Gallbladder Disease test 3 Flashcards
(111 cards)
0
Q
what is the most important hx question to ask before beginning a study on the GB?
A
when is the last time the patient had anything to eat?
1
Q
What are the clinical symptoms of GB disease?
A
RUQ pain -especially after fatty meals
nausea and vomiting
right shoulder and mid epigastric pain
jaundice
chills
fever
2
Q
what is sludge?
A
concentrated (thickened) bile
bile stasis (the stoppage of bile from flowing)(not moving)
3
Q
what are the symptoms of a patient with GB sludge?
A
asymptomatic
associated GB disease
4
Q
How does sludge appear sonographically?
A
soft echoes layered in dependent part of gb that change with patient position
5
Q
What is GB sludge dependent on?
A
gravity dependent
6
Q
what are some factors that cause GB sludge?
A
prolonged fasting
hyper alimentation therapy
7
Q
What can tumefactive sludge resemble?
A
mass
psuedotumor (color doppler can help determine)
long standing biliary obstruction
may or may not move when patient position is changed
8
Q
what are sludge balls?
A
medium level echogenic masses
sticky - may not move like stones
9
Q
What is a normal GB wall thickness?
A
< 3mm
10
Q
How should you measure the GB wall?
A
measure on the transverse image at the anterior wall that is perpendicular to the transducer
11
Q
what is the cholelithiasis etiology?
A
abnormal bile composition
stasis
infection
12
Q
what are the stages of gallstone formation?
A
saturation of bile
nucleation
growth
13
Q
what are gallstones composed of?
A
cholesterol
calcium bilirubinate
calcium carbonate
14
Q
What is the most common disease of the GB?
A
cholelithiasis
15
Q
What sizes can gallstones be?
A
large
tiny
16
Q
why are tiny gallstones dangerous?
A
they can obstruct the bile flow in the ducts
17
Q
what are the 6 F’s of cholelitiasis?
A
fat
female
forty
fertile
fair
flatulent
18
Q
What are factors that cause cholelithiasis?
A
obesity
diabetes
pregnancy
oral contraceptive
estrogen replacement
pancreatitis
biliary infection
alcohol cirrhosis
diet induced
rapid weight loss programs
total parenteral nutrition
19
Q
What percentage of cholelithiasis envokes no clinical manifestations?
A
80%
20
Q
what is a serious consequence of cholelithiasis?
A
obstruction of the cystic duct or CBD with resulting GB hydrops
21
Q
What is Bouveret’s Syndrome?
A
gastric outlet obstruction caused by gallstone in the pylorus or proximal duodenum
22
Q
what do we see sonographically with cholelithiasis?
A
gallstones
increased GB size
WES sign - completely filled with gallstones (cannot see lumen)
decubitus
acoustic shadowing
acoustic impedance of the gallstones
23
Q
sonographically, what do stones > 3mm do?
A
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
