Flashcards in Gallbladder Deck (76)
GB fossa, main lobar fissure
CBD turns into CHD when...
< or = 6 mm
< or = 4 mm
It passes the hepatic artery
Right shoulder to left hip
What is a Phrygian Cap
Fold at GB fundus
What is Hartmann's pouch / Junctional parenchymal fold
Fold at GB neck
Teardrop / pear shape
Stores bile. Contracts under colicystickinine
7-10 cm L, 2.5 cm W
GB wall < 3 mm
Fundus body neck
Capacity 50 ml bike storage.
Cystic duct + common hepatic duct = common bile duct
CBD < 6 mm
CHD < 4 mm
CBD lat/rt to hep artery, ant to the right of portal vein
CBD post/lat to panc head.
Valves of Heister
Spiral folds of mucosa in cystic duct
Arterial and Venous supply to GB
Cystic artery (branch of rt hepatic), and cystic vein (drains into portal)
Bile made mostly of
Direct/obstructive jaundice/conjugated bile, water soluble/surgical jaundice
Indirect bile/non obstructive/unconjugated/ water insoluble/medical jaundice
Serum direct bilirubin inc with obstruction.
Sludge aka echogenic bile
Inspissated bile made of pigment granules & cholesterol crystals
Assos w. obstruction, cholecystitis, TPN, gallstones
Non shadowing low level echoes. Moves slowly.
Sludge completely fills GB. Looks isoechoic to liver.
Sludge with tumor like appearance
What is cholelithiasis?
Gallstones. Most common GB disease. Affects 20 million Americans
5 F's, biliary infection, ETOH cirrhosis, anemia, TPN, ileal disease, estrogen, bypass surgery, obesity, pregnancy, diabetes, hypercholesterolemia, IV nutrition, OCP, rapid wt loss from diet, white, Hispanic.
Abnl bile composition, bile stasis (not contracting with IV nutrition), infection
Asymptomatic, RUQ pain, n/v, belching, chest pain, pain with fatty meal, pain radiating to right shoulder or epigastrium.
Echogenic foci, shadowing, mobile, dependent, WES sign when contracted.
Obstruction, cholecystitis, assoc w. GB cancer
Female Fat Forty Fertile Flatulent Fair
What are the steps of formation of a gallstone?
Saturation, nucleation, growth.
What is a gallstone made of?
Bilirubin, cholesterol, calcium
What is the WES sign?
Seen in patients with gallstones when the GB is contracted. Wall echo shadow
What is cholecystitis?
GB inflammation. 1/3 pt with stones will have cholecystitis.
95% with stones, usually stone obstructs cystic duct. Obstructs cystic drainage and gb wall inflames
Murphy's sign, gallstones, diffuse wall thickening, gb dilatation, sludge
MC cause is stone in neck or cystic duct
Inc alk phos, alt, ast, wbc, bilirubin
Wall thickening > 3 mm, stones, halo w. edema (pericholecystic fluid), distended GB
Infection with gas forming bacteria in GB wall. May not have stones.
Sudden progressive RUQ pain, fever, inc wbc.
Intraluminal and intramural gas. Reverb comet tail.
Serious complication of acute cholecystitis. Wall hemorrhage. Necrosis.
Thickened striated wall, intraluminal echoes, taut GB, ff around GB, stones
Complication of acute, usually in fundus, from cystic duct obstruction, GB distends and causes necrosis.
Stones, infection, diabetes, trauma, cancer, drugs
FF, abscess, wall thick, perforation,
Usually males. No stones.
Burn patients, sepsis, prolonged TPN, dehydrated, congenital biliary anomalies, prolonged fasting, pancreatic reflux, hemolysis
Thick GB wall, ff, murphy's sign, GB wall edema, pericholecystic fluid
90% with stones, enlg, thick wall, contracted GB, WES sign,
Fatty food intolerance, n/v, RUQ pain, epigastric pain, pain radiating to scapula
Alk Phos, AST, ALT, Bilirubin w. Jaundice, Amylase
Fistula between duodenum and GB causing obstruction. Air can get to biliary tract & obstruct.
Large stone impacted in cystic duct. presses on common hep duct & causes pressure necrosis & erosion in duct wall.
IHDD, large stone in cystic duct. Normal size CBD
Pus in GB, bacterial inflamed GB assoc w. acute cholecystitis. Lumen filled with exudate mainly pus.
Inc fever, chills, WBC