Chapter 3: Gallbladder Flashcards
The gallbladder is located posterior to which lobe of the liver
The right lobe
Name the three layers of the gallbladder wall from innermost to outermost
Mucosal, fibromuscular, serosal
What connects the gallbladder to the rest of the biliary system
The cystic duct
What is the most common location for stones and why
The fundus, because is the most dependent part
What hormone causes gallbladder contraction
Cholecystokinin
The _____ artery is a small branch of the right hepatic artery, and supplies blood to the gallbladder
Cystic artery
What does a bilobed gallbladder (normal variant) looks like
Like an hourglass
The Phrygian cap is the most common gallbladder variant. Describe it
The fundus is folded
Describe the septate gallbladder variant
Thin separations within gallbladder
What is the Hartman pouch variant
Outpouching of gallbladder neck
What is the junctional fold variant
Fold at the neck junction
A floating gallbladder can twist off the blood supply and this is called
Gallbladder torsion or gallbladder vulvulus
Which type of gallbladder is totally surrounded by liver
Intrahepatic gallbladder
The gallbladder holds about ___ ml of bile
40
The normal length of the gallbladder is between ____ and ____ cm
8-10
The normal diameter of the gallbladder should be
4-5 cm
The gallbladder wall should measure
3mm
Describe Cholelithiasis
Stones within gallbladder lumen
What are the symptoms of cholelithiasis
(Can be asymptomatic)
Biliary colic, pain after meals, nausea and vomiting, pain that radiates to shoulders
Stones typically consist of a mixture of what
Cholesterol, calcium, bilirubinate, and calcium carbonate
Cholelithiasis is most commonly seen in _____ patients
Female
What are some risk factors that can lead to Cholelithiasis
Obesity, pregnancy, increased parity, gestational diabetes, estrogen use, Crohn disease, total parenteral nutrition, rapid weight loss
Sludge is most often associated with biliary _____
Stasis
What are the symptoms of sludge
Asymptomatic
What is tumefactive sludge
Thick sludge that looks like a mass. Make sure it moves to rule out a mass
What is hepatization of the gallbladder referred to
When the gallbladder is completely filled with tumefactive sludge, it looks isoechoic to the liver
What are the symptoms of gallbladder polyps
Asymptomatic
______ polyps are the most common type
Cholesterol
Polyps tend to measure less than ____ mm
10
Large polyps or fast growing ones are concerning for
Carcinoma
Polyps are often seen with cholesterolosis, which is
Build up cholesterol in wall
What is hyperplastic cholecytosis
A group of proliferative and degenerative gallbladder disorders
Hyperplastic cholecytosis includes what two disorders
Adenomyomatosis and cholesterolosis
What is a strawberry gallbladder
Diffuse polyploid appearance of the gallbladder
What is adenomyomatosis
When the muscular layer of the gallbladder becomes thickened
When the muscular layer of the GB is thickened (adenomyomatosis) what does this produce
Tiny pockets called Rokitansky Aschoff sinuses
What are the symptoms of adenomyomatosis
Asymptomatic
Adenomyomatosis will produce what artifact
Comet tail
What is emphysematous cholecystitis
Form of acute cholecystitis caused by gas forming infection
What are the Sonographic findings of emphysematous cholecystitis
Dirty shadowing reverberation or ring down artifact
What are the clinical findings of emphysematous cholecystitis
RUQ pain (negative Murphy sign)
Fever
Diabetic patient
Emphysematous cholecystitis can become into _____
Sepsis
What is acute cholecystitis
Sudden onset of gallbladder inflammation. Commonly caused by a stone stuck in the neck or cystic duct
What are the symptoms of acute cholecystitis
RUQ tenderness with positive Murphy sign
Nausea and vomiting
Fever
Pain that radiates to shoulder
Jaundice (if there’s an obstruction)
What lab values are expected to be elevated when acute cholecystitis is present
WBCs
Bilirubin (with obstruction)
ALP, ALT, GGT
What are the sonographic findings of acute cholecystitis
Gallstones, wall thickening, enlargement of gallbladder, pericholecystic fluid, and sludge
What is a gangrenous cholecystitis
A direct evolution of acute cholecystitis
What are the sono findings of gangrenous cholecystitis (in addition to those of acute cholecystitis)
Focal wall necrosis
Bulges of the wall
Sloughed membranes
Ulcerative craters
Perforation of the GB has a high mortality rate. Would the pt demonstrate a positive Murphy sign with this finding
No
Chronic cholecystitis results from the intermittent ________ of cystic ducts by stones
Obstruction
Patients with chronic cholecystitis will have what symptoms
Intolerance to fatty foods and nontender gallbladder
What lab values may be elevated with chronic cholecystitis
ALP, AST, and ALT
What are the sono findings of chronic cholecystitis
Thickened wall, stones, WES sign, contracted GB
Acalculus cholecystitis presents with all symptoms and findings of _________, except no stones are present
Cholecystitis
What is empyema/ suppurative cholecystitis
When the gallbladder is filled with pus.
It will appear echogenic
Xanthogranulomatous cholecystitis results from chronic infection in GB, what are the findings related to this
Intramural accumulation of inflammatory cells (echogenic debris)
Asymmetrical thickening of wall
An enlarged gallbladder is also called
Hydropic gallbladder
An enlarged gallbladder can be caused by a blockage of the _____ duct, or other parts of the biliary tree
Cystic
What are the symptoms of an enlarged gallbladder
Maybe asymptomatic. Pts can have epigastric pain, nausea or vomiting
What is a Courvoisier gallbladder
Enlarged, palpable gallbladder caused by a pancreatic head mass
Gallbladder hydrops in infants can be associated with what disease
Kawasaki disease
What are the symptoms of a porcelain gallbladder
Asymptomatic
What is porcelain gallbladder
Calcification of gallbladder wall
Xray or CT is often used to confirm the diagnosis of ______ GB
Porcelain
______ carcinoma is the most common cancer of the biliary tract, even though is rare
Gallbladder
Gallbladder carcinoma is caused by chronic irritation of the wall by_____
Stones
Pts who suffer from chronic cholecystitis have an increased risk of developing _______
Gallbladder carcinoma
What are the symptoms of gallbladder carcinoma
Asymptomatic at first.
Then, nausea, vomiting, weight loss, RUQ pain, jaundice and hepatomegaly
What does gallbladder carcinoma look like on ultrasound
Nonmobile hypoechoic mass in the lumen, or as diffuse wall thickening. May contain stones
Gallbladder carcinoma is suspected if there’s a mass or polyp measuring more than ___cm
1
What is the gold standard imaging for gallbladder
Ultrasound
