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Gallbladder > Ch. 11- Gallbladder > Flashcards

Ch. 11- Gallbladder Flashcards

1
Q

Hyperplastic Cholecystisis Characterized by

A

Hyperconcentration: increase amt. of concentrated bile Hyperexcitability: ______ Hyperexcertion: too much bile

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2
Q

Types of Hyperplastic Cholecystitis

A

Cholesterolosis Adenomyomatosis

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3
Q

Cholesterolosis

A

condition in which cholesterol is deposited w/in lumina propria of GB

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4
Q

Adenoma

A

Benign neoplasms w/ a potential to become malignant

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5
Q

Adenoma occurs

A

as a solitary lesion Small: pedunculated Large: contain foci malignant transformation

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6
Q

Adenoma Sonographic Appearance

A

Homogenously hyperechoic - as grow in size will become heterogenous - thick wall= hourglass appearance

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7
Q

Adenomyomatosis

A

Hyperplastic change in the GB wall

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8
Q

How do papillomas occur?

A

Singularly or in groups

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9
Q

Where may adenomyomatosis be found?

A

May be scattered over a large part of the mucosal surface of the GB

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10
Q

What is adenomyomatosis associated w/?

A

Rokitansky- Aschoff Sinuses

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11
Q

What are Rokitanksy-Aschoff sinuses?

A

Small mucosal herniations into the muscular layer of the GB

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12
Q

Rokitanksy-Aschoff sinuses appear- if filled w/bile

A

Cystic

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13
Q

Rokitanksy-Aschoff- if filled w/cholesterol deposits

A

Echogenic foci w/v-shaped reverberation artifact

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14
Q

Adenomyomatosis Sonographic Appearance

A

small elevelations in lumen of the GB Maintain their initial location during positional changes

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15
Q

What type of artifact does adenomyomatosis cause?

A

Comet tail artifact

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16
Q

Porcelain

A

Calcium incrustation of GB wall

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17
Q

What is Porcelain gallbladder associated with?

A

gallstones

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18
Q

What are the symptoms of a porcelain gallbladder?

A

asymptomatic

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19
Q

How is a diagnosis made for Porcelain gallbladder

A
  • incidental finding - mass is found on physical examination
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20
Q

Can porcelain gallbladder develop into cancer?

A

Yes; 25%

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21
Q

Porcelain Sonographic Findings

A

Bright echogenic echo region of GB w/posterior shadowing (can’t see a wall majority of the time)

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22
Q

Gallbladder Carcinoma -characteristics

A

Rare & rapidly progressive 100% mortality rate 2X as common as cancer of the bile ducts

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23
Q

What is GB carcinoma associated w/?

A

cholelithiasis 80-90%

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24
Q

What increases the chance of developing GB carcinoma?

A

Cholelithiasis- presence of stones in the GB

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25
Q

GB carcinoma occurs most frequently in?

A

Women over 60 yrs

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26
Q

Where may GB carcinoma tumor arise from?

A

-body of the GB - cystic duct (rare)

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27
Q

Effects of GB carcinoma tumor

A
  • infiltrate the GB -causes thickening and rigidity of the wall
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28
Q

What or how do you differentiate between a benign or malignant tumor of the GB

A

Put color doppler - Malignant= GB carcinoma = hypervascularity will show

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29
Q

How does GB carcinoma affect the liver?

A

Liver is invaded by direct continuity extending through tissue spaces= Ducts of Lushka - lymph channels - or any combination

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30
Q

How does obstruction of the cystic ducts occur in relation to GB carcinoma?

A
  • Direct extenstion of the tumor - Extrinsic compression by involved lymph nodes
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31
Q

GB carcinoma sonographic findings

A

global shape of malignant GB masses- looks similar to GB -heterogenous solid or semi-solid mass

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32
Q

GB carcinoma sonographic findings

A

adjacent liver tissue in hilar area ( main-lobar fissure& pv- where it inserts into the liver) is heterogenous due to tumor spread - Shotgun sign= dilated biliary ducts w/in liver -cause non-visualization of gb on oral cholecystogram

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33
Q

Dilated Biliary Ducts - what is the measurement to be considered dilated?

A
  • greater than 4 mm
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34
Q

What are the biliary ducts parallel to?

A

Portal sytem

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35
Q

What is the internal diameter of the CHD?

A
  • less than 4 mm
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36
Q

What is the borderline measurement for the duct diameter?

A
  • 5mm
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37
Q

What does the it mean if the duct diameter 6mm

A
  • requires further investigation
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38
Q

What may look normal but still have a distal obstruction

A

normal size hepatic duct ( <4mm)

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39
Q

The distal duct is often obscured by what?

A
  • gas
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40
Q

CBD internal diameter?

A
  • slightly greater than the hepatic duct
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41
Q

What measurement of the duct is considered dilated?

A

10 mm

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42
Q

What is the most common cause of a biliary obstruction?

A
  • tumor or thrombus w/in the ductal system
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43
Q

Where may a biliary obstruction be found?

A
  • extrahepatic ductal pathway - intrahepatic ductal pathway
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44
Q

What is seen as a sign when intrahepatic ducts are dilated?

A
  • to many tubes - shotgun sign
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45
Q

How do bile ducts expand?

A

centrifugally- from the point of obstruction

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46
Q

When does extrahepatic dilation occur?

A

before intrahepatic ***if obstruction is extrahepatic!

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47
Q

What are the three primary areas for Extrahepatic obstruction?

A
  • Intrapancreatic - Suprapancreatic - Porta hepatic (portal triad)
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48
Q

What are the three intrapancreatic conditions?

A
  • pancreatic carcinoma - choledocolithiasis - chronic pancreatitis w/stricture formation
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49
Q

What is intrapancreatic obstruction?

A
  • Extrahepatic - obstruction at the level of the distal duct
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50
Q

What is suprapancreatic obstruction? Where does it originate?

A
  • Extrahepatic obstruction -originates b/w head of pancreas
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51
Q

What structures appear normal on ultrasound in a suprapancreatic obstruction?

A
  • head of pancreas - intrapancreatic duct - pancreatic duct
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52
Q

What is the most common cause of suprapancreatic obstruction?

A

Malignancy or adenopathy

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53
Q

Porta hepatic obstruction usually occurs due to what?

A

Neoplasm

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54
Q

What will appear on an ultrasound of a porta hepatic obstruction?

A
  • intrahepatic ductal dilation - Normal CBD - possibly GB hydrop
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55
Q

Where does cholangiocarcinoma originate from?

A

w/in the larger bile ducts = CBD or CHD

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56
Q

Specific type of cholangiocarcinoma?

A
  • Klatskin’s tumor
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57
Q

Where can the Klatskin’s tumor occur?

A
  • bifurcation of the CHD (involves all parts- central, left &amp; right)
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58
Q

What sonographic feature suggests Klatskin’s tumor?

A

Non-union of the rt. &amp; lt. ducts

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59
Q

What sonographic features indicates cholagiocarcinoma?

A
  • isolated intrahepatic duct dilation
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60
Q

What should be down to confirm Klatskins tumor?

A
  • contrast &amp; color doppler
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61
Q

Mirizzi Syndrome is caused by?

A

Extrahepatic biliary obstruction due to an impacted stone in the cystic duct

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62
Q

If a stone is penetrated into the CHD or gut what disease could this indicate?

A

Mirizzi syndrome

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63
Q

Cholecystobiliary or cholecystenteric fistula is a result of what? &amp; associated w/ what?

A
  • stone penetrated into the CHD or gut - Mirizzi Syndrome
64
Q

What allows Mirizzi syndrome to occur?

A

cystic duct inserts unusually low into the CHD &amp; 2 ducts have parallel alignment

65
Q

Mirizzi Syndrome- Sonographic Findings

A
  • intrahepatic ductal dilation - normal CBD - large stone in neck or cystic duct
66
Q

What type of tumors will have the same sonographic appearance as pancreatic tumors?

A
  • Tumors arising from GB - Ampullar carcinoma
67
Q

What indicates cancer of the biliary convergence?

A
  • ducal wall w/out bulging outside
68
Q

What indicates ampulloma?

A
  • specific pattern - bulge inside dilated CBD
69
Q

Cancer of the hepatic duct usually infiltrates what?

A
  • the ducal wall w/out bulging outside
70
Q

Extrahepatic biliary obstruction - sonographic findings

A
  • minimal dilation in patients w/ 1.)NON-jaundice w/ a.) gallstones [OR] b.) pancreatitis 2.) Jaundice w/ a.) common duct stone [OR] b.) tumor
71
Q

A diameter >11 mm suggests an obstruction by what?

A
  • stone - tumor of the a.) duct b.) pancreas c.) other source
72
Q

What causes intermittent obstruction resulting from a ball-valve effect?

A

Biliary obstruction involving - 1 HD - early obstruction 2nd to carcinoma/ gallstones

73
Q

Extra obs.- What is found in Non-jaundice dilate ducts?

A

Biliary obstruction involving - 1 HD - early obstruction 2nd to carcinoma/ gallstones

74
Q

What characteristics traditionally distinguish bile ducts from other intrahepatic structures?

A

1.) alteration in pattern adjacent to RMPV segment &amp; bifurcation 2.) irregular walls of dilated ducts 3.) stellate confluence of dilated ducts 4.) acoustic enhancement by DD 5.) peripheral duct dilation

75
Q

Intrahepatic biliary ducts occur…

A

2nd to extrahepatic bile duct obstruction

76
Q

Cystadenoma &amp; cystadenocarcinoma are rare and primarily limited diseases that may occassionally occur from?

A
  • intrahepatic lesions–> changes in the duct
77
Q

Intrahepatic biliary neoplasms frequently found in

A
  • middle aged women
78
Q

Clinical Presentation of Intrahepatic biliary neoplasms

A
  • abd. pain - abd. mass - jaundice - dilated intra ducts
79
Q

Abd. mass near the porta hepatis will cause

A
  • jaundice
80
Q

What pattern variations may show in an intrahepatic biliary neoplasm mass

A
  • uniocular - calcifies - multiple
81
Q

What are the differential diagnoses of an intrahepatic biliary neoplasm

A
  • hemorrhagic cyst - infection -echinococcal cysts - abscess - cystic metastasis
82
Q

What is cholangitis

A
  • inflammation of the bile ducts
83
Q

What are the clinical symptoms of cholangitis

A
  • malaise (can’t localize pain) - Fever - sweating &amp; shivering - Lethargic -Prostrate - in shock
84
Q

Cholangitis is caused by the dependence on the type of disease; but obstruction may include

A
  • ductal strictures - parasitic infestation - bacterial infection - stones - neoplasm
85
Q

How is cholangitis identified?

A
  • oriental sclerosing cholangitis -AIDS “” - acute obstructive suppurative “”
86
Q

What does cholangitis cause?

A
  • increased pressure on biliary tree w/pus accumulation
87
Q

What lab values are associated w/ cholangitis?

A
  • increase in a.) alk phos b.) bilirubin
88
Q

Which two cholangitis diseases have identical ultrasonic intrahepatic biliary changes?

A
  • sclerosing - aids
89
Q

Decompression of what is necessary in cholangitis

A
  • decompression of CBD
90
Q

What are the sonographic findings of cholangitis?

A
  • smooth/irregular wall thickening of CBD - CBD wall so thin- diff. to recognize
91
Q

Choledocholithiasis

A
  • stones in the CBD
92
Q

The majority of stones in the CBD have migrated from where?

A

GB

93
Q

Choledocholithiasis is usually associated w/ what other GB disease?

A
  • calculous cholecystitis
94
Q

Choledocholithiasis- sonographic findings

A
  • impacted @ ampulla of Vater - hyperechoic density w/in CBD producing shadowing
95
Q

Causes of shadowing

A
  • calcifications of small vascular structures - air/gas in duodenum= dirty - Intrabiliary gas= pneumobilia
96
Q

Which biliary diesease is congenital?

A
  • Caroli’s disease
97
Q

What is Caroli’s disease?

A
  • communicating cavernous ectasia of intrahepatic ducts= dilated or extended ducts
98
Q

How is Caroli’s disease described?

A
  • congenital segmental saccular cystic dilation of major intrahepatic bile ducts
99
Q

What is the the Caroli’s disease common in whom?

A
  • younger adults - pediatric
100
Q

Caroli’s Disease- Symptoms

A
  • reoccurring cramp-like upper abd. pain
101
Q

How does milk of calcium bile occur?

A
  • GB becomes filled w/ pasty semi-solid substance
102
Q

What is milk of calcium bile mostly made up of?

A
  • calcium carbonate
103
Q

Milk of calcium bile is often associated w/

A
  • bile stasis
104
Q

What other GB disease may milk of calcium bile cause?

A
  • acute cholecystitis - migrate into bile ducts
105
Q

Milk of Calcium bile- sonographic appearance

A
  • highly echogenic material - posterior acoustic shadowing
106
Q

Posterior acoustic shadowing forming a level w/ different patient positioning may indicate what?

A
  • milk of calcium bile
107
Q

What does sludge occur from?

A

Bile Stasis

108
Q

What is bile stasis?

A

When bile cannot flow from liver to duodenum; GB is not contracting

109
Q

Sludge may be seen in patients w/?

A
  • prolonged fasting - hyperalimentation - obstruction of GB
110
Q

Alimenation, what is it?

A

admin. of nutrients by IV feeding

111
Q

Where is sludge usually found in?

A

CBD

112
Q

Sludge- Sonographic Findings

A
  • low level internal echoes
113
Q

What other disease may sludge be seen in?

A
  • cholelithiasis - Cholecystitis etc.
114
Q

What disease occurred from bile stasis will mimic polypoid tumors?

A
  • Tumefactive sludge
115
Q

What is it called when sludge in GB is isoechoic w/liver?

A

Hepatization

116
Q

Adenomyomatosis- definition

A

small polypoid projections from the GB wall

117
Q

Causes of GB wall thickening

A
  • cholecystitis - adenomyomatosis - AIDS - Cholangiopathy - Sclerosing cholangitis
118
Q

What is Sclerosing cholangitis

A

bile dues narrow

119
Q

What is cholangiopathy

A

any disease of the bile ducts

120
Q

Which diseases are an inflammation of the GB?

A
  • Acute & Chronic Cholecystitis - Acalculous - Emphysematous - Gangrenous
121
Q

Unique about Acalculous?

A
  • w/out a stone
122
Q

Unique about Emphysematous

A
  • Gas in GB–> ring down artifact
123
Q

Which inflammatory disease creates usually creates a cystic duct obstruction?

A
  • Acute cholecystitis
124
Q

Acute Cholecystitis- Symptoms

A
  • acute RUQ pain - + murphy’s sign - Fever - Leukocytosis
125
Q

Acute -cystisis complications =

A
  • Empyema - Emphysematous - Gangrenous - Perforation
126
Q

Murphy’s sign definition:

A

+ sign implies tenderness over GB area upon palpation (touched)

127
Q

What is empyema?

A
  • collection of pus
128
Q

Acute Cholecystisis - Sonographic findings

A
  • irregular GB wall - sonolucent area w/ thick wall - Hydrop - + Murphy sign - Pericholecystic fluid ( can be there or not)
129
Q

Sludge definiton:

A

low- level echoes found along posterior margin of GB

130
Q

Hydrop definition:

A

enlargment of GB

131
Q

Describe the presence of pericholecystic fluid

A
  • inflammed wall & swelling w/leakage into pericholecystic space–> space surrounding GB
132
Q

What is perforation

A
  • hole; piercing; aperature; could be row of small holes - Whole/opening in the GB wall
133
Q

What feeds the GB?

A
  • cystic artery
134
Q

What non-biliary diseases may sludge be found in?

A
  • hepatitis - severe hypoalbuminec states
135
Q

What disease is the most common form of inflammation?

A
  • chronic cholecystitis
136
Q

What is chronic- cystitis

A
  • end result of acute -cystitis
137
Q

Chronic -cystitis – sonographic findings

A
  • cholelithiasis- found in contracted GB w/ coarse GB wall thickening - WES
138
Q

WES- definition:

A

Sonographic pattern found when GB packed w/stones

139
Q

What is acalculous - cystitis

A
  • acute infl. w/out stones (cholelithiasis)
140
Q

What type of patients would most likely have a decrease in blood flow of the cystic artery? What GB disease could they develop?

A
  • Trauma - Burn - Post OP *** Acalculous -cystitis
141
Q

What is the measurment of an acalculous- cystitis wall?

A

4-5mm

142
Q

Which inflammatory GB disease is rapidly progressive and fatal?

A

Emphysematous -cystitis

143
Q

50 % of patients have this GB disease

A

Emphysematous Cholecystitis

144
Q

Which inflammatory GB disease may lead to perforation?

A

Gangrenous -cystitis

145
Q

Gangrenous -cystitis caused by?

A
  • prolonged infection
146
Q

What are other clinical factors of cholelithiasis

A
  • pregnancy -diabetes -oral contraceptive use -diet induced weight loss - total parenteral nutrition (coma pts)
147
Q

When do patients w/-lithiasis start to experience symptoms

A
  • small stone lodges in the cystic or common duct
148
Q

What portion of the GB should stones shift after changing patient positions

A
  • dependent portion of the GB (closest to earth)
149
Q

Which type of reflections affect shadowing the most?

A
  • specular reflection
150
Q

What is the shadow of the gallstone from

A
  • acoustic impedance - Refraction through them or diffraction around them
151
Q

What type of stones will not cast an acoustic shadow?

A
  • <3mm
152
Q

Shadow is dependent on what/

A
  • relationship b/w stone & sound beam
153
Q

Which biliary disease causes wall abnormality, weakness, & outpouching of the ductal walls?

A

Choledochal cysts

154
Q

Choledocal cysts cause?

A

pancreatic juices refluxing into bile duct

155
Q

What would cause pancreatic juices to reflux into the bile duct? What GB disease is this?

A
  • b/c an anomalous junction of pancreatic duct into distal CBD - Choledochal cysts
156
Q

Choledochal cysts may be associated w/?

A
  • stones - pancreatitis - cirrhosis
157
Q

How are -dochal cysts classified?

A
  • localize cystic dilation of CBD - sac from CBD (diverti) -invag (outpouch) CBD into duo - dilation of entire CBD &CHD

Gallbladder (2 decks)

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