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Abdomen > Gallbladder > Flashcards

Gallbladder Flashcards

0
Q

CBD measure

CHD measure

CBD turns into CHD when…

A

< or = 6 mm

< or = 4 mm

It passes the hepatic artery

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1
Q

GB location

A

GB fossa, main lobar fissure

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2
Q

Kazaam view

A

Right shoulder to left hip

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3
Q

What is a Phrygian Cap

A

Fold at GB fundus

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4
Q

What is Hartmann’s pouch / Junctional parenchymal fold

A

Fold at GB neck

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5
Q

Gallbladder

A

Teardrop / pear shape

Stores bile. Contracts under colicystickinine

7-10 cm L, 2.5 cm W
GB wall < 3 mm

Fundus body neck

Capacity 50 ml bike storage.

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6
Q

CBD

A

Cystic duct + common hepatic duct = common bile duct

CBD < 6 mm
CHD < 4 mm

CBD lat/rt to hep artery, ant to the right of portal vein

CBD post/lat to panc head.

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7
Q

Valves of Heister

A

Spiral folds of mucosa in cystic duct

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8
Q

Arterial and Venous supply to GB

A

Cystic artery (branch of rt hepatic), and cystic vein (drains into portal)

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9
Q

Bile made mostly of

A

Bilirubin

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10
Q

Bilirubin

A

Direct/obstructive jaundice/conjugated bile, water soluble/surgical jaundice

Indirect bile/non obstructive/unconjugated/ water insoluble/medical jaundice

Serum direct bilirubin inc with obstruction.

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11
Q

Sludge aka echogenic bile

Assoc

US findings

A

Inspissated bile made of pigment granules & cholesterol crystals

Assos w. obstruction, cholecystitis, TPN, gallstones

Non shadowing low level echoes. Moves slowly.

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12
Q

GB hepatization

A

Sludge completely fills GB. Looks isoechoic to liver.

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13
Q

Tumefactive sludge

A

Sludge with tumor like appearance

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14
Q

What is cholelithiasis?

Predisposing factors?

Cause

Symptoms

US findings

Complications

A

Gallstones. Most common GB disease. Affects 20 million Americans

5 F’s, biliary infection, ETOH cirrhosis, anemia, TPN, ileal disease, estrogen, bypass surgery, obesity, pregnancy, diabetes, hypercholesterolemia, IV nutrition, OCP, rapid wt loss from diet, white, Hispanic.

Abnl bile composition, bile stasis (not contracting with IV nutrition), infection

Asymptomatic, RUQ pain, n/v, belching, chest pain, pain with fatty meal, pain radiating to right shoulder or epigastrium.

Echogenic foci, shadowing, mobile, dependent, WES sign when contracted.

Obstruction, cholecystitis, assoc w. GB cancer

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15
Q

5 F’s

A

Female Fat Forty Fertile Flatulent Fair

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16
Q

What are the steps of formation of a gallstone?

A

Saturation, nucleation, growth.

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17
Q

What is a gallstone made of?

A

Bilirubin, cholesterol, calcium

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18
Q

What is the WES sign?

A

Seen in patients with gallstones when the GB is contracted. Wall echo shadow

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19
Q

What is cholecystitis?

A

GB inflammation. 1/3 pt with stones will have cholecystitis.

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20
Q

Acute cholecystitis

A

95% with stones, usually stone obstructs cystic duct. Obstructs cystic drainage and gb wall inflames

Murphy’s sign, gallstones, diffuse wall thickening, gb dilatation, sludge

MC cause is stone in neck or cystic duct

Inc alk phos, alt, ast, wbc, bilirubin

Wall thickening > 3 mm, stones, halo w. edema (pericholecystic fluid), distended GB

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21
Q

Emphysematous cholecystitis

A

Infection with gas forming bacteria in GB wall. May not have stones.

Sudden progressive RUQ pain, fever, inc wbc.

Intraluminal and intramural gas. Reverb comet tail.

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22
Q

Gangrenous cholecystitis

A

Serious complication of acute cholecystitis. Wall hemorrhage. Necrosis.

Diffuse pain

Thickened striated wall, intraluminal echoes, taut GB, ff around GB, stones

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23
Q

Perforation

A

Complication of acute, usually in fundus, from cystic duct obstruction, GB distends and causes necrosis.

Stones, infection, diabetes, trauma, cancer, drugs

FF, abscess, wall thick, perforation,

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24
Q

Acalculous cholecystitis

A

Usually males. No stones.

Burn patients, sepsis, prolonged TPN, dehydrated, congenital biliary anomalies, prolonged fasting, pancreatic reflux, hemolysis

Thick GB wall, ff, murphy’s sign, GB wall edema, pericholecystic fluid

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25
Q

Chronic cholecystitis

A

90% with stones, enlg, thick wall, contracted GB, WES sign,

Fatty food intolerance, n/v, RUQ pain, epigastric pain, pain radiating to scapula

Alk Phos, AST, ALT, Bilirubin w. Jaundice, Amylase

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26
Q

Bouveret’s Syndrome

A

Fistula between duodenum and GB causing obstruction. Air can get to biliary tract & obstruct.

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27
Q

Mirizzi Syndrome

A

Large stone impacted in cystic duct. presses on common hep duct & causes pressure necrosis & erosion in duct wall.

IHDD, large stone in cystic duct. Normal size CBD

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28
Q

Empyema

A

Pus in GB, bacterial inflamed GB assoc w. acute cholecystitis. Lumen filled with exudate mainly pus.

Inc fever, chills, WBC

Complex appearance.

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29
Q

Porcelain GB

A

Various amount of calcifications of GB wall, rare,

females > 60 yrs.

assoc w. stone 95%, GB cancer

Asymptomatic, may be palpable

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30
Q

Hyperplastic cholecytosis

A

Benign proliferation of GB wall

Adenomyomatosis, cholesterolosis

31
Q

Cholesterolosis

A

Strawberry GB, cholesterol polyps in wall

Stones, females

Polyps, focal areas w. comet tail artifact in wall

32
Q

Adenomyomatosis

A

Comet tail/ v shaped reverb artifact in GB wall. Overgrowth of wall epithelium. Diffuse, focal, or segmental.

Females, > 40yrs

Wall thickening, intramural comet tail

33
Q

GB carcinoma

A

Rare, adenocarcinoma is most common 80%

Lobular mass that fills lumen, liver mets, periaortic lymph nodes, bile duct obstruction

Females, > 60yrs, stones

Asymptomatic, late dx, loss of appetite, n/v, fatty food intolerance

Localized wall thickening, hetero polypoid lesion w. Irregular borders, cauliflower or broccoli appearance.

intrahepatic ducal dilatation, mets, ascites, color flow to tumor, porcelain GB

Poor prognosis

34
Q

Caroli’s Disease

A

Rare, saccular dilatation of ducts

Assoc with infantile polycystic kidney disease & congenital hepatic fibrosis

35
Q

Choledocholithiasis

A

Stones in ducts

36
Q

Cholangitis

A

Inflamed bile ducts. Bacterial or parasitic. Fever chills fatigue RUQ pain jaundice

Dilated ducts 3-4mm, thick duct walls, extrahepatic ducts with stones, gallstones, large palp gb

37
Q

Ascariasis

A

Parasitic roundworm grows in sm bowel and enters Ampulla of Vater. Poor sanitation areas.

38
Q

Cholangiocarcinoma

A

Cancer of biliary tree. Assoc with primary sclerosing cholangitis. Adenocarcinoma most common.

  1. Intrahepatic
  2. Hilar
  3. Distal

Duct mass with irregular shadowing. Hepatomegaly. Intrahepatic ductal dilatation.

39
Q

Klatskin Tumor

A

Bile duct cancer at hepatic duct bifurcation. Hilar. IHDD without extrahepatic ductal dilatation. Non Union of right and left hepatic ducts. Small solid mass at liver hilum. Death in months.

40
Q

Mets to GB

A

Melanoma (mc), breast, colon

41
Q

GB duplication

A

2 GB

42
Q

Biliary atresia

A

Total absence of biliary tree or small GB. Persistent jaundice

Absent or small GB < 1.5 cm, hepatosplenomegaly, ascites

43
Q

Choledochal cyst

A

Congenital cystic fusiform dilatation of cbd.

Cyst adj to GB.

44
Q

Biliary Rhabdomyosarcoma

A

Rare soft tissue tumor, 1-5 years old. Arises in biliary tract and caused obstruction. Lobulated mass at hilum. Dilated ducts.

45
Q

Hydropic GB

A

GB dramatically enlarged without wall thickening due to total obstruction of cystic duct

Asymptomatic, palp RUQ mass. Obstructing stone noted in an enlarged non tender gb.

46
Q

What artifact can cause smudgy echoes?

A

Reverberation, side lobes, slice thickness artifact.

47
Q

GB prep

A

8-12 hours NPO

48
Q

GB thickening can be due to

A

Inflammation, hepatic dysfunction, congestive heart failure, GB wall varices, cholecystitis, ascites, hypoalbuminemia, acute hepatitis, adenomyomatosis, cancer, contracted normal gallbladder

49
Q

Post prandial GB appearance

A

Contraction of GB with diffuse wall thickening

50
Q

Murphy’s sign

A

Tenderness in GB

51
Q

Dilated, nontender GB, look in…

A

Head of pancreas for a mass

52
Q

Complication of acute cholecystitis, look for

A

Pancreatitis, GB perforation, gangrenous cholecystitis, emphysematous cholecystitis

53
Q

Severe RUQ pain, n/v, thick GB wall, stones, adj complex fluid. This suggests.

A

Acute cholecystitis complicated by GB perforation

54
Q

Male diabetic severe epigastric pain radiating to back, vomit, chills, fever. Large GB with nondependent hyperechoic foci associated with ring down artifacts. This suggests.

A

Emphysematous cholecystitis

55
Q

Hypervascularity associated with acute cholecystitis is best evaluated with color Doppler on…

A

The cystic artery

56
Q

Shadow at both edges of trvs GB due to

A

Refraction artifact/edge shadowing

57
Q

Irregular mass within GB lumen with hypervascularity and stones. Suggests.

A

GB carcinoma

58
Q

Rokitansky-Aschoff sinuses

A

Associated with adenomyomatosis.

Small mucosal herniation into muscular layer of GB. Diverticuliti in wall.

Appear cystic if filled with bile. Appear echogenic with v shaped reverb if filled with cholesterol.

59
Q

Best way to image intrahepatic biliary system

A

Intrahepatic portal veins

60
Q

Pneumobilia

Hemobilia

A

Air in biliary tract; echogenic foci in biliary tree with shadow and reverb comet tail, commonly seen in liver hilum. MC seen after endoscopic retrograde cholangiopancreatogram.

Blood in biliary tract

61
Q

Courvoiser GB

A

GB distention without wall thickening due to obstructive neoplasm distal to the cystic duct.

62
Q

Junctional fold

A

Incomplete wall appearing between the body and neck. Most common GB variant.

63
Q

Difference between dilated bile ducts and hepatic veins.

A

Dilated bile ducts have irregular tortuous walls, bile ducts have no color flow

64
Q

Which position helps see cbd?

A

Right posterior oblique

65
Q

Most accurate test for acute cholecystitis?

A

Cholescintigraphy

66
Q

Administering cholecystokinin will

A

Contract the GB if normal

67
Q

CHD is located

A

Anterior to the hepatic artery and portal vein

68
Q

Stone impacted in distal cbd. Evaluate for

A

Pancreatitis

69
Q

Courvoiser GB

A

Enlg GB due to extrinsic cause (panc cancer)

70
Q

Fatty meal

A

Bile duct dilates if obstructed and dec in size if not

71
Q

MC cause of bile duct obstruction and labs elevated

A

Gallstones, panc cancer

Elevated serum alkaline phosphate and conjugated direct bilirubin

72
Q

3 extrahepatic bile ducts

A

CHD, cystic duct, CBD

73
Q

3 intrahepatic bile ducts

A

Right hepatic duct, left hepatic duct, Intrahepatic biliary radicals

74
Q

Causes of enlarged gallbladder

A 
Prolonged fasting
Obstructed cystic duct (hydrops)
Obstructed CBD
Courvoiser GB (panc cancer)
Intravenous hyperalinentation
Diabetes
Postvagotomy
75
Q

Solid mass in GB evaluate

A

Liver for mets

Abdomen (15 decks)

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