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Flashcards in Gallbladder Disease test 3 Deck (111):
0

What are the clinical symptoms of GB disease?

RUQ pain -especially after fatty meals

nausea and vomiting

right shoulder and mid epigastric pain

jaundice

chills

fever

1

what is the most important hx question to ask before beginning a study on the GB?

when is the last time the patient had anything to eat?

2

what is sludge?

concentrated (thickened) bile

bile stasis (the stoppage of bile from flowing)(not moving)

3

what are the symptoms of a patient with GB sludge?

asymptomatic

associated GB disease

4

How does sludge appear sonographically?

soft echoes layered in dependent part of gb that change with patient position

5

What is GB sludge dependent on?

gravity dependent

6

what are some factors that cause GB sludge?

prolonged fasting

hyper alimentation therapy

7

What can tumefactive sludge resemble?

mass

psuedotumor (color doppler can help determine)

long standing biliary obstruction

may or may not move when patient position is changed

8

what are sludge balls?

medium level echogenic masses

sticky - may not move like stones

9

What is a normal GB wall thickness?

< 3mm

10

How should you measure the GB wall?

measure on the transverse image at the anterior wall that is perpendicular to the transducer

11

what is the cholelithiasis etiology?

abnormal bile composition

stasis

infection

12

what are the stages of gallstone formation?

saturation of bile

nucleation

growth

13

what are gallstones composed of?

cholesterol

calcium bilirubinate

calcium carbonate

14

What is the most common disease of the GB?

cholelithiasis

15

What sizes can gallstones be?

large

tiny

16

why are tiny gallstones dangerous?

they can obstruct the bile flow in the ducts

17

what are the 6 F's of cholelitiasis?

fat

female

forty

fertile

fair

flatulent

18

What are factors that cause cholelithiasis?

obesity

diabetes

pregnancy

oral contraceptive

estrogen replacement

pancreatitis

biliary infection

alcohol cirrhosis

diet induced

rapid weight loss programs

total parenteral nutrition

19

What percentage of cholelithiasis envokes no clinical manifestations?

80%

20

what is a serious consequence of cholelithiasis?

obstruction of the cystic duct or CBD with resulting GB hydrops

21

What is Bouveret's Syndrome?

gastric outlet obstruction caused by gallstone in the pylorus or proximal duodenum

22

what do we see sonographically with cholelithiasis?

gallstones

increased GB size

WES sign - completely filled with gallstones (cannot see lumen)


decubitus

acoustic shadowing

acoustic impedance of the gallstones

23

sonographically, what do stones > 3mm do?

cast a shadow

24

what are floating stones?

a layer of stones "floating" on a thick bile layer of sludge

25

if you suspect gallstones, what should you do with the patient?

roll them and see if the stones move

want to make sure you aren't seeing Heister's valve it's near the neck

26

what is the WES sign?

Wall Echo Shadow (bright wall, no lumen, lg shadow)

indicates a packed bag

characterized by two curvilinear, parallel echogenic lines separated by a thin hypoechoic space and acoustic shadowing distal to the echogenic line in the far field

27

what is cholecystitis?

inflammation of the GB

28

What are the different forms of cholecystits?

acute

chronic

acalculous

emphysematous

gangrenous

29

What is Murphy's sign?

hypersensitivity with deep palpitation in the sub costal area when a patient takes in a deep breath that may produce inspiratory arrest

John B. Murphy 1903

30

what is acute cholecystitis?

caused by stones being impacted in the cystic duct or in the neck of the gallbladder (hartmann's pouch)

31

what is the most common cause of acute choelcystitis?

gallstones

32

What accompany's acute cholecystitis?

cholelithiasis

cystic duct obstruction or neck of the GB obstruction

typically females

positive Murphy's

fever

leukocytosis

Abnormal LFT's

33

What are the five causes of acute cholecystitis?

obstruction of the cystic duct

impacted stone

extrinsic pressure

microorganisms

pancreatic reflux

34

How does acute cholecystitis appear sonographically?

thickened wall

edema-halo

enlarged - trv gb >5cm

pericholecystic fluid

35

What is chronic cholecystitis?

most common form of GB inflammation

contraction of GB

coarse wall thickening

WES sign

36

What are the symptoms of chronic cholecystitis?

intermittent RUQ pain

intolerance to fatty, fried food

intermittent nausea and vomiting

37

What is acalculous cholecystitis?

acute inflammation of the GB

absence of cholelithiasis

positive Murphy's Sign

38

What condition has decreased blood flow in the cystic artery?

acalculous cholecystitis

39

What condition causes extrinsic compression of the cystic duct by a mass?

acalculous cholecystitis

40

What are the sonographic findings of acalculous cholecystitis?

GB wall thickened

sludge

pericholecystic fluid

abnormal LFT's

increase serum amylase

increase WBC

41

What is emphysematous cholecystitis?

acute cholecystitis

gas forming bacteria AIR IN THE WALL and lumen into ducts

42

what condition has a relationship to diabetes?

emphysematous cholecystitis

43

what condition may lead to gangrene with associated perforation?

emphysematous cholecystitis

44

what are the symptoms of emphysematous cholecystitis?

fever

pain

infection

surgical emergency

45

How does emphysematous cholecystitis appear sonographically?

prominent bright echo along the anterior wall

ring down or comet tail artifact

46

what is gangrenous cholecystitis?

necrosis-absent blood supply

may lead to perforation

thickened and edematous wall

hemorrhage

abnormal LFT's

47

what are some other considerations for gangrenous cholecystitis?

ulcerations

pericholecystic abscesses

peritonitis

gallstones or fine gravel

painful complication

48

what condition sonographically has medium to coarse echogenic densities?

gangrenous cholecystitis

not shadowing

not gravity dependent

not layering

49

What is a benign neoplasm of the GB?

adenoma

cholesterolosis

adenomyomatosis

50

What is cholesterolosis?

cholesterol deposited in the GB wall

51

What condition has the Strawberry GB?

cholesterolosis

52

What is the most common pseudo tumor of the GB?

cholesterolosis polyps

53

How are cholesterolosis polyps attached to the GB?

with a stalk

less than 10 mm

54

Do multiple cholesterolosis polyps of the wall of the GB shadow?

nope!

55

What is adenomyomatosis?

hyperplastic change

papillomas

over the mucosal surface

56

what are adenomyomatosis papillomas?

may occur singly or in groups

may be scattered over a large part of the mucosal surface of the GB

not a precursor to cancer


57

With adenomyomatosis what will various patient positions and compression allow?

to show the lesion to be immobile in the GB

58

When you have multiple papillomas demonstrated along the anterior wall of the GB what will it cause?

"ring down" echoes to occur

comet tail

59

With adenomyomatosis where will you find W shaped (ring down or comet tail) reverberation?

between diverticula (pockets) Rokitanski-Aschoff sinus

in the wall

60

What is porcelain GB?

****CAN LEAD TO CANCER****

rare

GB wall calcified

gallstones

asymptomatic

because it's a calcified wall it can be seen on x-ray

61

What is Gallbladder Cancer?

Primary is rare

mortality rate near 100%

tumor infiltrates and often invades the liver through tissue, ducts of Luschka and lymph channels

62

Where does metastatic GB Ca come from?

may occur from melanoma

63

with GB Ca what duct might get compressed?

obstruction of the cystic duct due to compression

64

How does GB Ca appear sonographically?

heterogenous solid mass

dilated ducts (double barrel)

most common biliary malignancy

65

What is metastatic GB disease?

primary of stomach, pancreas and ducts

focal thickening of the duct

intraluminal mass

66

With metastases to the biliary tree what are the most common tumor sites that can spread to the biliary system?

breast

colon

melanoma

67

what two ductal systems do metastases affect?

intrahepatic and extrahepatic ductal systems

68

sonographically, the appearance of metastases is similiar to that of _________________.

cholangiocarcinoma

69

What is intrahepatic cholangiocarcinoma?

the second most common primary malignancy of the liver

cancer within the duct

often unresectable with a poor prognosis


70

which tumor has a rising insidence, secondary to increasing number of patients with liver cirrhosis and hep C?

cholangiocarcinoma

71

What are dilated biliary ducts?

generally a duct > 6mm is considered borderline

> 10mm is dilated

72

What is Courvoisier?

obstruction of the CBD due to pancreatic mass

enlarged?? slide 91

73

what is cholecystomegaly?

hydropic GB

enlarged GB without wall thickening

obstruction of duct

74

What is an extra hepatic obstruction?

intrapancreatic

pancreatic Ca

choledocholithiasis

chronic pancreatitis

75

What is a suprapancreatic extra hepatic obstruction?

between pancreas and porta hepatis

head of pancreas and duct are normal

76

What is a porta hepatic extra hepatic obstruction?

neoplasm

hydrops of the GB

77

What is Klatskin's tumor?

specific cholangiocarcinoma at the junctionof the right and left hepatic duct

78

what is Mirizzi syndrome?

impacted stone in the cystic duct or GB neck

79

Inflammation of the pancreas may cause the common duct to ________.

dilate

80

carcinoma of the head of the pancreas may cause obstruction of the _________ ________ ________.

common bile duct

81

What might you be able to see inside the common duct if the duct is dilated?

stones

82

What is obstruction?

indicated in diameter is > 11mm

83

what is cholangitis?

inflammation of the bile ducts

84

what are the clinical symptoms of cholangitis?

fever

malaise

sweating and shivering

can lead to shock

85

Sonographically/lab values for cholangitis?

increases ALK PHOS and Bili

thickened ductal wall

post enodoscopic retrograde cholangiopancreatography (ERCP)

86

What is ascariasis?

disease is caused by the parasitic roundworm, ascaris lumbricoides

uses a fecal-oral route of transmission

the worms grow in the small bowel before entering the biliary tree through the ampulla

case acute biliary obstruction

87

what is choledocholithiasis?

stone in CBD

associated with calculous cholecystitis

impacted stones in the ampulla of vater

elevated direct bili and alk phos

88

What is hemobilia?

blood in the biliary tree

89

what is the main cause of hemobilia?

biliary trauma secondary to percutaneous biliary procedures or liver biopsies

90

what are other causes of hemobilia?

cholangitis

cholecystitis

vascular malformations

abdominal _____________slide 110

malignancies

91

what is pneumobilia?

air within the biliary tree

92

In a patient with an acute abdomen, pneumobilia may be caused by...

emphysematous cholecystitis

inflammation from an impacted CBD

93

What are choledochal cysts?

CONGENITAL conditions involving cystic dilatation of bile ducts

pancreatic juices refluxing into the bile duct

rare

more common in females

congenital - infants to ten years

94

what is choledochal cysts associated with?

gallstones

pancreatitis

cirrhosis

95

what are the clinical symptoms of choledochal cysts?

abdominal mass

pain

fever

jaundice

confirmed with nuc med scan

96

What is type I choledochal cysts classification?

a fusiform dilation of the common bile duct

97

what are type II choledochal cysts?

true diverticuli of the bile ducts

98

what are type III choledochal cysts?

choledochoceles

confined to the intraduodenal portion of the common bile duct

99

what is type IVa choledochal cysts?

intrahepatic and extrahepatic biliary dilations

100

what is type IVb choledochal cysts?

confined to the extrahepatic biliary tree

101

What are type V choledochal cysts?

classified as caroli's disease

KNOW THIS ONE!!!!

102

What is caroli's disease?

rare congenital disorder that classically causes saccular ductal dilatation

103

with what condition do multiple cystic structures in the area of the ductal system converge toward the porta hepatis?

caroli's disease

104

in what condition are masses seen as localized or diffusely scattered cysts communicate with bile ducts?

caroli's disease

105

in what condition do ducts show a beaded appearance as they extend into the periphery of the liver

caroli's disease

cysts in the liver

106

What is biliary atresia?

ducts are obliterated (no ducts from birth)

congenital

neonatal

107

With what diseases would you find GB wall diffuse thickening?

normal contracted GB

ascites

acute hepatitis, cirrhosis

CHF

renal disease

AIDS

pancreastitis

108

When would you find GB wall focal thickening?

adenomyomatosis

polyp

adenoma

carcinoma

metastatic

109

WHat is the most common intrinsic factor cause thickening of the gallbladder wall?

cholecystitis

110

What is the most common extrinsic cause of GB wall thickening?

hepatitis and cirrhosis

renal failure

right heart failure