacteria in the GB wall and lumen with extension into the biliary ducts
49
complication of Emphysematous cholecystitis?
- gangrene with associated perforation
| - this condition is a surgical emergency
50
“packed bag” or WES sign is associated with?
Emphysematous Cholecystitis
51
Emphysematous Cholecystitis
52
what is gangrenous cholecystitis?
- serious, painful complication of acute cholecystitis that may lead to perforation
- occurs after a prolonged infection which causes the GB to undergo necrosis
53
Gangrenous Cholecystitis s/s?
- GB wall thickened and edematous with focal areas of exudate
- hemorrhage
- necrosis
54
what % of patients have gallstones with gangrenous cholecystitis?
90-95%
55
The common echo feature of gangrene is the?
presence of diffuse medium to coarse echogenic densities filling the gallbladder lumen in the absence of bile duct obstruction
56
This echogenic material has the following three characteristics (gangrene)
Does not cause shadowing
Is not gravity-dependent
Does not show a layering effect
57
Gangrenous Cholecystitis
58
what is acalculous cholecystitis?
Is the acute inflammation of the gallbladder in the absence of cholelithiasis
59
what is Acalculous Cholecystitis most likely caused by?
decreased blood flow through the cystic artery
60
conditions that produce depessed motility may precede the development of?
Acalculous Cholecystitis
61
Extrinsic compression of the cystic duct by a mass or lymphadenopathy may cause?
Acalculous Cholecystitis
62
Acalculous Cholecystitis clinically
murphys sign
63
Acalculous Cholecystitis
64
whos affected by GB Perforation?
Occurs in 5-10% of patients with acute cholecystitis due to prolonged inflammation
65
what is GB perforation?
focal defect in wall and deflation of GB
66
perforated GB
67
what is the Most common form of gallbladder inflammation?
Chronic Cholecystitis
68
what is Chronic Cholecystitis?
Result of numerous attacks of acute cholecystitis with subsequent fibrosis of the gallbladder wall
69
chronic cholecystitis clinically?
- patients may have some transient RUQ pain, but not the tenderness as experienced with acute cholecystitis
- advanced cases may involve wall thickening and fibrosis
70
chronic cholecystitis is differentiated from acute cholecystits by the absence of? (3)
1-gallbladder distension
2-positive murphy’s sign
3-hyperemia of the wall
71
Most common disease of the gallbladder?
Cholelithiasis
72
what is Cholelithiasis?
- Single, large gallstone or multiple tiny stones
- Tiny stones are the most dangerous because they can enter the bile ducts and obstruct the outflow of bile.
- After a fatty meal, the gallbladder contracts to release bile; if the outflow tract is blocked by gallstones, then pain results.
73
Cholelithiasis 5 F's?
fat, female, forty, fertile, fair
74
risk factors of Cholelithiasis?
- pregnancy
- OC use
- hemolytic diseases
- diet-induced weight loss
- parenteral nutrition
75
s/s of Cholelithiasis?
- asymptomatic
- RUQ pain with radiation to the shoulder after a high-fat meal
- epigastric pain
- nausea
- vomiting
76
what is “Wall echo shadow” (WES) sign?
indicates that the gallbladder is a packed bag. The sharp posterior shadow is noted. This appearance is different from that of the porcelain gallbladder because the anterior wall is not as bright or echogenic.
77
WES sign
78
is mostly found in?
- rare
| - found more often in older women
79
Torsion of the Gallbladder is associated with?
a mobile gallbladder with a long suspensory mesentery
80
torsion of the GB s/s?
- typical of acute cholecystitis
81
torsion of GB on u/s?
- GB lies in a horizontal position
- massively inflamed and distended
- cystic artery and cystic duct may become twisted
82
Porcelain Gallbladder?
Rare occurrence that is defined as calcium incrustation of the gallbladder wall.
83
what is porcelain GB associated with?
- gallstones
| - occurs more in older female patients
84
porcelain GB on u/s?
- Bright echogenic echo is seen in the region of the gallbladder with posterior shadowing.
- The differential will include a packed bag or WES sign.
85
porcelain GB on u/s?
- Bright echogenic echo is seen in the region of the gallbladder with posterior shadowing.
- The differential will include a packed bag or WES sign.
86
porcelain GB
87
Hyperplastic Cholecystitis Hyperplastic Cholecystitis is represented by?
Represented by a variety of degenerative and proliferative changes of the gallbladder:
Hyperconcentration
Hyperexcitability
Hyperexcretion
88
what are 2 types of hyperplastic cholecystitis?
Cholesterolosis and adenomyomatosis
89
Cholesterolosis?
- A condition in which cholesterol is deposited within the lamina propria of the gallbladder.
- The disease process is associated with cholesterol stones in 50% to 70% of patients.
- Often referred to as a “strawberry gallbladder” because the mucosa resembles the surface of a strawberry.
90
Cholesterolosis s/s?
- Most patients do not show thickening of the gallbladder wall.
- Small percentage of patients with this condition will show cholesterol polyps.
- These polyps are usually found in the middle third of the gallbladder and are <10 mm in diameter
91
cholesterolosis
92
what is Adenomyomatosis?
Adenomatous hyperplasia
Benign and usually asymptomatic
Exaggeration of the normal invaginations of luminal epithelium
93
Adenomyomatosis s/s?
Rokitansky-Aschoff sinuses:
- May appear as cystic spaces or echogenic foci with comet tail artifact
Key to diagnosis:
- Thickening of adjacent gallbladder wall
94
Adenomyomatosis u/s?
May appear as ‘twinkling’ artifact on doppler
May be focal or diffuse
Focal- seen in fundus
Hourglass appearance
95
what might be seen with Adenomyomatosis?
- Papillomas may occur singly or in groups and may be scattered over a large part of the mucosal surface of the gallbladder.
- Papillomas are not precursors to cancer.
= Various patient positions and compression show the lesion to be immobile in the gallbladder.
96
adenomyomatosis
97
Polypoid Masses benign?
More common
May be multiple
< 10mm
Do not change in size when followed
98
Polypoid Masses malignant?
```
>10mm
Singularity
> age 60
Gallstone disease
Rapid change in size when followed
```
99
Adenomas?
```
True benign neoplasms
Solitary & pedunculated
< 5% of polyps seen are adenomas
Thickening of wall adjacent suggests malignancy
Always check for a vascular stalk
```
100
Adenomyoma?
Exists with adenomyomatosis
Due to in large part from chronic irritation to the mucosa
A diverticular process that appears as a sessile polypoid lesion
101
Inflammatory polyps?
Comprises 5-10% of polyps seen
Often multiple
Occurs with gallstone disease & chronic cholecystitis
102
Malignancies of GB? (4)
- primary GB adenocarcinoma
- melanoma
- advanced HCC
- GB carcinoma
103
Primary gallbladder adenocarcinoma?
May appear as polypoid mass
104
melanoma?
Cause of 50-60% of metastases to GB
105
advanced HCC?
May directly invade the gallbladder fossa into lumen-hypervascular mass
106
GB carcinoma?
```
Uncommon malignancy
Elderly &female
98%-adenocarcinoma
Associated with gallstones
Focal or diffuse polypoid mass
arises from lumen
Invades adjacent liver
```
107
U/S- GB carcinoma?
Absence of normal appearing GB with no history of cholecystectomy-raises suspicion
Immobile stone engrossed in tumor- suspicious-trapped stone sign
Arterial &venous flow seen on doppler
Irregular wall thickening- loss of mural layers
Polypoid intraluminal masses>1cm
Mucin distending the gallbladder
CT scan recommended
108
GB carcinoma
