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ABD Pathology > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

Impacted stone in the cystic duct, cystic duct remnant or gallbladder neck

A

Mirizzi syndrome

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2
Q

Inflammation around stone may cause partial mechanical obstruction of the CHD

A

Mirizzi syndrome

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3
Q

RUQ pain
Jaundice
Recurrent cholangitis
Cholangitic cirrhosis

A

Clinical presentation of Mirizzi syndrome

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4
Q

Sonographic finding of Mirizzi Syndrome

A

Dilatation of CHD and intrahepatic ducts above impacted stone w/ normal CBD

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5
Q

GB considered contracted if measures:

A

Less than 2 cm in diameter after appropriate fasting

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6
Q

Non visualization of GB

A

In 15-25% of PTs with cholelithiasis

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7
Q

“Double arc” sign

A

WES sign

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8
Q

WES triad

A

Wall
Echo
Shadow

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9
Q

Chronic cholecystitis

A

Gallbladder wall fibrosis due to recurrent episodes of acute cholecystitis

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10
Q

Lab values w/ chronic cholecystitis

A 
May be elevated: 
AST
ALT
ALP
direct bilirubin
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11
Q

Sonographic findings of Chronic Cholecystitis

A

Contracted GB w/ shadowing from stones
Hyperechoic wall 4-5mm
May see sludge
Decreased response after CCK injection

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12
Q

Cholecystomegaly AKA

A

Hydropic GB

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13
Q

Hydropic GB

A

GB distention w/o wall thickening
Prolonged total obstruction of cystic duct
GB filled with mucous secretions from wall

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14
Q

Difference between Hydropic GB and courvousier’s GB

A

Courvoisier’s due to obstruction distal to cystic duct

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15
Q

Risk factors for cholecystomegaly

A 
Obstruction of cystic duct/GB neck
Kawasakis disease
Scarlet fever
Recent surgery
Prolonged biliary stasis
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16
Q

Sonographic findings of Hydropic GB

A

TRV/AP > 4cm
Thin walls
Evaluate for Mirizzi syndrome

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17
Q

Courvoisier GB

A

GB distention w/o wall thickening due to obstruction outside of GB

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18
Q

Causes of Courvoisier GB

A

Pancreatic head mass
Duodenal papilla mass
Ampulla of Vater mass
CBD mass

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19
Q

Sonographic findings of Courvoisier GB

A

Same as Hydropic GB

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20
Q

Porcelain GB

A

Complete/patchy calcification of GB wall

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21
Q

Incidence of porcelain GB

A

In 0.6-0.8% of PTs

More frequent in females (5:1)

22
Q

Risk factors for porcelain GB

A

Cholelithiasis

23
Q

Sonographic findings of Porcelain GB

A

May appear as stone filled but lacks WES sign

24
Q

Adenoma

A

Benign epithelial tumor

Localized overgrowth of epithelial lining

25
Q

Adenoma incidence

A

<5% of all GB polyps

26
Q

Risk factors for Adenoma

A

Cholelithiasis

Chronic cholecystitis

27
Q

Sonographic findings of Adenoma

A 
Solitary
<1 cm in diameter
Homogeneous, hyperechoic immobile mass
DO NOT shadow or move
Usually near fundus 
Thickening of GB wall near polyp increases malignancy suspicion
28
Q

Adenomyomatosis AKA

A

Diverticulosis of GB

29
Q

A form of hyperplastic cholecystosis

A

Adenomyomatosis

30
Q

Adenomyomatosis occurs where in most cases?

A

Almost exclusively in fundus

31
Q

Sonographic findings of Adenomyomatosis

A

Thickening of GB wall
Intraluminal diverticula may be seen
Comet tail artifacts in B mode
Twinkle artifact w/ color Doppler

32
Q

Small cholesterol stones/crystals lodged in Rokitansky-Aschoff sinuses

A

Adenomyomatosis

33
Q

Degenerative or proliferation changes due to deposits of cholesterol in GB or mucosal membranes

A

Cholesterolosis

AKA hyperplastic cholecystosis

34
Q

Focal form of cholesterolosis

A

Cholesterol polyps

35
Q

Strawberry GB

A

Diffuse form of cholesterolosis

36
Q

How big do polyps usually measure with cholesterolosis?

A

2-10 mm

37
Q

Strawberry GB is diagnosed with sonography.

T/F

A

False

38
Q

Primary GB carcinoma

A

Malignant neoplasm of GB wall

39
Q

Represents 98% of neoplasms in GB

A

Adenocarcinoma

40
Q

Incidence of primary GB carcinoma

A

Most common biliary malignancy
Most in PTs >50 years
More common in Native Americans and Hispanic Americans w/cholelithiasis
More common in females (3:1)

41
Q

Risk factors for Primary GB carcinoma

A 
Obesity
Smoking
Female
Chronic salmonella typhi infection 
Exposure to industrial chemicals
Cholelithiasis 
Chronic cholecystitis
Porcelain GB
Polyp >2 cm
Primary sclerosis cholangitis
Congenital biliary anomalies
IBD
42
Q

Most common pattern of disease with Primary GB carcinoma

A

Mass from GB fossa replacing GB and invading adjacent liver

43
Q

Patterns of GB carcinoma

A

Irregular GB wall thickening
Polyploid intraluminal lesions w/ irregular borders
“Trapped stone”
Tumors in infundibular/fundal region
May grow into cystic duct and porta hepatis mimicking cholangiocarcinoma

44
Q

Direct extension Mets commonly arise from:

A

Cancers of stomach, pancreas, and bile ducts

45
Q

Hematogenous and lymphatic Mets

A

Lung
Kidney
Esophagus
Malignant melanoma

46
Q

Differential of Mets from primary GB carcinoma

A

Cholelithiasis usually absent

47
Q

Non-inflammatory causes of GB: Diffuse

A 
Normal contracted GB
Hypoalbuminemia-hypoproteinemia
Ascites
Acute hepatitis
CHF
Renal disease
AIDS
Pancreatitis
Cirrhosis
Sepsis
48
Q

Non-inflammatory causes of GB wall thickening:

Focal

A 
Adenomyomatosis 
Adenomatous polyp
Cholesterol polyp
Papillary Adenomas
Primary GB carcinoma
Mets
49
Q

Pseudo-wall thickening

A

TGC too high
Beam average artifact
Tumefactive sludge

50
Q

Thickened GB wall

A

> 3 mm

ABD Pathology (5 decks)

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