Lesson 2A (Part 3) Flashcards Preview

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Flashcards in Lesson 2A (Part 3) Deck (31)
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1

Who does GB perforation occur in?

5-10% of patients with acute cholecystitis due to prolonged inflammation

2

What is the sonographic appearance of GB perforation? (5)

1. Focal defect in wall and deflation of GB
2. Loss of normal shape
3. Pericholecystic fluid collection
- abscess type stranding
4. Perforation extends into adjacent liver parenchyma
- forming abscess
5. Cystic liver lesion around GB fossa
- suggests a pericholecystic abscess

3

Perforated GB

Opening in the wall

4

Who is emphysematous cholecystitis more common in? (2)

1. Men
2. Diabetics

5

What is the sonographic appearance of emphysematous cholecystitis? (4)

1. Frequently acalculus
2. Higher incidence of perforation
3. Gas
- forming bacteria after ischemic event appears as gas in lumen and wall
4. Echogenic line with posterior dirty shadow or reverberation artifact “Ring Down Artifact”

6

What may be present in emphysematous cholecystitis?

Pneumobilia

7

Pneumobilia

Air in ducts

8

Who is acaulous cholecystitis common in?

Critically ill
- elderly men

9

Why is acaulous cholecystitis difficult to asses?

Because it has the same signs that are commonly seen in the critically ill without cholecystitis

10

What is absence with acaulous cholecystitis?

A positive murphy's sign
- on pain meds (dont feel anything)

11

What can help in the diagnosis of acaulous cholecystitis?

Cholescintigraphy

12

What is torsion of the gallbladder?

Twisting of cystic artery or duct

13

How common is torsion of the gallbladder?

Rare
- acute

14

What are the symptoms of torsion of the gallbaldder? (5)

1. RUQ pain
2. Epigastric pain
3. RUQ tenderness
4. Nausea/vomiting
5. Positive murphy’s sign **

same as acute cholecystitis

15

What is the sonographic appearance of torsion of the gallbladder?

1. Massively distended and inflamed gallbladder
2. Gallbladder lies in an unusual horizontal position
3. Death of local tissues may occur if torsion is >180 degrees

16

What is the usual treatment for torsion of the gallbladder?

Surgery

17

Porcelain gallbladder

Calcification of the gallbladder

18

What is the sonographic appearance of porcelain gallbladder? (4)

1. Wall is thickly calcified
2. Dense posterior acoustic shadowing
3. WES complex is absent
4. Presence of stones

19

What can porcelain gallbladder represent a form of?

Chronic cholecystitis

20

Who is porcelain gallbladder common in?

Females
- in their 60s

21

What is advised as a treatment option for porcelain gallbladder?

Resection

22

What type of polypoid mass is more common?

A benign one

23

Are benign polypoid masses multiple of singularity?

Multiple

24

Are malignant polypoid masses multiple of singularity?

Singularity

25

What is the size of benign polypoid masses?

< 10mm

26

What is the size of malignant polypoid masses?

> 10mm

27

What happens to benign polypoid masses during a follow up exam?

Nothing
- they stay the same size and dont change

28

What happens to malignant polypoid masses during a follow up exam?

They rapidly change in size

29

What are polypoid masses a type of?

Gallstone disease

30

What do polyps do?

They protrude the lining of teh gallbladder