Gallbladder Flashcards
Where is the gallbladder located?
Inferior to inter lobar fissure.
Between left and right lobes of liver
What are the transverse and longitudinal upper limits of size of the gallbladder?
What are the ultrasound descriptors for gallstones?
Mobile Echogenic Intraluminal Casts acoustic shadows Occasionally get a 'wall-echo-shadow' complex for gallbladders filled with stones
What changes to the ultrasound wave can we make to make stones shadow?
Increase frequency
Adjust focal zone to level of stones
For small stones position patient so stones come together
What are differential considerations for gallbladder stones?
Polyps
Sludge balls
What are sonographic signs of acute cholecystitis ?
Gallstone Wall greater than or equal to 3mm Gallbladder enlargement Pericholecystic fluid Impacted stone Sonographic murphys
What are US signs of advanced cholecystitis?
Pericholecystic fluid Sloughed mucosa Irregular striated lucencies Wall disruption Wall ulceration Focal wall budge Intramural abscess
US findings of gallbladder cancer?
Mass centered in fossa with assoc stones
Eccentric irregular wall thickening
Infiltration of adjacent liver or vessels
Periportal or peri pancreatic lymphadenopathy
Bile duct obstruction
What cancer has the greatest tendency to spread to gallbladder?
Melanoma
At what size can we not followup gallbladder polyps?
5mm or less require no further evaluation.
5-10mm follow for stability.
10mm remove
What is the normal gallbladder wall thickness?
Less than 3mm
What is the differential for gallbladder wall thickening?
Primary gallbladder:
Cholecystitis (acute, chronic, acalculus, xanthogranulomatous)
Gallbladder carcinoma
Adenomyomatosis
Secondary: Liver cirrhosis Hepatitis Congestive RH failure Renal failure Pancreatitis
What is the differential for gallbladder wall thickening?
Primary gallbladder:
Cholecystitis (acute, chronic, acalculus, xanthogranulomatous)
Gallbladder carcinoma
Adenomyomatosis
Secondary: Liver cirrhosis Hepatitis Congestive RH failure Renal failure Pancreatitis
