Gallbladder Flashcards by Valerie Snyder

mechanical obstruction can result from what 3 things?

gallstones, tumors in biliary tree, enlargement of pancreatic head

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4 symptoms of gallbladder disease

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

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most classic symptom of gallbladder disease

pain

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when will jaundice develop

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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what is sludge?

thickened bile due to bile stasis

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what patients are seen with sludge?

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

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2 sonographic findings of sludge

prominent gallbladder, low level echoes

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

sludge

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what is tumefactive sludge?

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

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what else may tumefactive sludge resemble?

polypoid mass or pseudo tumor

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normal gallbladder wall measures

less than 3 mm

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5 gallbladder diseases that may cause the wall to thicken

cholecystitis, adenomyomatosis, cancer, cholangiopathy, sclerosing cholangitis

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7 Nonbiliary diseases that may also cause wall thickening

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

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in what plane should gallbladder wall be measured?

transducer perpendicular to anterior gallbladder wall (usually transverse)

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what is cholecystitis

inflammation of the gallbladder

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5 forms of inflammation of the gallbladder

Acute
Chronic
Acalculous
Emphysematous
Gangrenous

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what is the most common cause of acute cholecystitis?

cholelithiasis that creates a cystic duct obstruction

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acute cholecystitis is six times more common in who?

middle aged women

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6 symptoms of acute cholecystitis

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

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what is murphy’s sign?

patient is tender over gallbladder region to touch

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4 complications of acute cholecystitis

Empyema
Emphysematous cholecystitis
Gangrenous cholecystitis
Perforation

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6 sonographic findings of acute cholecystitis

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

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what is the most common form of gallbladder inflammation?

chronic cholecystitis

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

loses the ability to store bile efficiently

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4 symptoms of chronic cholecystitis

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

4 sonographic findings of chronic cholecystitis

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

what is the WES sign?

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

what is acalculous cholecystitis?

inflammation of gallbladder without the presence of stones

symptom of acalculous cholecystitis

positive Murphy's sign

3 sonographic findings of acalculous cholecystitis

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

what is emphysematous cholecystitis

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

T or F? emphysematous cholecystitis is a surgical emergency

true, it is life threatening

what is emphysematous cholecystitis associated with?

diabetes

what is a complication of emphysematous cholecystitis

gangrene with perforation

2 sonographic findings of emphysematous cholecystitis

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

7 sonographic findings of gangrenous cholecystitis

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

what is the most common disease of the gallbladder

cholelithiasis

what is cholelithiasis

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

what are the 5 F's?

fat, female, forty, fertile, fair

6 factors predisposing someone to cholelithiasis

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

5 symptoms of cholelithiasis

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

3 sonographic findings of cholelithiasis

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

what are choledochal cysts?

rare congenital dilation of CBD

3 people choledochal cysts are more common in

females, infants, Asian population

choledochal cysts are prone to what 3 things?

biliary stasis, sstone formation, cholangitis

2 sonographic findings of choledochal cysts

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

what causes cholesterolosis

an abnormality in the metabolism of cholesterol within the gallbladder wall

what is strawberry gallbladder?

cholesterolosis

what are gallbladder polyps?

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

how do polyps appear differently than stones

polyps are immobile and don't produce shadows

what is adenomyomatosis

a hyperplastic change in the gallbladder wall

4 sonographic findings of adenomyomatosis

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

what is porcelain gallbladder?

completely calcified gallbladder

reason for complete calcification

unknown but believed to be due to chronic cholecystitis

porcelain gallbladder increases the chance of developing gallbladder carcinoma by

25%

2 sonographic findings of porcelain gallbladder

bright echo seen in region of gallbladder, WES sign

what is the differential diagnosis for porcelain gallbladder

gallbladder packed with stones

who usually has gallbladder carcinoma

elderly

T or F? gallbladder carcinoma usually has a favorable outcome

false, almost always fatal

3 symptoms of gallbladder carcinoma

jaundice, weight loss, palpable RUQ mass

3 sonographic findings of gallbladder carcinoma

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

3 things that may result in dilated biliary ducts

choledocholithiasis, cholangiosarcoma, enlargement of pancreatic head

most common cause for biliary dilation

choleodocholithiasis

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

they are having a heart attack

patients with cholangiocarcinoma present with what 2 things

jaundice and weight loss

3 forms of cholangiocarcinoma

scirrhous, polypoid, Klatskin's tumor

What is acute cholecystitis?

the sudden onset of gallbladder inflammation

What is adenomyomatosis?

benign hyperplasia of the GB wall

What is biliary colic?

pain located in the RUQ in the area of the GB

What is the surgical removal of the GB?

cholecystectomy

What is cholecystokinin?

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

Describe Courvoisier GB?

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

What is the cystic duct?

Duct that connects the GB to the common hepatic duct

What is hydropic GB?

enlarged GB

What is a junctional fold?

fold in the neck of a GB

What is pericholecystic fluid?

fluid around the GB

Describe the Phrygian Cap

GB fundus folds back on itself

What are Rokitansky-Aschoff sinuses?

tiny pockets with in the GB wall

What are the spiral valves of Heister?

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

Where is the GB located?

posterior to the RT lobe of the liver

Is the gb intraperitoneal or retroperitoneal?

Intraperitoneal

What supplies blood to the GB?

cystic artery, which branches off the right hepatic artery

What is the normal size of the GB

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

What are 3 sources of focal GB wall thickening?

- polyp - adenomyomatosis - GB carcinoma

A GB that is completely filled with gallstones with exhibit

WES sign

Risk factors for cholelithiasis (9)

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

Sludge is AKA

viscid bile

What are the most common kind of GB polyp?

cholesterol polyps

Benign hyperplasia of the GB will result in what?

adenomyomatosis

T/F: Adenomyomatosis is clinically significant?

False

Clinical findings of acute cholecystitis?

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

Acalculous cholecystitis is more commonly found in who?

children, recently hospitalized patients, those who are immunocompromised

An enlarged GB can be caused by what?

obstruction of cystic duct (results in hydopic GB)

What is the most common cancer of the biliary tract?

GB carcinoma

Most common metastatic disease of GB

malignant melanoma

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

Courvoisier GB

The innermost layer of the GB wall is the

mucosal layer

The cystic artery is a branch of the

right hepatic artery

The middle layer of the GB wall is the

fibromuscular layer

The outermost layer of the GB wall is the

serosal layer

The GB is connected to the biliary tree by the

cystic duct

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

A. malignant ascites

WES sign denotes:

a GB filled with cholelithiasis

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

D. GB polyp (focal)

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

emphysematous cholecystitis

Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with

adenomyomatosis

The spiral vavles or Heister are found within the

cystic duct