Chapter 3: The Gallbladder Flashcards
inflammation of the gallbladder without associated gallstones
acalculous cholecystitis
the sudden onset of gallbladder inflammation
acute cholecystitis
benign hyperplasia of the gallbladder wall
adenomyomatosis
when a polyp appears to be a round object, like a ball, that is stuck to the gallbladder wall
“ball on the wall” sign
pain located in the RUQ in the area of the GB
biliary colic
the effect of dirty shadowing, reverberation, or ring-down artifact caused by gas or air bubbles produced by bacteria within the nondependent (typically anterior) gallbladder wall
champagne sign
the surgical removal of the GB
cholecystectomy
the hormone produced by the duodenum that causes the GB to contracty
cholecystokinin
the presence of gallstone(s) within the biliary tree
choledocholithiasis
gallstone(s)
cholelithiasis
a condition that results from the disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the GB wall; may be diffuse and referred to as a strawberry GB
cholesterolis
results from intermittent obstruction of the cystic duct by gallstones
chronic cholecystitis
partially digested food from the stomach
chyme
artifact caused by several small reflective interfaces
comet-tail artifact
the clinical detection of an enlarged, palpable GB caused by an obstruction in the area of the pancreatic head, typically caused by a pancreatic head mass
courvosier GB
chronic inflammatory bowel disease that leads to thickening and scarring of the bowel walls, leading to chronic pain and recurrent bowel obstructions
Crohns disease
the duct that connects the gallbladder to the common hepatic duct
cystic duct
having two gallbladders that are often, but not always, paired with their own cystic ducts
duplication of the gallbladder
abnormal distention of an organ with air or gas
emphysematous
the presence or collection of pus
empyema
a gallbladder that is highly mobile and thus prone to torsion
floating gallbladder
the twisting of the vascular supply to the gallbladder
gallbladder torsion
an outpouching of the gallbladder neck
Hartmann pouch
a condition that results in the destruction of red blood cells
hemolytic anemia
situation in which the gallbladder is completely filled with tumefactive sludge, causing the gallbladder to appear isoechoic to the liver tisue
hepatization of the gallbladder
an enlarged gallbladder; also referred to as mucocele of the gallbladder
hydropic gallbladder
the intravenous administration of nutrients and vitamins
hyperalimentation
a group of proliferative and degenerative gallbladder disorders, which includes both adenomyomatosis and cholesterolysis
hyperplastic cholecystosis
abnormal low level of albumin in the blood;
hypoalbuminemia
performing sonographic imaging between the ribs
intercostal sonographic imaging
rare anomaly of the biliary tree where the main hepatic ducts drain directly into the gallbladder and the gallbladder drains directly into the common bile duct; may lead to childhood jaundice, enlarged gallbladder, and intermittent abdominal pain
interposition of the gallbladder
a gallbladder that is completely surrounded by the hepatic parenchyma
intrahepatic gallbladder
a fold in the neck of the gallbladder
junctional fold
a condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes; also referred to as mucocutaneous lymph node syndrome
Kawasaki disease
an elevated white blood cell count
leukocytosis
pain directly over the gallbladder with applied probe pressure
Murphy sign
the total number of completed pregnancies that have reached the age of viability
parity
fluid around the gallbladder
pericholecystic fluid
inflammation of the peritoneal lining
peritonitis
gallbladder variant when the gallbladder fundus is folded onto itself
Phyrgian cap
the calcification of all or part of the gallbladder wall
porcelain gallbladder
after a meal
postprandial
tiny pockets within the gallbladder wall
Rokitansky-Aschoff sinuses
a life-threatening condition caused by the body’s response to systemic infection; also referred to as blood poisoning; results in a number of issues including low blood pressure, rapid heartbeat, and fever
sepsis
a gallbladder that has one or more septa within its lumen; a gallbladder with several septa; may be referred to as a multiseptate gallbladder
septate gallbladder
an illness resulting from another disease, trauma, or injury
sequela
form of hemolytic anemia typically found in Africans or people of African descent; characterized by dysfunctional sickle-shaped red blood cells
sickle cell disease
folds located within the cystic duct that prevent it from collapsing and distending
spiral valves of Hester
complication of acute cholecystitis characterized by pus accumulation within the gallbladder
suppurative gallbladder
the feeding of a person intravenously
total parenteral nutrition
thick sludge
tumefactive slude
shadowing from the gallbladder fossa produced by a gallbladder that is completely filled with gallstones
wall-echo-shadow sign
The sonographic sign of gallbladder torsion when color Doppler is applied to the spiraled, twisted cystic artery
whirlpool sign
rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells, noted sonographically as asymmetrical thickening of the gallbladder wall and intraluminal echogenic debris
xanthogranulomatous cholecystitis
hourglass appearance of the gallbladder
bilobed gallbladder
appears as thin separations within the gallbladder
septate gallbladder
gallbladder is folded onto itself
phyrgian cap
most common gallbladder variany
phyrygian cap
outpouching of the gallbladder neck
hartmann pouch
prominent fold located at the junction of the gallbladder neck
junctional fold
Sources of diffuse gallbladder wall thickening
postprandial
acute cholecystitis
chronic cholecystitis
adenomyomatosis
hepatic dysfunction
benign ascites
hypoalbuninemia
AIDS cholangiopathy
congestive heart failure
gallbladder carcinoma
sources of focal gallbladder wall thickening
gallbladder polyp
adenomyomatosis
gallbladder carcinoma
adhered gallstone
risk factors and predisposing conditions for cholelithiasis
obesity
pregnancy
increased parity
gestational diabetes
estrogen therapy
oral contraceptive use
rapid weight loss programs
hemolytic disorder
Chron’s disease
total parenteral nutrition
Clinical findings of cholithiasis
asymptomatic
biliary colic
abdominal pain after fatty meals
epigastric pain
nausea and vomiting
pain that radiates to the shoulders
echogenic, mobile, shadowing structure(s) with the lumen of the gallbladder, stones that lodge within the cystic duct or neck of the gallbladder may not move; WES sign may be present
sonographic findings of cholelithiasis
A collection of low-level, nonshadowing, dependent, echoes within the gallbladder lumen
sonographic findings of gallbladder sludge
hyperechoic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen
sonographic findings of gallbladder polyps
focal or diffuse thickening of the gallbladder wall; comet-tail artifact that projects from the gallbladder wall into the lumen of the gallbladder
sonographic findings of Adenomyomatosis
RUQ tenderness
epigastic or abdominal pain
leukocytosis
possible elevation in ALP, ALP, GGT, and bilirubin (with obstruction)
fever
paid that radiates to the shoulders
nausea and vomiting
jaundice if there is an obstruction
clinical findings of acute cholecystitis
gallstones, positive sonographic Murphy sign, gallbladder wall thickening, gallbladder enlargement, pericholecystic fluid, sludge
sonographic findings of acute cholecystitis
RUQ pain, epigastric or abdominal pain, leukocystosis, possible elevation in ALP, ALT, GGT, and bilirubin, fever, pain that radiates to the shoulders, nausea and vomiting
clinical findings of gangrenous cholecystitis and Gallbladder perforation
galls stones, loss of the sonographic Murphy sign, gallbladder wall thickening with a possible perceptible wall tear, focal wall necrosis, bulges of the gallbladder wall, sloughed membranes, and ulcerative craters, gallbladder typically loses its shape, pericholecystic fluid, sludge
sonographic findings of gangrenous cholecystitis and gallbladder perforation
diabetic patient
RUQ pain, possible without Murphy sign
fever
can progress to sepsis
clinical findings of emphysematous cholecystitis
dirty shadowing reverberation, or ring-down artifact emanating from the gallbladder wall or gallbladder lumen consistent with air, champagne sign
sonographic findings of emphysematous cholecystitis
gas bubbles within the gallbladder wall may rise to the nondependent wall of the gallbladder
Champagne sign
intolerance to fatty foods because of subsequent abdominal pain; nontender gallbladder
clinical findings of chronic cholecystitis
contracted gallbladder; WES sign; gallstones; wall thickening
sonographic findings of chronic cholecystitis
RUQ tenderness, epigastric or abdominal pain, leukocytosis
clinical findings of acalculus cholecystitis
positive sonographic Murphy sign, gallbladder wall thickening, pericholecystic fluid, sludge
sonographic findings of alcalculous cholecystitis
palpable gallbladder, could suffer from painless jaundice, possible elevation in ALP, ALT, GGR, and bilirubin
clinical findings of gallbladder enlargement
gallbladder measures greater than 4-5 cm in diameter or greater than 8-10 cm in length
sonographic signs of gallbladder enlargement
calcification of the gallbladder wall recognized by an echogenic curvilinear structure within the gallbladder fossa with shadowing; the identification of the calcified posterior wall of the gallbladder is helpful to differentiate from the WES sign, signs of chronic cholecystitis may be present
sonographic findings of porcelain gallbladder
weight loss; RUQ pain; jaundice; nausea and vomiting; hepatomegaly; possible elevation in ALP, AST, GGT, and bilirubin
clinical findings of gallbladder carcinoma
nonmobile mass within the gallbladder lumen that measures greater than 1 cm; diffuse or focal gallbladder wall thickening; irregular mass that may completely fill the gallbladder fossa; invasion of the mass into surrounding liver tissue
sonographic findings of gallbladder carcinoma
Where is the gallbladder located/
posterior to the right lobe of the liver within the gallbladder fossa
The gallbladder is an ____peritoneal organ
intra
pear shaped sac, used to store and concentrate bile that is produced by liver
main lobar fissure
3 distinct layers to main lobar fissue
mucusal layer (innermost layer, consists of multiple folds and rugae)
fibromuscular layer (middle layer)
serosal layer (outer layer)
The gallbladder consists of the ____, ____, and _____.
neck
body
fundus
contiguous with cystic duct, connects gallbladder to rest of biliary system as level of common hepatic duct
neck
portion of biliary tree that lies distal to union of the cystic duct with hepatic duct
common bile duct
most dependent portion of the gallbladder
fundus
Blood supply to the gallbladder is via:
cystic artery
The cystic artery is a small branch of the _____
right hepatic artery
The hormone _____, causes the gallbladder to contract
cholecystokinin
twisting of the blood supply of the gallbladder
gallbladder torsion
gallbladder torsion is also known as:
gallbladder volvulus
the “whirlpool” sign is associated with:
gallbladder torsion
spiral appearance of cystic artery with color Doppler
“whirlpool” sign
gallbladder totally surrounded by hepatic parenchyma
intrahepatic gallbladder
The normal gallbladder is __-__ cm in length.
8-10
The normal gallbladder is __-__ cm in diameter.
4-5
Gallbladder volume equation
v= 0.523(LxWxH)
The gallbladder normally holds __ mL of bile.
40
The gallbladder should measure no more than __mm
3
Helpful labs for gallbladder
ALP
AST
bilirubin
GGT
LDH
WBC
biliary stones that form within the gallbladder
cholelithiasis
Gallstones usually consist of:
cholesterol
calcium bilrubinate
calcium carbonate
6Fs associated with cholelithiasis
fat
female
fertile
flatulent
fair
forty
mobile, echogenic structure within gallbladder lumen that produces an acoustic shadow; WES sign, twinkle artifact
cholelithiasis
WES sign
wall echo shadow sign
occurs posterior to a strong, granular, and irregular surface
twinkle artifact
viscid bile, most often associated with biliary stasis
gallbladder sludge
collection of low-level, nonshadowing, dependent echoes within gallbladder lumen
gallbladder sludge
thick sludge that can mimic an intraluminal gallbladder mass
tumefactive sludge
gallbladder completely fills with tumefactive sludge; isoechoic to liver parenchyma
hepatization of gallbladder
projection of tissue from gallbladder wall that protrudes into the lumen of the gallbladder
gallbladder polyps
most common type of gallbladder polyp
cholesterol polyps
cholesterol polyps measure less than __ mm
10
result of accumulation of cholesterol and triglycerides within gallbladder wall
cholesterol polyps
round object stuck to gallbladder wall
“ball-on-the-wall” sign
results from disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the gallbladder wall
cholesterol polyps
diffuse polypoid appearance of gallbladder filled with polyps
strawberry gallbladder
dissemination of glands within the muscle
adenomyomatosis
luminal epithelium hyperplastic; muscular layer becomes thickened; produces diverticuli or tiny pockets
adenomyomatosis
sinuses may contain cholesterol crystals that produce comet tail artifact; most often seen protruding into gallbladder lumen from anterior wall
Rokitansky Aschoff sinuses
sudden onset of gallbladder inflammation
acute cholecystitis
most common cause of acute cholecystitis is
gallstone that has become lodged in cystic duct or neck of gallbladder
laboratory findings of acute cholecystitis
elevation in ALP and ALT
leukocytosis
elevation of bilirubin
focal tenderness over gallbladder
Positive Murphy sign
sonographic findings of acute cholecystitis
gallstones
pericholecystic fluid
sludge
thickened gallbladder wall that may contain edematous fluid
can be a direct evolution of acute cholecystitis; focal wall necrosis; buldges of gallbladder wall; sloughed membranes; ulcerative craters
gangrenous cholecystitis
most often discovered in diabetic patients; form of acute cholecystitis; caused by gas-forming infection invading gallbladder lumen or wall or both
emphysematous cholecystitis
gas or gas bubbles produced by bacteria within gallbladder wall will lead to manifestation of _____, ______, or _____
dirty shadowing
reverberation
ring-down artifact
gas bubbles rise to nondependent portion of gallbladder wall
champagne sign
results from intermittent obstruction of cystic duct by gallstones, resulting in multiple bouts of acute cholecystitis
chronic cholecystitis
presents with all symptoms and sonographic findings of cholecystitis but no gallstones are present
chronic cholecystitis
chronic cholecystitis is most often found in:
children; recently hospitalized patients; immunocompromised
also referred to as suppurative cholecystitis
empyema of the gallbladder
gallbladder filled with purulent material (pus)
empyema of the gallbladder
chronic infection of the gallbladder; characterized by intramural accumulation of inflammatory cells
xanthogranulomatous cholecystitis
sonographic findings of xanthogranulomatous choelcystitis
asymmetrical thickening of the gallbladder wall; intraluminal echogenic debris
The gallbladder should not exceed ____in diameter
4-5 cm
The gallbladder should not exceed ____ in length
8-10
also referred to hydropic gallbladder or mucocele of the gallbladder
Gallbladder enlargement
clinical detection of an enlarged, palpable gallbladder caused by a pancreatic head mass, painless jaundice
courvoiser gallbladder
Courveisier gallbladder may be associated with _____ disease
Kawasaki
results from the calcification of the gallbladder
porcelain gallbladder
echogenic curvilinear structure within the gallbladder fossa with shadowing; gallstones and chronic inflammation present
porcelain gallbladder
most common cancer of the biliary tract
gallbladder carcinoma
through to be caused by chronic irritation of the gallbladder wall by stones; almost always associated with gallstones; increased risk in patients with gallstones
gallbladder carcinoma
distinct, nonmobile, hypoechoic mass with lumen, diffuse gallbladder wall thickening, irregulary polypoid mass that completely fills gallbladder fossa
sonographic findings of gallbladder carcinoma
Gallbladder carcinoma is suspected if a polyp or mass more than __ cm
1
most common metastatic disease of the gallbladder
malignant melanoma
The most common location of gallstones is in the _____ because it is the most dependent part of the gallbladder
fundus
_______, produced by the entero-endocrine cells of the duodenum, causes gallbladder to contract
cholecystokinin
___, ___, and _____ may be most beneficial for determining evidence of gallbladder and bile duct disease
AST
ALP
bilirubin
The ______ can be used to identify small gallstones
twinkle artifact
_______, which is a group of proliferative and degenerative gallbladder disorders includes both adenomyomatosis and cholesterolosis
hyperplastic cholecystoris
______ is associated with comet-tail artifact
adenomyomatosis
The presence of gallstones and a positive sonographic Murphy sign is a strong indicator of _____
acute cholecystitis
________ is most often discovered in diabetic patients
emphysematous cholecystitis
The identifaction of the calcified posterior wall of the gallbladder is helpful to differentiate porcelain gallbladder from _____
WES sign
Hepatization of the gallbladder occurs when the gallbladder:
fills with sludge
A 71 year old patient presents to the emergncy department with painless jaundice and an enlarged palpable gallbladder. These findings are highly suspicious for:
Courvosier gallbladder
The innermost layer of the gallbladder wall is the:
mucosal layer
Which of the following would not be a laboratory finding typically analyzed with suspected gallbladder disease?
a. ALP
b. ALT
c. Bilirubin
d. Alpha-fetoprotein
d
The cystic artery is most often a direct branch of the:
right hepatic artery
The middle layer of the gallbladder wall is:
fibromuscular layer
Which structure is a useful landmark for identifying the gallbladder?
main lobar fissure
What of the following would be least likely to cause focal gallbladder wall thickening?
a. gallbladder polyp
b. adenomyomatosis
c. ascites
d. adhered gallstone
c
What hormone causes the gallbaldder to contract?
cholecystokinin
The gallbladder wall should measure no more than:
3mm
Which of the following is associated with cholelithiasis and is characteristically found in Africans or people of African descent?
a. Sickle cell disease
b. gallbladder torsion
c. cholesterolosis
d. Arland-Berlin syndrome
a
The direct blood supply to the gallbladder is the:
cystic artery
The outermost layer of the gallbladder wall is the:
serosal layer
Which part of the gallbladder is involved in Hartmann pouch?
Neck
The gallbladder is connected biliary tree by the:
cystic duct
At which layer of the gallbladder is the junctional fold found?
neck
Empyema of the gallbladder denotes:
gallbladder filled with pus
What is/are cholelithiasis?
gallstones
The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with:
cholesterolosis
The most common variant of gallbladder shape is the:
phyrgian cap
The diameter of the gallbladder should not exceed:
5 cm
Patients who suffer from acute cholecystitis that leads to perforation and rupture have a high mortality and morbidity rate secondary to:
peritonitis
All of the following are sources of diffuse gallbladder wall thickening except:
a. acute cholecystitis
b. AIDS
c. hepatitis
d. gallbladder polyp
d
Which statement is not true of cholelithiasis?
a. Men have an increased likelihood of developing cholelithiasis compared to women
b. Patients who have been or are pregnant have an increased occurence of cholelithiasis
c. A rapid weight loss may increase the likelihood of developing cholelithiasis
d. patients who have hemolytic disorders have an increased occurrence of cholelithiasis
a
WES sign denotes:
a gallbladder filled with cholelithiasis
Which of the following is most likely clinical finding of adenomyomatosis?
a. Murphy sign
b. Hepatitis
c. congestive heart failure
d. asymptomatic
d
Tumefactive sludge can resemble the sonographic appearance of:
gallbladder carcinoma
The champagne sign is associated with:
emphysematous cholecystitis
The sequela of acute cholecystitis that is associated with a tear in the gallbladder wall is:
gallbladder perforation
A 32 year old female patient presents to the sonography department with vague abdominal pain. The sonographic investigation of the gallbladder reveals a focal area of gallbladder wall thickening that produces comet-tail artifact. These findings are consistent with:
adenomyomatosis
Which of the following would not be a finding of alcalculous cholecystitis?
a. gallbladder wall thickening
b. pericholecystic fluid
c. cholelithiasis
d. Positive Murphy sign
c
Intermittent obstruction of the cystic duct by a gallstone results in:
chronic cholecystitis
Which of the following is not a risk factor for the development of gallstones?
a. phrygian cap
b. pregnancy
c. total parenteral nutrition
d. oral contraceptive use
a
A nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represents:
gallbladder polyp
Focal tenderness over the gallbladder with probe pressure describes:
Murphy sign
Diabetic patients suffering from acute cholecystitis havfe an increased risk for developing:
emphysematous cholecystitis
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found within:
adenomyomatosis
The spiral valves of Heister are found within:
cystic duct
Which of the following would yield a gallbladder with an hourglass appearance?
a. Hartmann pouch
b. Phyrgian cap
c. Junctional fold
d. Bilobed
d
With which of the following is Courvoisier gallbladder associated?
a. a pancreatic head mass
b. a stone in the cystic duct
c. cholecystitis
d. chronic diverticulitis
a
Calcification of the gallbladder wall is termed:
porcelain gallbladder
What produces the hormone cholecystokinin?
duodenum
What is the artifact associated with adenomyomatosis?
comet tail
Which of the following is a condition associated with vasculitis and gallbladder hydrops?
a. Kawasaki disease
b. Beckwith-Wiedemann syndrome
c. sickle cell disease
d. multiple hepatic hemangioma
a
Unconjugated bilirubin may also be referred to as:
indirect bilirubin
Which of the following may not be a clinical or sonographic finding in patients with emphysematous cholecystitis?
a. diabetes
b. gas formation in the wall of the gallbladder
c. fever
d. Murphy sign
d
Which of the following is a rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells?
a. gallbladder perforation
b. adenomyomatosis
c. xanthogranulomatous gallbladder
d. emphysematous cholecystitis
c
Which of the following would most likely be associated with gallstones or biliary tree obstruction?
a. elevated direct bilirubin
b. elevated indirect bilirubin
c. decreased conjugated bilirubin
d. decreased unconjugated bilirubin
a
Which of the following is associated with focal wall necrosis, bulges in the gallbladder wall, sloughing membranes, and ulcerative craters?
a. porcelain gallbladder
b. adenomyomatosis
c. gangrenous cholecystitis
d. emphysematous cholecystitis
c
What condition may increase the likelihood of developing gallbladder carcinoma?
chronic cholecystitis
Gallbladder carcinoma may be suspected when a gallbladder polyp exceeds:
1 cm
Which of the following would increase the likelihood of suffering from gallbladder torsion?
a. floating gallbladder
b. gallstones
c. acalculous cholecystitis
d. AIDS cholangiopathy
a
Which of the following is a result of an accumulation of cholesterol and triglycerides within the gallbladder wall?
a. gallstones
b. gallbladder carcinoma
c. gallbladder polyp
d. xanthogranulomatous cholecystitis
c
Which of the following is not a section of the gallbladder?
a. neck
b. body
c. fundus
d. head
d
What is another name for empyema of the gallbladder?
suppurative cholecystitis
Which of the following could be a likely cause of a hydropic gallbladder?
a. multiple gallbladder polyps
b. gallstone in the cystic duct
c. phyrgian cap
d. hartman pouch
b
What clinical finding is not typically associated with gallbladder carcinoma?
a. weight gain
b. hepatomegaly
c. jaundice
d. elevation in ALP
a
