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Case Studies > Ch 1 and Biliary PowerPoint > Flashcards

Ch 1 and Biliary PowerPoint Flashcards

1
Q

What is the most common disease of the gallbladder?

A

Cholelithiasis—-or stones

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2
Q

Are gallstones mobile or do they stay put when you roll the patient?

A

they are mobile

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3
Q

What type of patients are at risk for gallstones?

A

patients that have impaired gallbladder motility and bile stasis.

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4
Q

What is the Five F’s and what are they associated with?

A 
Fat
Female
Forty
Fertile
Flatulent

Cholelithiasis.

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5
Q

Describe the symtpoms of someone with cholelithiasis?

A
  • Asymptomatic or RUQ pain radiating to the shoulder

- N/V

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6
Q

What lab values will be increased with cholelithiasis?

A

Lipase, amylase, LFT, Bilirubin, AST and ALT

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7
Q

What are the sonographic findings of cholelithiasis?

A

Echogenic stones that cause shadowing and are mobile. Wall could be thickened or have the WES sign

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8
Q

What is sludge?

A

thickened echogenic bile from bile stasis

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9
Q

T/F

Sludge is gravity dependent.

A

True

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10
Q

T/F

Sludge does not move with the patients position.

A

False , it DOES move with the patient position.

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11
Q

Sludge common in found in patients that have________ and _________

A

fasting and hyperalimentation

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12
Q

DO NOT confuse a sludge ball with a mass.

A

No question just know it :)

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13
Q

The GB is considered thickened if it is more than __ mm parallel to the liver parenchyma.

A

3 mm

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14
Q

You should measure ___ wall to _____ wall,

A

outer to outer

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15
Q

Wall thickening can be indicative of _____

A

cholecystitis

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16
Q

What are some diagnosis’ for patients with wall thickening?

A

cholecystitis, adenomyomatosis, CA, hepatitis, pancreatitis, heart failure..

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17
Q

What is acalculous cholecystitits?

A

cholecystitits without the presence of stones

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18
Q

What is emphysematous cholecystitis?

A

gas forming bacteria in the gallbladder wall.

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19
Q

What types of cholecystitis will have abnormal LFTs and increased pancreatic enzymes?

A

Acute, Chronic, and Acalculous

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20
Q

What is the most common cause of acute cholecystitis?

A

cholelithiasis

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21
Q

F/T

Acute cholecystitis is worse in males then it is in females.

A

True

It is more common in females but is worse in males.

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22
Q

Patients with acute cholecystitis are at risk for ________ _______?

A

Gallbladder rupture

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23
Q

What are the symptoms of acute cholecystitis?

A

sudden RUQ pain, POSTIVE MURPHY SIGN, fever and WBC

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24
Q

What is the murphy sign?

A

When the patient gasps in exruciating pain while we are scanning over it.

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25
Q

Pericholecystits fluid is indicitive of __________

A

cholecystitis.

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26
Q

What is the sonographic findings of Cholecystitis?

A
  • thickened wall
  • pericholecystits abscess
  • Enlarged GB
  • pericholecystic fluid.
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27
Q

T/F

Stones in the cystitc duct will cause back pain.

A

True

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28
Q

Multiple attacks of acute cholecystitis leads to ____________ cholecystitis

A

chronic cholecystitis

29
Q

What sign is most common with chronic cholecystitis? What is it?

A

WES Sign. (GB packed with stones)

Wall
Echo
Shadow

30
Q

Acalculous (cholecystitis without stones) is common in patients in the ____ of the hospital because they are long term.

A

ICU

31
Q

T/F

With ascites the GB wall will not be inflamed?

A

FALSE

it will be inflamed

32
Q

A type of cholecystitis in which gas invades the GB wall and lumen and also in the biliary ducts. It is a bacterial invasion.

A

Emphysematous Cholecystitis

33
Q

Emphysematous cholecystitis has the ring down effect on ultrasound

T/F

A

True

34
Q

A person with ______ is more at risk for the air forming bacteria of emphysematous cholecystitis.

A

Diabetes.

35
Q

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.

A

Gangrenous Cholecystitis.

36
Q

What are the symptoms of choledochal cysts

A

jaundice, abdominal mass, pain and fever

37
Q

Increased bilirubin will be seen in choledochal cysts

T/F

A

true

38
Q

Choledochal cysts are associated with what three things?

A

Stones, pancreatitis & cirrhosis.

39
Q

Papillomas adherent to the walls that are benign and present with a comet tail artifact.

Patient is asymptomatic

What is this diagnosis?

A

Adenomyomatosis

40
Q

What is also known as the strawberry GB and why?

A

Cholesterolosis

because of the cholesterol deposits that are attatched with a stalk within the mucosa

41
Q

When scanning a gallbladder adenoma (which is benign but can turn malignant), what should we be looking for?

A

calcifications, edema, and walll thickening.

42
Q

What is a porcelain GB? Is it asymptomatic or does the patient feel pain?

A

calcium buildup in the GB wall

asymptomatic

43
Q

What is the most common cancer of the biliary tract and where are they usually found?

A

Gallbladder carcinoma.

Most commonly found in the fundus.

44
Q

What are some factors that can cause gallbladder carcinoma?

Is it more common in males or females?

A

Gallstones, chronic cholecystitis, porcelain GB, exposure to carcinogens, and blood groups.

Females

45
Q

What are some sonographic findings of GB carcinoma?

A

heterogenous, wall thickened, edematous GB, dilated ducts, liver parenchyma is heterogenous often with stones.

46
Q

What sign is associated with ductal dilation?

A

the double barrel sign

47
Q

Carcinoma, stone in duct, or stricture from chronic pancreatitis

What type of dilation are these causing?

A

Intrapancreatic obstruction

48
Q

malignancy or adenopathy between pancreas and PV

What type of dilation are these causing?

A

suprapancreatic obstruction

49
Q

mass, CBD will be normal with intrahepatic dilation

What type of dilation are these causing?

A

porta hepatic obstruction

50
Q

Carcinoma of ducts, isolated intrahepatic ductal dilation

What type of dilation are these causing?

A

cholangiocarcinoma.

51
Q

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

A

Cholangitis

52
Q

stones in the bile duct or ampulla of Vater

A

choledocholithiasis.

53
Q

Obstruction in the distal end of the CBD with an enlargement of the GB

Patient presents with jaundice

A

Courvoisier GB

54
Q

What are some risk factors for developing gallstones?

A

family history, diet induced weightloss , pregnancy, diabetes, estrogen use and oral contraceptive use.

55
Q

Is acalculous cholecystitis more often found in male or female patients?

A

males.

56
Q

Is emphysematous cholecystitis more commonly found in female or male patients?

A

male patients

57
Q

What is a complication of emphysematous cholecystitis?

A

the development of gangrene in gallbladder and gallbladder rupturing

58
Q

Which type of cholecystitis has an increased morbidity and mortality rate?

A

gangrenous cholecystitis

59
Q

What are two types of hyperplastic cholecytosis?

A

adenomyomatosis and cholesterolosis

60
Q

When does gallbladder perforation usually occurs?

A

in the gallbladder fundus after cystic duct obstruction, gallbladder distention and necrosis.

61
Q

Can GB perforation be deadly?

A

UH YEAH.

62
Q

What artifact is associated with adenomyomatosis?

A

comet tail artifact

63
Q

Gallbladder polyps measuring more than ___ mm in size suggest malignancy

A

10

64
Q

What lab value will be elevated with choledocholithasis?

A

bilirubin levels

65
Q

Klatskin tumors are associated with which malignancy?

A

Cholangiocarcinoma (cancer in the biliary tract)

66
Q

What are the clinical findings of cholangiocarcinoma?

A

Painless jaundice (Laura :O), pruritus, abdomen pain, anorexia, and weight loss.

67
Q

Liver abscess have a high association with morbidity and mortality.

T/F

A

True

68
Q

I am a sheep herder. What liver mass am I usually associated with?

A

echinococcus tapeworm

this is an inflammatory cystic reaction that may manifest as a cystic or complex lesion

69
Q

Hematomas are caused by trauma.

T/F

A

true

Case Studies (14 decks)

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