Gallbladder

Question 1

Impacted stone in the cystic duct, cystic duct remnant or gallbladder neck

Answer 1

Mirizzi syndrome

Question 2

Inflammation around stone may cause partial mechanical obstruction of the CHD

Answer 2

Mirizzi syndrome

Question 3

RUQ pain
Jaundice
Recurrent cholangitis
Cholangitic cirrhosis

Answer 3

Clinical presentation of Mirizzi syndrome

Question 4

Sonographic finding of Mirizzi Syndrome

Answer 4

Dilatation of CHD and intrahepatic ducts above impacted stone w/ normal CBD

Question 5

GB considered contracted if measures:

Answer 5

Less than 2 cm in diameter after appropriate fasting

Question 6

Non visualization of GB

Answer 6

In 15-25% of PTs with cholelithiasis

Question 7

“Double arc” sign

Answer 7

WES sign

Question 8

WES triad

Answer 8

Wall
Echo
Shadow

Question 9

Chronic cholecystitis

Answer 9

Gallbladder wall fibrosis due to recurrent episodes of acute cholecystitis

Question 10

Lab values w/ chronic cholecystitis

Answer 10

May be elevated: 
AST
ALT
ALP
direct bilirubin

Question 11

Sonographic findings of Chronic Cholecystitis

Answer 11

Contracted GB w/ shadowing from stones
Hyperechoic wall 4-5mm
May see sludge
Decreased response after CCK injection

Question 12

Cholecystomegaly AKA

Answer 12

Hydropic GB

Question 13

Hydropic GB

Answer 13

GB distention w/o wall thickening
Prolonged total obstruction of cystic duct
GB filled with mucous secretions from wall

Question 14

Difference between Hydropic GB and courvousier’s GB

Answer 14

Courvoisier’s due to obstruction distal to cystic duct

Question 15

Risk factors for cholecystomegaly

Answer 15

Obstruction of cystic duct/GB neck
Kawasakis disease
Scarlet fever
Recent surgery
Prolonged biliary stasis

Question 16

Sonographic findings of Hydropic GB

Answer 16

TRV/AP > 4cm
Thin walls
Evaluate for Mirizzi syndrome

Question 17

Courvoisier GB

Answer 17

GB distention w/o wall thickening due to obstruction outside of GB

Question 18

Causes of Courvoisier GB

Answer 18

Pancreatic head mass
Duodenal papilla mass
Ampulla of Vater mass
CBD mass

Question 19

Sonographic findings of Courvoisier GB

Answer 19

Same as Hydropic GB

Question 20

Porcelain GB

Answer 20

Complete/patchy calcification of GB wall

Question 21

Incidence of porcelain GB

Answer 21

In 0.6-0.8% of PTs

More frequent in females (5:1)

Question 22

Risk factors for porcelain GB

Answer 22

Cholelithiasis

Question 23

Sonographic findings of Porcelain GB

Answer 23

May appear as stone filled but lacks WES sign

Question 24

Adenoma

Answer 24

Benign epithelial tumor

Localized overgrowth of epithelial lining

Question 25

Adenoma incidence

Answer 25

<5% of all GB polyps

Question 26

Risk factors for Adenoma

Answer 26

Cholelithiasis | Chronic cholecystitis

Question 27

Sonographic findings of Adenoma

Answer 27

``` Solitary <1 cm in diameter Homogeneous, hyperechoic immobile mass DO NOT shadow or move Usually near fundus Thickening of GB wall near polyp increases malignancy suspicion ```

Question 28

Adenomyomatosis AKA

Answer 28

Diverticulosis of GB

Question 29

A form of hyperplastic cholecystosis

Answer 29

Adenomyomatosis

Question 30

Adenomyomatosis occurs where in most cases?

Answer 30

Almost exclusively in fundus

Question 31

Sonographic findings of Adenomyomatosis

Answer 31

Thickening of GB wall Intraluminal diverticula may be seen Comet tail artifacts in B mode Twinkle artifact w/ color Doppler

Question 32

Small cholesterol stones/crystals lodged in Rokitansky-Aschoff sinuses

Answer 32

Adenomyomatosis

Question 33

Degenerative or proliferation changes due to deposits of cholesterol in GB or mucosal membranes

Answer 33

Cholesterolosis | AKA hyperplastic cholecystosis

Question 34

Focal form of cholesterolosis

Answer 34

Cholesterol polyps

Question 35

Strawberry GB

Answer 35

Diffuse form of cholesterolosis

Question 36

How big do polyps usually measure with cholesterolosis?

Answer 36

2-10 mm

Question 37

Strawberry GB is diagnosed with sonography. | T/F

Answer 37

False

Question 38

Primary GB carcinoma

Answer 38

Malignant neoplasm of GB wall

Question 39

Represents 98% of neoplasms in GB

Answer 39

Adenocarcinoma

Question 40

Incidence of primary GB carcinoma

Answer 40

Most common biliary malignancy Most in PTs >50 years More common in Native Americans and Hispanic Americans w/cholelithiasis More common in females (3:1)

Question 41

Risk factors for Primary GB carcinoma

Answer 41

``` Obesity Smoking Female Chronic salmonella typhi infection Exposure to industrial chemicals Cholelithiasis Chronic cholecystitis Porcelain GB Polyp >2 cm Primary sclerosis cholangitis Congenital biliary anomalies IBD ```

Question 42

Most common pattern of disease with Primary GB carcinoma

Answer 42

Mass from GB fossa replacing GB and invading adjacent liver

Question 43

Patterns of GB carcinoma

Answer 43

Irregular GB wall thickening Polyploid intraluminal lesions w/ irregular borders “Trapped stone” Tumors in infundibular/fundal region May grow into cystic duct and porta hepatis mimicking cholangiocarcinoma

Question 44

Direct extension Mets commonly arise from:

Answer 44

Cancers of stomach, pancreas, and bile ducts

Question 45

Hematogenous and lymphatic Mets

Answer 45

Lung Kidney Esophagus Malignant melanoma

Question 46

Differential of Mets from primary GB carcinoma

Answer 46

Cholelithiasis usually absent

Question 47

Non-inflammatory causes of GB: Diffuse

Answer 47

``` Normal contracted GB Hypoalbuminemia-hypoproteinemia Ascites Acute hepatitis CHF Renal disease AIDS Pancreatitis Cirrhosis Sepsis ```

Question 48

Non-inflammatory causes of GB wall thickening: | Focal

Answer 48

``` Adenomyomatosis Adenomatous polyp Cholesterol polyp Papillary Adenomas Primary GB carcinoma Mets ```

Question 49

Pseudo-wall thickening

Answer 49

TGC too high Beam average artifact Tumefactive sludge

Question 50

Thickened GB wall

Answer 50

>3 mm