Ch 1 and Biliary PowerPoint Flashcards
What is the most common disease of the gallbladder?
Cholelithiasis—-or stones
Are gallstones mobile or do they stay put when you roll the patient?
they are mobile
What type of patients are at risk for gallstones?
patients that have impaired gallbladder motility and bile stasis.
What is the Five F’s and what are they associated with?
Fat Female Forty Fertile Flatulent
Cholelithiasis.
Describe the symtpoms of someone with cholelithiasis?
- Asymptomatic or RUQ pain radiating to the shoulder
- N/V
What lab values will be increased with cholelithiasis?
Lipase, amylase, LFT, Bilirubin, AST and ALT
What are the sonographic findings of cholelithiasis?
Echogenic stones that cause shadowing and are mobile. Wall could be thickened or have the WES sign
What is sludge?
thickened echogenic bile from bile stasis
T/F
Sludge is gravity dependent.
True
T/F
Sludge does not move with the patients position.
False , it DOES move with the patient position.
Sludge common in found in patients that have________ and _________
fasting and hyperalimentation
DO NOT confuse a sludge ball with a mass.
No question just know it :)
The GB is considered thickened if it is more than __ mm parallel to the liver parenchyma.
3 mm
You should measure ___ wall to _____ wall,
outer to outer
Wall thickening can be indicative of _____
cholecystitis
What are some diagnosis’ for patients with wall thickening?
cholecystitis, adenomyomatosis, CA, hepatitis, pancreatitis, heart failure..
What is acalculous cholecystitits?
cholecystitits without the presence of stones
What is emphysematous cholecystitis?
gas forming bacteria in the gallbladder wall.
What types of cholecystitis will have abnormal LFTs and increased pancreatic enzymes?
Acute, Chronic, and Acalculous
What is the most common cause of acute cholecystitis?
cholelithiasis
F/T
Acute cholecystitis is worse in males then it is in females.
True
It is more common in females but is worse in males.
Patients with acute cholecystitis are at risk for ________ _______?
Gallbladder rupture
What are the symptoms of acute cholecystitis?
sudden RUQ pain, POSTIVE MURPHY SIGN, fever and WBC
What is the murphy sign?
When the patient gasps in exruciating pain while we are scanning over it.
Pericholecystits fluid is indicitive of __________
cholecystitis.
What is the sonographic findings of Cholecystitis?
- thickened wall
- pericholecystits abscess
- Enlarged GB
- pericholecystic fluid.
T/F
Stones in the cystitc duct will cause back pain.
True
Multiple attacks of acute cholecystitis leads to ____________ cholecystitis
chronic cholecystitis
What sign is most common with chronic cholecystitis? What is it?
WES Sign. (GB packed with stones)
Wall
Echo
Shadow
Acalculous (cholecystitis without stones) is common in patients in the ____ of the hospital because they are long term.
ICU
T/F
With ascites the GB wall will not be inflamed?
FALSE
it will be inflamed
A type of cholecystitis in which gas invades the GB wall and lumen and also in the biliary ducts. It is a bacterial invasion.
Emphysematous Cholecystitis
Emphysematous cholecystitis has the ring down effect on ultrasound
T/F
True
A person with ______ is more at risk for the air forming bacteria of emphysematous cholecystitis.
Diabetes.
The gallbladder wall is thickened and edematous with focal areas of hemorrhage and necrosis. The patient will have more abdominal pain instead of a positive murphy sign.
Gangrenous Cholecystitis.
What are the symptoms of choledochal cysts
jaundice, abdominal mass, pain and fever
Increased bilirubin will be seen in choledochal cysts
T/F
true
Choledochal cysts are associated with what three things?
Stones, pancreatitis & cirrhosis.
Papillomas adherent to the walls that are benign and present with a comet tail artifact.
Patient is asymptomatic
What is this diagnosis?
Adenomyomatosis
What is also known as the strawberry GB and why?
Cholesterolosis
because of the cholesterol deposits that are attatched with a stalk within the mucosa
When scanning a gallbladder adenoma (which is benign but can turn malignant), what should we be looking for?
calcifications, edema, and walll thickening.
What is a porcelain GB? Is it asymptomatic or does the patient feel pain?
calcium buildup in the GB wall
asymptomatic
What is the most common cancer of the biliary tract and where are they usually found?
Gallbladder carcinoma.
Most commonly found in the fundus.
What are some factors that can cause gallbladder carcinoma?
Is it more common in males or females?
Gallstones, chronic cholecystitis, porcelain GB, exposure to carcinogens, and blood groups.
Females
What are some sonographic findings of GB carcinoma?
heterogenous, wall thickened, edematous GB, dilated ducts, liver parenchyma is heterogenous often with stones.
What sign is associated with ductal dilation?
the double barrel sign
Carcinoma, stone in duct, or stricture from chronic pancreatitis
What type of dilation are these causing?
Intrapancreatic obstruction
malignancy or adenopathy between pancreas and PV
What type of dilation are these causing?
suprapancreatic obstruction
mass, CBD will be normal with intrahepatic dilation
What type of dilation are these causing?
porta hepatic obstruction
Carcinoma of ducts, isolated intrahepatic ductal dilation
What type of dilation are these causing?
cholangiocarcinoma.
inflammation of the bile ducts
The patient will have a fever, lethargy, sweating, shivering, bacterial infection or obstruction
Sonographically the ductal wall will look thickened and edematous
Cholangitis
stones in the bile duct or ampulla of Vater
choledocholithiasis.
Obstruction in the distal end of the CBD with an enlargement of the GB
Patient presents with jaundice
Courvoisier GB
What are some risk factors for developing gallstones?
family history, diet induced weightloss , pregnancy, diabetes, estrogen use and oral contraceptive use.
Is acalculous cholecystitis more often found in male or female patients?
males.
Is emphysematous cholecystitis more commonly found in female or male patients?
male patients
What is a complication of emphysematous cholecystitis?
the development of gangrene in gallbladder and gallbladder rupturing
Which type of cholecystitis has an increased morbidity and mortality rate?
gangrenous cholecystitis
What are two types of hyperplastic cholecytosis?
adenomyomatosis and cholesterolosis
When does gallbladder perforation usually occurs?
in the gallbladder fundus after cystic duct obstruction, gallbladder distention and necrosis.
Can GB perforation be deadly?
UH YEAH.
What artifact is associated with adenomyomatosis?
comet tail artifact
Gallbladder polyps measuring more than ___ mm in size suggest malignancy
10
What lab value will be elevated with choledocholithasis?
bilirubin levels
Klatskin tumors are associated with which malignancy?
Cholangiocarcinoma (cancer in the biliary tract)
What are the clinical findings of cholangiocarcinoma?
Painless jaundice (Laura :O), pruritus, abdomen pain, anorexia, and weight loss.
Liver abscess have a high association with morbidity and mortality.
T/F
True
I am a sheep herder. What liver mass am I usually associated with?
echinococcus tapeworm
this is an inflammatory cystic reaction that may manifest as a cystic or complex lesion
Hematomas are caused by trauma.
T/F
true
