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Flashcards in Gallbladder Deck (76)
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GB location

GB fossa, main lobar fissure

1

CBD measure

CHD measure

CBD turns into CHD when...

< or = 6 mm

< or = 4 mm

It passes the hepatic artery

2

Kazaam view

Right shoulder to left hip

3

What is a Phrygian Cap

Fold at GB fundus

4

What is Hartmann's pouch / Junctional parenchymal fold

Fold at GB neck

5

Gallbladder

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.

6

CBD

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.

7

Valves of Heister

Spiral folds of mucosa in cystic duct

8

Arterial and Venous supply to GB

Cystic artery (branch of rt hepatic), and cystic vein (drains into portal)

9

Bile made mostly of

Bilirubin

10

Bilirubin

Direct/obstructive jaundice/conjugated bile, water soluble/surgical jaundice

Indirect bile/non obstructive/unconjugated/ water insoluble/medical jaundice

Serum direct bilirubin inc with obstruction.

11

Sludge aka echogenic bile

Assoc

US findings

Inspissated bile made of pigment granules & cholesterol crystals

Assos w. obstruction, cholecystitis, TPN, gallstones

Non shadowing low level echoes. Moves slowly.

12

GB hepatization

Sludge completely fills GB. Looks isoechoic to liver.

13

Tumefactive sludge

Sludge with tumor like appearance

14

What is cholelithiasis?

Predisposing factors?

Cause

Symptoms

US findings

Complications

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

15

5 F's

Female Fat Forty Fertile Flatulent Fair

16

What are the steps of formation of a gallstone?

Saturation, nucleation, growth.

17

What is a gallstone made of?

Bilirubin, cholesterol, calcium

18

What is the WES sign?

Seen in patients with gallstones when the GB is contracted. Wall echo shadow

19

What is cholecystitis?

GB inflammation. 1/3 pt with stones will have cholecystitis.

20

Acute 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

21

Emphysematous cholecystitis

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.

22

Gangrenous cholecystitis

Serious complication of acute cholecystitis. Wall hemorrhage. Necrosis.

Diffuse pain

Thickened striated wall, intraluminal echoes, taut GB, ff around GB, stones

23

Perforation

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,

24

Acalculous cholecystitis

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

25

Chronic cholecystitis

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

26

Bouveret's Syndrome

Fistula between duodenum and GB causing obstruction. Air can get to biliary tract & obstruct.

27

Mirizzi Syndrome

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

28

Empyema

Pus in GB, bacterial inflamed GB assoc w. acute cholecystitis. Lumen filled with exudate mainly pus.

Inc fever, chills, WBC

Complex appearance.

29

Porcelain GB

Various amount of calcifications of GB wall, rare,

females > 60 yrs.

assoc w. stone 95%, GB cancer

Asymptomatic, may be palpable