Gallbladder Pathology

Question 1

Hartman’s pouch

Answer 1

fold in the neck of the gallbladder

Question 2

Phrygian cap

Answer 2

fold in the fundus of the gallbladder

Question 3

what is a complete septation of the gallbladder?

Answer 3

complete septation of the gallbladder is where the gallbladder has walls formed within itself

Question 4

what is the potential concern for a gallbladder septations?

Answer 4

gallstones since the walls make it hard for bile to move around, so bile sits and become calcified

Question 5

removal of the gallbladder

Answer 5

cholecystectomy

Question 6

what happens to bile after the gallbladder is removed?

Answer 6

bile will go directly into the intestines. This can cause a lot of bowel issues for people who have gotten their gallbladder out since all the bile they produces goes straight to their bowels.

Question 7

what are the normal measurements of the GB?

Answer 7

the normal measurements of the GB are
- 3cm TRV
- AP <7-10cm longitudinal
- wall thickness should be less than 3mm

Question 8

what are the landmarks for the GB?

Answer 8

the GB should be located in the RUQ near the MLF and portal vein

Question 9

what are the clinical symptoms of gallbladder disease

Answer 9

the clinical symptoms of gallbladder disease include RUQ pain after eating greasy foods, N/V, gallbladder attack, or jaundice

Question 10

define sludge

Answer 10

thickened bile from bile stasis, which is when bile sits still for a long period of time

Question 11

what patients are at risk for developing sludge?

Answer 11

patients with hyperalimentation therapy and with obstruction of the GB

Question 12

what is the sonographic appearance of sludge or sludgeballs

Answer 12

sludgeballs appear more echogenic and dense compared to normal bile. it looks like a ball inside the GB that moves around freely within the GB

Question 13

what are some causes of GB wall thickening

Answer 13

GB wall thickening is caused by cholecystitis, gallbladder perforation, gallbladder carcinoma, hepatitis and cirrhosis, ascites, renal failure, and right heart failure

Question 14

what is cholecystitis?

Answer 14

cholecystitis is inflammation of the gallbladder

Question 15

define acute cholecystitis

Answer 15

acute cholecystitis is caused by gallstones being impacted in the cystic duct or in the neck of the gallbladder.

Question 16

what is the most common cause of acute cholecystitis?

Answer 16

gallstones

Question 17

clinical signs of acute cholecystitis

Answer 17

• acute RUQ pain (+ murphy’s sign)
• fever
• N/V
• leukocyotsis
• increased serum bilirubin and alkaline phosphate levels

Question 18

what are the complications of acute cholecystitis?

Answer 18

may be serious and include empyema, emphysematous, or gangrenous cholecystitis, and perforation

Question 19

what is the sonographic appearance of cholecystitis?

Answer 19

The sonographic appearance of acute cholecystitis:
- Wall > 3mm
- Distended gallbladder lumen > 4cm
- Gallstones
- Impacted stones in cystic duct of neck/ Hartman’s pouch of the gallbladder
- Positive murphy’s sign
- Increased doppler flow
- Pericholecystic fluid collection

Question 20

define cholelithiasis

Answer 20

cholelithiasis is where a single, large gallstone or tiny gallstones are collected within the gallbladder

Question 21

what is the danger of cholelithiasis?

Answer 21

tiny stones in the gallbladder are the most dangerous because they can enter the bile ducts and obstruct the outflow of bile

Question 22

who is at risk for gallstones?

Answer 22

gallstones are most common in the 5fs
1) fat
2) female
3) forty
4) fertile
5) fair-skinned

Question 23

what are the symptoms of gallstones?

Answer 23

• RUQ pain
• radiation of pain to the shoulder after a high-fat meal
• epigastric pain
• N/V when the symptoms become acute

gallstones may also be asymptomatic until the stone lodges into the cystic or common bile duct

Question 24

what is a rare complication of acute cholecystitis?

Answer 24

emphysematous cholecystitis

Question 25

what is emphysematous cholecystitis?

Answer 25

rapidly progressive and 15% fatal in patients. it is associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts

Question 26

what are the risk factors of emphysematous cholecystitis?

Answer 26

- more present in men - 50% of patients are diabetic - gallstones may not be present in 30% to 50% of patients

Question 27

what is the sonographic appearance of emphysematous cholecystitis?

Answer 27

depends on the amount of gas within the wall of the gallbladder - if the gas is intraluminal, a prominent and bright echo is demonstrated along the anterior wall with a ring down or comet-tail artifact directly posterior to the echogenic structure.

Question 28

define gangrenous cholecystitis

Answer 28

Gangrenous cholecystitis is a serious and painful complication of acute cholecystitis that my lead to perforation. It is where the gallbladder dies

Question 29

when can gangrenous cholecystitis occur?

Answer 29

this can occur after a prolonged infection, and causes the gallbladder to undergo necrosis

Question 30

what is the sonographic appearance of gangrenous cholecystitis?

Answer 30

-thickened GB wall and edematous with focal areas of exudate, hemorrhage, and necrosis. ulcerations and perforations may be present, resulting in the pericholecystic abscess or peritonitis

Question 31

define acalculus cholecystitis

Answer 31

the acute inflammation of the GB without the presence of cholelithiasis

Question 32

who is at risk for acalculus cholecystitis?

Answer 32

those who have depressed gastric motility; postoperative patients, trauma, burns, HIV, etc.

Question 33

how does acalculus cholecystitis appear on US?

Answer 33

thickening of GB wall, edema, and inflammation

Question 34

define chronic cholecystitis

Answer 34

the most common form of GB inflammation. it is the result of numerous GB attacks of acute cholecystitis with subsequent fibrosis (thickening) of the GB wall.

Question 35

what are the clinical symptoms of chronic cholecystitis?

Answer 35

transient RUQ pain but no tenderness like with acute

Question 36

define porcelain gallbladder

Answer 36

a rare occurrence where calcium is incrusted into the gallbladder wall

Question 37

what are the risk factors of porcelain gallbladder?

Answer 37

- most common in females - usually found as a mass or by accident in an exam

Question 38

why is porcelain gallbladder a concern?

Answer 38

because 25% of patients with porcelain gallbladder develop cancer on the gallbladder wall

Question 39

what is the sonographic appearance of porcelain gallbladder?

Answer 39

bright echogenic echo is seen on a region of the gallbladder with posterior shadowing (WES sign)

Question 40

define cholesterolosis

Answer 40

a condition in which cholesterol is deposited within the lamina propria of the gallbladder

Question 41

what is another name for cholesterolosis?

Answer 41

"strawberry bladder" because the mucosa resembles a strawberry

Question 42

what is the sonographic appearance of cholesterolosis?

Answer 42

echogenic lines within the lumen of the gallbladder and attached to the walls on the inside of the gallbladder. these appear like the inside of a cave.

Question 43

define polyp

Answer 43

polyps are small, well-defined soft-tissue projections connected by the stalk to the gallbladder wall

Question 44

what is the sonographic appearance of a polyp?

Answer 44

polyps appear as echogenic balls/masses attached to the inside wall of the gallbladder; looks like the inside of a cave

Question 45

define adenomyomatosis

Answer 45

a hyperplastic change in the gallbladder wall. papilloma may occur singly or in groups and may be scattered over a large part of the mucosal surface of the gallbladder.

Question 46

what is the sonographic appearance of adenomyomatosis

Answer 46

cause a "ring down" appearance within the gallbladder that looks like the inside of a cave.

Question 47

what is the most common type of gallbladder cancer?

Answer 47

adenocarcinoma

Question 48

risk factors for gallbladder cancer?

Answer 48

gallbladder cancer is associated with 80% to 90% of patients with cholelithiasis

Question 49

what is the sonographic appearance of gallbladder cancer?

Answer 49

gallbladder cancer causes the thickening and rigidity of the gallbladder walls adenocarcinoma appears more echogenic compared to the surrounding tissues, it also appears ill-defined