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Abdominal > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

mechanical obstruction can result from what 3 things?

A

gallstones, tumors in biliary tree, enlargement of pancreatic head

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2
Q

4 symptoms of gallbladder disease

A

pain, RUQ pain after ingestion of greasy foods, nausea and vomiting, right shoulder pain

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3
Q

most classic symptom of gallbladder disease

A

pain

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4
Q

when will jaundice develop

A

when a stone blocks the bile ducts between gallbladder and intestines, producing pressure on liver and forcing bile into the blood

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5
Q

what is sludge?

A

thickened bile due to bile stasis

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6
Q

what patients are seen with sludge?

A

patients with prolonged fasting or hyperalimentation therapy and with obstruction of gallbladder

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7
Q

2 sonographic findings of sludge

A

prominent gallbladder, low level echoes

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8
Q

what may be seen with cholelithiasis, cholecystitis and other biliary diseases?

A

sludge

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9
Q

what is tumefactive sludge?

A

sludge balls- mobile round non-shadowing echogenic masses in gallbladder

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10
Q

what else may tumefactive sludge resemble?

A

polypoid mass or pseudo tumor

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11
Q

normal gallbladder wall measures

A

less than 3 mm

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12
Q

5 gallbladder diseases that may cause the wall to thicken

A

cholecystitis, adenomyomatosis, cancer, cholangiopathy, sclerosing cholangitis

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13
Q

7 Nonbiliary diseases that may also cause wall thickening

A

Cirrhosis, Hepatitis, Pancreatitis, Portal hypertension, Heart failure, Ascites, AIDS

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14
Q

in what plane should gallbladder wall be measured?

A

transducer perpendicular to anterior gallbladder wall (usually transverse)

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15
Q

what is cholecystitis

A

inflammation of the gallbladder

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16
Q

5 forms of inflammation of the gallbladder

A 
Acute
Chronic
Acalculous
Emphysematous
Gangrenous
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17
Q

what is the most common cause of acute cholecystitis?

A

cholelithiasis that creates a cystic duct obstruction

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18
Q

acute cholecystitis is six times more common in who?

A

middle aged women

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19
Q

6 symptoms of acute cholecystitis

A 
Sharp RUQ pain radiating to the back
Elevated WBC
Fever
Nausea
Vomiting
Positive Murphy’s sign
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20
Q

what is murphy’s sign?

A

patient is tender over gallbladder region to touch

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21
Q

4 complications of acute cholecystitis

A

Empyema
Emphysematous cholecystitis
Gangrenous cholecystitis
Perforation

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22
Q

6 sonographic findings of acute cholecystitis

A

irregular outline of thickened wall, stones, sludge, hydrops, pericholecystic fluid, gallbladder may appear normal

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23
Q

what is the most common form of gallbladder inflammation?

A

chronic cholecystitis

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24
Q

what happens when the mucosal lining of the gallbladder becomes damaged?

A

loses the ability to store bile efficiently

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25
Q

4 symptoms of chronic cholecystitis

A

RUQ pain after eating greasy foods, creams, chocolate (not as severe as acute attack), flatulent, frequent belching, sour taste in mouth

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26
Q

4 sonographic findings of chronic cholecystitis

A

cholelithiasis, contracted gallbladder, coarse gallbladder wall thickening, WES sign

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27
Q

what is the WES sign?

A

(wall, echo, shadow)-contracted bright gallbladder with posterior shadowing caused by a packed gallbladder of stones

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28
Q

what is acalculous cholecystitis?

A

inflammation of gallbladder without the presence of stones

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29
Q

symptom of acalculous cholecystitis

A

positive Murphy’s sign

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30
Q

3 sonographic findings of acalculous cholecystitis

A

wall is extremely thick, echogenic sludge seen within dilated gallbladder, pericholecystic fluid

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31
Q

what is emphysematous cholecystitis

A

complication of acute cholecystitis associated with the presence of gas-forming bacteria within gallbladder wall and lumen with extension into the ducts

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32
Q

T or F? emphysematous cholecystitis is a surgical emergency

A

true, it is life threatening

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33
Q

what is emphysematous cholecystitis associated with?

A

diabetes

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34
Q

what is a complication of emphysematous cholecystitis

A

gangrene with perforation

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35
Q

2 sonographic findings of emphysematous cholecystitis

A

bright echo along anterior wall, ring down artifact due to gas

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36
Q

7 sonographic findings of gangrenous cholecystitis

A

thickened gallbladder wall, areas of edema, areas of hemorrhage, areas of necrosis, gallstones or fine gravel, pericholecystic abscesses or peritonitis, densities filling gallbladder lumen

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37
Q

what is the most common disease of the gallbladder

A

cholelithiasis

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38
Q

what is cholelithiasis

A

a large single gallstone or hundreds of tiny gallstones (tiny are most dangerous)

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39
Q

what are the 5 F’s?

A

fat, female, forty, fertile, fair

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40
Q

6 factors predisposing someone to cholelithiasis

A

pregnancy, diabetes, oral contraceptives, hemolytic diseases, diet induced weight loss, poor nutrition

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41
Q

5 symptoms of cholelithiasis

A

may be asymptomatic, RUQ pain with radiation to right shoulder after fatty meal, epigastric pain, nausea, vomiting

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42
Q

3 sonographic findings of cholelithiasis

A

enlarged gallbladder, increased wall thickness, internal reflectors within lumen with posterior shadowing

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43
Q

what are choledochal cysts?

A

rare congenital dilation of CBD

44
Q

3 people choledochal cysts are more common in

A

females, infants, Asian population

45
Q

choledochal cysts are prone to what 3 things?

A

biliary stasis, sstone formation, cholangitis

46
Q

2 sonographic findings of choledochal cysts

A

dilation of biliary system, appear as true cysts in RUQ with or without communication with biliary system

47
Q

what causes cholesterolosis

A

an abnormality in the metabolism of cholesterol within the gallbladder wall

48
Q

what is strawberry gallbladder?

A

cholesterolosis

49
Q

what are gallbladder polyps?

A

larger deposits of cholesterol that are attached to gallbladder wall by a stalk

50
Q

how do polyps appear differently than stones

A

polyps are immobile and don’t produce shadows

51
Q

what is adenomyomatosis

A

a hyperplastic change in the gallbladder wall

52
Q

4 sonographic findings of adenomyomatosis

A

small elevations in gallbladder lumen
Gallbladder doesnt move
pouches project from wall

53
Q

what is porcelain gallbladder?

A

completely calcified gallbladder

54
Q

reason for complete calcification

A

unknown but believed to be due to chronic cholecystitis

55
Q

porcelain gallbladder increases the chance of developing gallbladder carcinoma by

A

25%

56
Q

2 sonographic findings of porcelain gallbladder

A

bright echo seen in region of gallbladder, WES sign

57
Q

what is the differential diagnosis for porcelain gallbladder

A

gallbladder packed with stones

58
Q

who usually has gallbladder carcinoma

A

elderly

59
Q

T or F? gallbladder carcinoma usually has a favorable outcome

A

false, almost always fatal

60
Q

3 symptoms of gallbladder carcinoma

A

jaundice, weight loss, palpable RUQ mass

61
Q

3 sonographic findings of gallbladder carcinoma

A

intraluminal mass, solid mass where gallbladder should be, thickened wall

62
Q

3 things that may result in dilated biliary ducts

A

choledocholithiasis, cholangiosarcoma, enlargement of pancreatic head

63
Q

most common cause for biliary dilation

A

choleodocholithiasis

64
Q

what may patients with choleodocholithiasis assume when they have an attack?

A

they are having a heart attack

65
Q

patients with cholangiocarcinoma present with what 2 things

A

jaundice and weight loss

66
Q

3 forms of cholangiocarcinoma

A

scirrhous, polypoid, Klatskin’s tumor

67
Q

What is acute cholecystitis?

A

the sudden onset of gallbladder inflammation

68
Q

What is adenomyomatosis?

A

benign hyperplasia of the GB wall

69
Q

What is biliary colic?

A

pain located in the RUQ in the area of the GB

70
Q

What is the surgical removal of the GB?

A

cholecystectomy

71
Q

What is cholecystokinin?

A

the hormone produced by the duodenum that causes the GB to contract

72
Q

Describe Courvoisier GB?

A

the clinical detection of an enlarged, palpable GB caused by biliary obstruction in the area of the pancreatic head

73
Q

What is the cystic duct?

A

Duct that connects the GB to the common hepatic duct

74
Q

What is hydropic GB?

A

enlarged GB

75
Q

What is a junctional fold?

A

fold in the neck of a GB

76
Q

What is pericholecystic fluid?

A

fluid around the GB

77
Q

Describe the Phrygian Cap

A

GB fundus folds back on itself

78
Q

What are Rokitansky-Aschoff sinuses?

A

tiny pockets with in the GB wall

79
Q

What are the spiral valves of Heister?

A

folds located within the cystic duct that prevent it from collapsing or distending

80
Q

Where is the GB located?

A

posterior to the RT lobe of the liver

81
Q

Is the gb intraperitoneal or retroperitoneal?

A

Intraperitoneal

82
Q

What supplies blood to the GB?

A

cystic artery, which branches off the right hepatic artery

83
Q

What is the normal size of the GB

A

8-10 cm in length, no more than 5 cm in diameter

84
Q

What are 3 sources of focal GB wall thickening?

A
  • polyp
  • adenomyomatosis
  • GB carcinoma
85
Q

A GB that is completely filled with gallstones with exhibit

A

WES sign

86
Q

Risk factors for cholelithiasis (9)

A
  • obesity
  • pregnancy
  • increased parity
  • gestational diabetes
  • oral contraceptive use
  • estrogen therapy
  • rapid weight loss programs
  • hemolytic disorder
  • total parenteral nutrition
87
Q

Sludge is AKA

A

viscid bile

88
Q

What are the most common kind of GB polyp?

A

cholesterol polyps

89
Q

Benign hyperplasia of the GB will result in what?

A

adenomyomatosis

90
Q

T/F: Adenomyomatosis is clinically significant?

A

False

91
Q

Clinical findings of acute cholecystitis?

A

RUQ pain, leukocytosis, elevated LFTs, potential positive Murphy’s sign, fever, pain radiating to shoulders, nausea, vomiting

92
Q

Acalculous cholecystitis is more commonly found in who?

A

children, recently hospitalized patients, those who are immunocompromised

93
Q

An enlarged GB can be caused by what?

A

obstruction of cystic duct (results in hydopic GB)

94
Q

What is the most common cancer of the biliary tract?

A

GB carcinoma

95
Q

Most common metastatic disease of GB

A

malignant melanoma

96
Q

A 71 year old patient presents to the ER with painless jaundice and an enlarged, palpable GB. These findings are highly suspicious for:

A

Courvoisier GB

97
Q

The innermost layer of the GB wall is the

A

mucosal layer

98
Q

The cystic artery is a branch of the

A

right hepatic artery

99
Q

The middle layer of the GB wall is the

A

fibromuscular layer

100
Q

The outermost layer of the GB wall is the

A

serosal layer

101
Q

The GB is connected to the biliary tree by the

A

cystic duct

102
Q 
All of the following are sources of diffuse GB wall thickening except:
A. Malignant ascites
B. AIDS
C. Hepatitis
D. Adenomyomatosis
A

A. malignant ascites

103
Q

WES sign denotes:

A

a GB filled with cholelithiasis

104
Q 
All of the following are sources of diffuse GB wall thickening except:
A. benign ascites
B. hepatitis
C. congestive heart failure
D. GB polyp
A

D. GB polyp (focal)

105
Q

The sequela of acute cholecystitis that is found more often in diabetic patients is

A

emphysematous cholecystitis

106
Q

Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with

A

adenomyomatosis

107
Q

The spiral vavles or Heister are found within the

A

cystic duct

Abdominal (15 decks)

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