Gallbladder Flashcards
mechanical obstruction can result from what 3 things?
gallstones, tumors in biliary tree, enlargement of pancreatic head
4 symptoms of gallbladder disease
pain, RUQ pain after ingestion of greasy foods, nausea and vomiting, right shoulder pain
most classic symptom of gallbladder disease
pain
when will jaundice develop
when a stone blocks the bile ducts between gallbladder and intestines, producing pressure on liver and forcing bile into the blood
what is sludge?
thickened bile due to bile stasis
what patients are seen with sludge?
patients with prolonged fasting or hyperalimentation therapy and with obstruction of gallbladder
2 sonographic findings of sludge
prominent gallbladder, low level echoes
what may be seen with cholelithiasis, cholecystitis and other biliary diseases?
sludge
what is tumefactive sludge?
sludge balls- mobile round non-shadowing echogenic masses in gallbladder
what else may tumefactive sludge resemble?
polypoid mass or pseudo tumor
normal gallbladder wall measures
less than 3 mm
5 gallbladder diseases that may cause the wall to thicken
cholecystitis, adenomyomatosis, cancer, cholangiopathy, sclerosing cholangitis
7 Nonbiliary diseases that may also cause wall thickening
Cirrhosis, Hepatitis, Pancreatitis, Portal hypertension, Heart failure, Ascites, AIDS
in what plane should gallbladder wall be measured?
transducer perpendicular to anterior gallbladder wall (usually transverse)
what is cholecystitis
inflammation of the gallbladder
5 forms of inflammation of the gallbladder
Acute Chronic Acalculous Emphysematous Gangrenous
what is the most common cause of acute cholecystitis?
cholelithiasis that creates a cystic duct obstruction
acute cholecystitis is six times more common in who?
middle aged women
6 symptoms of acute cholecystitis
Sharp RUQ pain radiating to the back Elevated WBC Fever Nausea Vomiting Positive Murphy’s sign
what is murphy’s sign?
patient is tender over gallbladder region to touch
4 complications of acute cholecystitis
Empyema
Emphysematous cholecystitis
Gangrenous cholecystitis
Perforation
6 sonographic findings of acute cholecystitis
irregular outline of thickened wall, stones, sludge, hydrops, pericholecystic fluid, gallbladder may appear normal
what is the most common form of gallbladder inflammation?
chronic cholecystitis
what happens when the mucosal lining of the gallbladder becomes damaged?
loses the ability to store bile efficiently
4 symptoms of chronic cholecystitis
RUQ pain after eating greasy foods, creams, chocolate (not as severe as acute attack), flatulent, frequent belching, sour taste in mouth
4 sonographic findings of chronic cholecystitis
cholelithiasis, contracted gallbladder, coarse gallbladder wall thickening, WES sign
what is the WES sign?
(wall, echo, shadow)-contracted bright gallbladder with posterior shadowing caused by a packed gallbladder of stones
what is acalculous cholecystitis?
inflammation of gallbladder without the presence of stones
symptom of acalculous cholecystitis
positive Murphy’s sign
3 sonographic findings of acalculous cholecystitis
wall is extremely thick, echogenic sludge seen within dilated gallbladder, pericholecystic fluid
what is emphysematous cholecystitis
complication of acute cholecystitis associated with the presence of gas-forming bacteria within gallbladder wall and lumen with extension into the ducts
T or F? emphysematous cholecystitis is a surgical emergency
true, it is life threatening
what is emphysematous cholecystitis associated with?
diabetes
what is a complication of emphysematous cholecystitis
gangrene with perforation
2 sonographic findings of emphysematous cholecystitis
bright echo along anterior wall, ring down artifact due to gas
7 sonographic findings of gangrenous cholecystitis
thickened gallbladder wall, areas of edema, areas of hemorrhage, areas of necrosis, gallstones or fine gravel, pericholecystic abscesses or peritonitis, densities filling gallbladder lumen
what is the most common disease of the gallbladder
cholelithiasis
what is cholelithiasis
a large single gallstone or hundreds of tiny gallstones (tiny are most dangerous)
what are the 5 F’s?
fat, female, forty, fertile, fair
6 factors predisposing someone to cholelithiasis
pregnancy, diabetes, oral contraceptives, hemolytic diseases, diet induced weight loss, poor nutrition
5 symptoms of cholelithiasis
may be asymptomatic, RUQ pain with radiation to right shoulder after fatty meal, epigastric pain, nausea, vomiting
3 sonographic findings of cholelithiasis
enlarged gallbladder, increased wall thickness, internal reflectors within lumen with posterior shadowing
what are choledochal cysts?
rare congenital dilation of CBD
3 people choledochal cysts are more common in
females, infants, Asian population
choledochal cysts are prone to what 3 things?
biliary stasis, sstone formation, cholangitis
2 sonographic findings of choledochal cysts
dilation of biliary system, appear as true cysts in RUQ with or without communication with biliary system
what causes cholesterolosis
an abnormality in the metabolism of cholesterol within the gallbladder wall
what is strawberry gallbladder?
cholesterolosis
what are gallbladder polyps?
larger deposits of cholesterol that are attached to gallbladder wall by a stalk
how do polyps appear differently than stones
polyps are immobile and don’t produce shadows
what is adenomyomatosis
a hyperplastic change in the gallbladder wall
4 sonographic findings of adenomyomatosis
small elevations in gallbladder lumen
Gallbladder doesnt move
pouches project from wall
what is porcelain gallbladder?
completely calcified gallbladder
reason for complete calcification
unknown but believed to be due to chronic cholecystitis
porcelain gallbladder increases the chance of developing gallbladder carcinoma by
25%
2 sonographic findings of porcelain gallbladder
bright echo seen in region of gallbladder, WES sign
what is the differential diagnosis for porcelain gallbladder
gallbladder packed with stones
who usually has gallbladder carcinoma
elderly
T or F? gallbladder carcinoma usually has a favorable outcome
false, almost always fatal
3 symptoms of gallbladder carcinoma
jaundice, weight loss, palpable RUQ mass
3 sonographic findings of gallbladder carcinoma
intraluminal mass, solid mass where gallbladder should be, thickened wall
3 things that may result in dilated biliary ducts
choledocholithiasis, cholangiosarcoma, enlargement of pancreatic head
most common cause for biliary dilation
choleodocholithiasis
what may patients with choleodocholithiasis assume when they have an attack?
they are having a heart attack
patients with cholangiocarcinoma present with what 2 things
jaundice and weight loss
3 forms of cholangiocarcinoma
scirrhous, polypoid, Klatskin’s tumor
What is acute cholecystitis?
the sudden onset of gallbladder inflammation
What is adenomyomatosis?
benign hyperplasia of the GB wall
What is biliary colic?
pain located in the RUQ in the area of the GB
What is the surgical removal of the GB?
cholecystectomy
What is cholecystokinin?
the hormone produced by the duodenum that causes the GB to contract
Describe Courvoisier GB?
the clinical detection of an enlarged, palpable GB caused by biliary obstruction in the area of the pancreatic head
What is the cystic duct?
Duct that connects the GB to the common hepatic duct
What is hydropic GB?
enlarged GB
What is a junctional fold?
fold in the neck of a GB
What is pericholecystic fluid?
fluid around the GB
Describe the Phrygian Cap
GB fundus folds back on itself
What are Rokitansky-Aschoff sinuses?
tiny pockets with in the GB wall
What are the spiral valves of Heister?
folds located within the cystic duct that prevent it from collapsing or distending
Where is the GB located?
posterior to the RT lobe of the liver
Is the gb intraperitoneal or retroperitoneal?
Intraperitoneal
What supplies blood to the GB?
cystic artery, which branches off the right hepatic artery
What is the normal size of the GB
8-10 cm in length, no more than 5 cm in diameter
What are 3 sources of focal GB wall thickening?
- polyp
- adenomyomatosis
- GB carcinoma
A GB that is completely filled with gallstones with exhibit
WES sign
Risk factors for cholelithiasis (9)
- obesity
- pregnancy
- increased parity
- gestational diabetes
- oral contraceptive use
- estrogen therapy
- rapid weight loss programs
- hemolytic disorder
- total parenteral nutrition
Sludge is AKA
viscid bile
What are the most common kind of GB polyp?
cholesterol polyps
Benign hyperplasia of the GB will result in what?
adenomyomatosis
T/F: Adenomyomatosis is clinically significant?
False
Clinical findings of acute cholecystitis?
RUQ pain, leukocytosis, elevated LFTs, potential positive Murphy’s sign, fever, pain radiating to shoulders, nausea, vomiting
Acalculous cholecystitis is more commonly found in who?
children, recently hospitalized patients, those who are immunocompromised
An enlarged GB can be caused by what?
obstruction of cystic duct (results in hydopic GB)
What is the most common cancer of the biliary tract?
GB carcinoma
Most common metastatic disease of GB
malignant melanoma
A 71 year old patient presents to the ER with painless jaundice and an enlarged, palpable GB. These findings are highly suspicious for:
Courvoisier GB
The innermost layer of the GB wall is the
mucosal layer
The cystic artery is a branch of the
right hepatic artery
The middle layer of the GB wall is the
fibromuscular layer
The outermost layer of the GB wall is the
serosal layer
The GB is connected to the biliary tree by the
cystic duct
All of the following are sources of diffuse GB wall thickening except: A. Malignant ascites B. AIDS C. Hepatitis D. Adenomyomatosis
A. malignant ascites
WES sign denotes:
a GB filled with cholelithiasis
All of the following are sources of diffuse GB wall thickening except: A. benign ascites B. hepatitis C. congestive heart failure D. GB polyp
D. GB polyp (focal)
The sequela of acute cholecystitis that is found more often in diabetic patients is
emphysematous cholecystitis
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with
adenomyomatosis
The spiral vavles or Heister are found within the
cystic duct
