Flashcards in Gallbladder Disease test 3 Deck (111):
What are the clinical symptoms of GB disease?
RUQ pain -especially after fatty meals
nausea and vomiting
right shoulder and mid epigastric pain
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?
what is sludge?
concentrated (thickened) bile
bile stasis (the stoppage of bile from flowing)(not moving)
what are the symptoms of a patient with GB sludge?
associated GB disease
How does sludge appear sonographically?
soft echoes layered in dependent part of gb that change with patient position
What is GB sludge dependent on?
what are some factors that cause GB sludge?
hyper alimentation therapy
What can tumefactive sludge resemble?
psuedotumor (color doppler can help determine)
long standing biliary obstruction
may or may not move when patient position is changed
what are sludge balls?
medium level echogenic masses
sticky - may not move like stones
What is a normal GB wall thickness?
How should you measure the GB wall?
measure on the transverse image at the anterior wall that is perpendicular to the transducer
what is the cholelithiasis etiology?
abnormal bile composition
what are the stages of gallstone formation?
saturation of bile
what are gallstones composed of?
What is the most common disease of the GB?
What sizes can gallstones be?
why are tiny gallstones dangerous?
they can obstruct the bile flow in the ducts
what are the 6 F's of cholelitiasis?
What are factors that cause cholelithiasis?
rapid weight loss programs
total parenteral nutrition
What percentage of cholelithiasis envokes no clinical manifestations?
what is a serious consequence of cholelithiasis?
obstruction of the cystic duct or CBD with resulting GB hydrops
What is Bouveret's Syndrome?
gastric outlet obstruction caused by gallstone in the pylorus or proximal duodenum
what do we see sonographically with cholelithiasis?
increased GB size
WES sign - completely filled with gallstones (cannot see lumen)
acoustic impedance of the gallstones
sonographically, what do stones > 3mm do?
cast a shadow
what are floating stones?
a layer of stones "floating" on a thick bile layer of sludge
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
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
what is cholecystitis?
inflammation of the GB
What are the different forms of cholecystits?
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
what is acute cholecystitis?
caused by stones being impacted in the cystic duct or in the neck of the gallbladder (hartmann's pouch)
what is the most common cause of acute choelcystitis?
What accompany's acute cholecystitis?
cystic duct obstruction or neck of the GB obstruction
What are the five causes of acute cholecystitis?
obstruction of the cystic duct
How does acute cholecystitis appear sonographically?
enlarged - trv gb >5cm
What is chronic cholecystitis?
most common form of GB inflammation
contraction of GB
coarse wall thickening
What are the symptoms of chronic cholecystitis?
intermittent RUQ pain
intolerance to fatty, fried food
intermittent nausea and vomiting
What is acalculous cholecystitis?
acute inflammation of the GB
absence of cholelithiasis
positive Murphy's Sign
What condition has decreased blood flow in the cystic artery?
What condition causes extrinsic compression of the cystic duct by a mass?
What are the sonographic findings of acalculous cholecystitis?
GB wall thickened
increase serum amylase
What is emphysematous cholecystitis?
gas forming bacteria AIR IN THE WALL and lumen into ducts
what condition has a relationship to diabetes?
what condition may lead to gangrene with associated perforation?
what are the symptoms of emphysematous cholecystitis?
How does emphysematous cholecystitis appear sonographically?
prominent bright echo along the anterior wall
ring down or comet tail artifact
what is gangrenous cholecystitis?
necrosis-absent blood supply
may lead to perforation
thickened and edematous wall
what are some other considerations for gangrenous cholecystitis?
gallstones or fine gravel
what condition sonographically has medium to coarse echogenic densities?
not gravity dependent
What is a benign neoplasm of the GB?
What is cholesterolosis?
cholesterol deposited in the GB wall
What condition has the Strawberry GB?
What is the most common pseudo tumor of the GB?
How are cholesterolosis polyps attached to the GB?
with a stalk
less than 10 mm
Do multiple cholesterolosis polyps of the wall of the GB shadow?
What is adenomyomatosis?
over the mucosal surface
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
With adenomyomatosis what will various patient positions and compression allow?
to show the lesion to be immobile in the GB
When you have multiple papillomas demonstrated along the anterior wall of the GB what will it cause?
"ring down" echoes to occur
With adenomyomatosis where will you find W shaped (ring down or comet tail) reverberation?
between diverticula (pockets) Rokitanski-Aschoff sinus
in the wall
What is porcelain GB?
****CAN LEAD TO CANCER****
GB wall calcified
because it's a calcified wall it can be seen on x-ray
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
Where does metastatic GB Ca come from?
may occur from melanoma
with GB Ca what duct might get compressed?
obstruction of the cystic duct due to compression
How does GB Ca appear sonographically?
heterogenous solid mass
dilated ducts (double barrel)
most common biliary malignancy
What is metastatic GB disease?
primary of stomach, pancreas and ducts
focal thickening of the duct
With metastases to the biliary tree what are the most common tumor sites that can spread to the biliary system?
what two ductal systems do metastases affect?
intrahepatic and extrahepatic ductal systems
sonographically, the appearance of metastases is similiar to that of _________________.
What is intrahepatic cholangiocarcinoma?
the second most common primary malignancy of the liver
cancer within the duct
often unresectable with a poor prognosis
which tumor has a rising insidence, secondary to increasing number of patients with liver cirrhosis and hep C?
What are dilated biliary ducts?
generally a duct > 6mm is considered borderline
> 10mm is dilated
What is Courvoisier?
obstruction of the CBD due to pancreatic mass
enlarged?? slide 91
what is cholecystomegaly?
enlarged GB without wall thickening
obstruction of duct
What is an extra hepatic obstruction?
What is a suprapancreatic extra hepatic obstruction?
between pancreas and porta hepatis
head of pancreas and duct are normal
What is a porta hepatic extra hepatic obstruction?
hydrops of the GB
What is Klatskin's tumor?
specific cholangiocarcinoma at the junctionof the right and left hepatic duct
what is Mirizzi syndrome?
impacted stone in the cystic duct or GB neck
Inflammation of the pancreas may cause the common duct to ________.
carcinoma of the head of the pancreas may cause obstruction of the _________ ________ ________.
common bile duct
What might you be able to see inside the common duct if the duct is dilated?
What is obstruction?
indicated in diameter is > 11mm
what is cholangitis?
inflammation of the bile ducts
what are the clinical symptoms of cholangitis?
sweating and shivering
can lead to shock
Sonographically/lab values for cholangitis?
increases ALK PHOS and Bili
thickened ductal wall
post enodoscopic retrograde cholangiopancreatography (ERCP)
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
what is choledocholithiasis?
stone in CBD
associated with calculous cholecystitis
impacted stones in the ampulla of vater
elevated direct bili and alk phos
What is hemobilia?
blood in the biliary tree
what is the main cause of hemobilia?
biliary trauma secondary to percutaneous biliary procedures or liver biopsies
what are other causes of hemobilia?
abdominal _____________slide 110
what is pneumobilia?
air within the biliary tree
In a patient with an acute abdomen, pneumobilia may be caused by...
inflammation from an impacted CBD
What are choledochal cysts?
CONGENITAL conditions involving cystic dilatation of bile ducts
pancreatic juices refluxing into the bile duct
more common in females
congenital - infants to ten years
what is choledochal cysts associated with?
what are the clinical symptoms of choledochal cysts?
confirmed with nuc med scan
What is type I choledochal cysts classification?
a fusiform dilation of the common bile duct
what are type II choledochal cysts?
true diverticuli of the bile ducts
what are type III choledochal cysts?
confined to the intraduodenal portion of the common bile duct
what is type IVa choledochal cysts?
intrahepatic and extrahepatic biliary dilations
what is type IVb choledochal cysts?
confined to the extrahepatic biliary tree
What are type V choledochal cysts?
classified as caroli's disease
KNOW THIS ONE!!!!
What is caroli's disease?
rare congenital disorder that classically causes saccular ductal dilatation
with what condition do multiple cystic structures in the area of the ductal system converge toward the porta hepatis?
in what condition are masses seen as localized or diffusely scattered cysts communicate with bile ducts?
in what condition do ducts show a beaded appearance as they extend into the periphery of the liver
cysts in the liver
What is biliary atresia?
ducts are obliterated (no ducts from birth)
With what diseases would you find GB wall diffuse thickening?
normal contracted GB
acute hepatitis, cirrhosis
When would you find GB wall focal thickening?
WHat is the most common intrinsic factor cause thickening of the gallbladder wall?