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Spring 2014 - ABD TEST 3 - GALLBLADDER ✔️ > Pathology > Flashcards

Pathology Flashcards

(92 cards)

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0
Q

What is an important question to ask the patient before scanning the GB?

A

The last time they have had anything by mouth

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1
Q

Clinical symptoms of GB disease…

A 
RUQ pain especially after fatty meals
Nausea & vomiting
Right shoulder & midepigastric pain
Jaundice
Chills & fever
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2
Q

What is sludge?

A

Concentrated bile - soft echoes layered in dependent part of GB that will change with patient position

Gravity dependent

Asymptomatic or with associated GB disease

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3
Q

What causes sludge?

A 
Thickened bile
Bile stasis (doesn't move)
Prolonged fasting or hyper alimentation therapy (feeding tube)
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4
Q

What can resemble a mass or psuedo tumor when related to sludge?

A

Tumefactive sludge - use color Doppler - long standing biliary obstruction

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5
Q

Describe a sludge ball…

A

Medium level echogenic masses

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6
Q

What is the normal thickness of the GB wall?

A

Less than 3 mm

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7
Q

Where do you measure the thickness of the GB wall?

A

Anterior wall

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8
Q

What is Cholelithiasis?

A

GB stones; can be large or small

Tiny stones are dangerous because they can obstruct the bile flow in the ducts

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9
Q

Cholelithiasis etiology…

A

Abnormal bile composition
Stasis
Infection

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10
Q

Stages of gallstone formation…

A

Saturation of bile
Nucleation (forming a blob)
Growth

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11
Q

Gallstone composition…

A

Cholesterol
Calcium bilirubinate
Calcium carbonate

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12
Q

What is the most common GB disease?

A

Cholelithiasis

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13
Q

Cholelithiasis clinically…list the “F’s”

A 
Fat
Female
Forty
Fertile
Fair
Flatulent
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14
Q

Causes of Cholelithiasis…

A 
Obesity
Diabetes
Pregnancy
Oral contraceptives
Estrogen replacement
Pancreatitis
Biliary infection
Alcohol cirrhosis
Diet induced
Rapid weight loss program
Feeding tube
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15
Q

What % of Cholelithiasis evokes no clinical manifestations?

A

80%

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16
Q

What is a serious consequence in obstruction of the cystic duct or CBD?

A

GB hydrops - getting bigger from fluid build up

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17
Q

What is Bouveret?

A

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

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18
Q

Cholelithiasis sonographically…

A 
Gallstones
Increased GB size
Decubitus
Acoustic shadowing
Acoustic impedance of gallstones
WES sign
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19
Q

What is the WES sign?

A

Completely filled with gallstones

No lumen…all shadow

Wall Echogenic Shadowing

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20
Q

When will you see floating gallstones?

A

Prolonged fasting, air, oral cholecystogram

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21
Q

What do you need to make sure your not confusing for gallstones?

A

GB valves

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22
Q

What is cholecystitis?

A

Inflammation of the GB

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23
Q

What are the 5 forms of cholecystitis?

A 
Acute
Chronic
Acalculous
Emphysematous
Gangrenous
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24
What is a Murphy's sign?
A hypersensitivity with deep palpitation in the sub costal area when a patient takes in a deep breath that may produce inspiratory arrest
25
Describe acute cholecystitis...
``` Cholelithiasis Cystic duct obstruction or neck of GB obstruction (Hartmann's Pouch) Females + Murphy's Fever Leukocytosis Abn LFTs Pancreatic reflux ```
26
The most common cause of acute cholecystitis is ___________.
Gallstones - impacted & extrinsic pressure
27
Acute cholecystitis sonographically...
Thickened wall Edema-halo Enlarged (greater than 5 cm trans) Pericholecystic fluid
28
Describe chronic cholecystitis...
Contraction of GB Coarse wall thickening WES sign
29
What is the most common form of GB inflammation?
Chronic cholecystitis
30
Clinical symptoms for cholecystitis...
Intermittent RUQ pain Intolerance to fatty, fried food Intermittent nausea and vomiting
31
Acute inflammation of the GB is ___________.
Acalculous cholecystitis
32
Acalculous cholecystitis is absent of ___________.
Gallstones - Cholelithiasis
33
Clinical workup of acalculous cholecystitis...
+ Murphy's Abn LFTs Increased amylase Increased WBC
34
Acalculous cholecystitis sonographically...
Decreased blood flow in the cystic artery Extrinsic compression of the cystic duct by a mass GB wall thickened Sludge Pericholecystic fluid
35
Describe emphysematous cholecystitis...
Acute cholecystitis Gas forming bacteria in wall and lumen into ducts Relationship to diabetes May lead to gangrene with associated perforation Surgical emergency Fever, pain, infection
36
Emphysematous cholecystitis sonographically...
Prominent bright echo along the anterior wall Ring down or comet tail artifact
37
Gangrenous cholecystitis sonographically...
Absent blood supply - necrosis Thickened and edematous wall Hemorrhage Gallstones or fine gravel
38
Describe gangrenous cholecystitis...
``` May lead to perforation Abn LFTs Ulcerations Pericholecystitis abscesses Peritonitis Painful complications ```
39
Gangrenous cholecystitis has a medium to coarse echogenic densities which means not ___________, not ___________, not ___________.
Shadowing Gravity dependent Layering
40
Name 3 types of benign neoplasm.
Adenoma Cholesterolosis Adenomyomatosis
41
Describe cholesterolosis...
``` Cholesterol deposited in the GB wall STRAWBERRY GB Polyps (most common psuedo tumor of GB) Attached with a stalk Less than 10 mm Do not shadow ```
42
Describe adenomyomatosis...
Hyperplastic change Papillomas Over the mucosal surface
43
Adenomyomatosis is a ___________ change in the GB wall.
Hyperplastic
44
With adenomyomatosis, ___________ may occur singly or in groups and may be scattered over a large part of the mucosal surface of the GB.
Papillomas
45
Papillomas are not a precursor to ___________.
Cancer
46
With adenomyomatosis, various patient positions and compressions show the ___________ to be ___________ in the GB.
Lesion Immobile
47
Adenomyomatosis sonographically...
Ring down or comet tail W shaped reverberation between diverticula Rokitanski-Aschoff sinuses
48
Describe porcelain gallbladder...
``` RARE GB wall calcified Calcium incrustation Gallstones Asymptomatic 25% progress to CA** ```
49
Primary GB CA is ___________.
Rare
50
What is the mortality rate if GB CA infiltrates other organs?
Near 100%
51
What is GB CA?
Obstruction of the cystic duct from compression Metastatic may occur from melanoma
52
GB CA sonographically...
Heterogenous solid mass Dilated ducts Most common biliary malignancy
53
Describe metastatic disease...
Primary of stomach, pancreas, & ducts Focal thickening of the duct Intraluminal
54
Most common tumor sites that can spread to the biliary system are from the ___________, ___________, & ___________.
Breast Colon Melanoma
55
Metastases can affect the ___________ and ___________ ductal system.
Intrahepatic Extrahepatic
56
On sonography, the appearance of metastases is similar to that of ___________.
Cholangiocarcinoma
57
___________ is the second most common primary malignancy of the GB.
Cholangiocarcinoma *poor prognosis
58
With cholangiocarcinoma, cancer is within the ___________.
Ducts
59
What 2 liver diseases are associated with cholangiocarcinoma?
Liver cirrhosis Hepatitis C
60
Generally a biliary duct measures ___________. A dilated duct measures ___________.
Greater than 6 mm Greater than 10 mm
61
What is courvoisier?
Obstruction of the CBD due to pancreatic mass Enlargement of the GB
62
What is cholecystomegaly?
Hydropic GB Enlarged GB without wall thickening Obstruction of duct
63
What are the 3 extra hepatic obstruction? Describe.
Intrapancreatic - pancreatic ca, choledocholthiasis, chronic pancreatitis Suprapancreatic - between pancreatic & porta hepatis, head of pancreas & duct are normal Porta hepatic - neoplasm, hydrops of the GB
64
___________ is a specific cholangiocarcinoma at the junction of the right and left hepatic duct.
Klatskin's tumor
65
___________ is when there is an impacted stone in the cystic duct or GB neck.
Mirizzi Syndrome
66
What will you see in a parasagital scan when there is an obstruction?
``` Alteration at PV Irregular walls of the ducts Stellate confluence Acoustic enhancement Peripheral ductal dilatation ```
67
___________ is an inflammation of the bile ducts.
Cholangitis *increased pressure in the biliary tree with pus
68
Clinical symptoms of cholangitis...
Fever Malaise Sweating and shivering Can lead to shock
69
3 types of cholangitis...
Oriental sclerosing cholangitis AIDS cholangitis Acute obstructive suppurative cholangitis
70
Lab values and sonographical appearance of cholangitis...
Increased Alk Phos and bili Thickened ductal wall
71
What is ERCP?
(Post) endoscopic retrograde cholangiopancreatopgraphy - this procedure can give you an inflection (cholangitis)
72
___________ is a disease caused by the parasitic roundworm, which uses a fecal-oral route of transmission.
Ascariasis
73
With ascariasis, the worm grows in the ___________ before entering the biliary tree though the ___________. This will cause ___________.
Small bowel Ampulla of Vater Acute biliary obstruction
74
Describe choledocholthiasis...
Stones in CBD Associated with acalculous cholecystitis Impacted stones in the ampulla of Vater Elevated direct bili and Alk Phos
75
___________ is when there is blood in the biliary tree.
Hemobilia
76
The main cause of hemobilia is ___________.
Biliary trauma
77
___________ is air within the biliary tree.
Pneumobilia
78
Pneumobilia may be caused by what 2 things?
Emphysematous cholecystitis Inflammation from an impacted stone in the CBD
79
Describe choledocholthiasis cysts...
CONGENITAL conditions involving cystic dilatation of bile ducts Pancreatic juices refluxing into the bile ducts Rare Females - infants to 10 years "Outpouching of the GB"
80
What is choledochal cysts associated with?
Gallstones Pancreatitis Cirrhosis
81
Clinical symptoms of choledochal cysts...
``` ABD mass Pain Fever Jaundice Confirmed with nuc med scan ```
82
How many classification types of choledochal cysts are there?
6 types
83
What is choledochal cysts type V?
Cysts have been classified as Caroli's disease
84
Choledochal cysts in the RUQ: _________ of the CBD _________ from the CBD _________ of the CBD
Dilatation Diverticulum Invagination
85
_________ is a rare congenital disorder that classically causes saccular ductal dilatation.
Caroli's disease
86
_________ will have multiple cystic structures in the are of the ductal system towards the _________.
Caroli's disease Porta hepatis
87
Caroli's disease sonographically...
Ducts may show a BEADED appearance as they extend into the periphery of the liver
88
Describe biliary atresia...
Ducts are obliterated Congenital Neonatal
89
_________ cause thickening of the GB wall from inside the GB..."chole-" will be attached to explanation. _________ cause thickening of the GB wall from outside the GB...other organs involved.
Intrinsic - cholecystitis Extrinsic - hepatitis & cirrhosis
97
What can cause GB wall diffuse thickening...
``` Normal contracted GB Ascites Acute hepatitis, cirrhosis CHF Renal disease AIDS Pancreatitis ```
98
What can cause GB wall focal thickening...
``` Adenomyomatosis Polyp Adenoma Carcinoma Metastatic ```

Spring 2014 - ABD TEST 3 - GALLBLADDER ✔️ (3 decks)

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