Gallbladder and ducts Flashcards
What should the wall thickness of the GB be under?
<3mm
Normal dimensions of the GB?
Length = 8cm
TRV and AP = 4-5cm
What valve located in the neck, prevents kinking of cystic duct?
Heister valve
What forms the CBD? hint: two ducts
Cystic duct and CHD
Intra-heptic bile ducts should measure less than?
<2mm
What structures make up the “mickey mouse” sign?
HA (more medial) and CBD (more lateral)
What structure forces bile into the GB?
A) Ampulla of vater
B) Sphincter of Oddi
C) Cystic duct
D) GB neck
B
What is NOT a function of the GB?
A) Secretes bile
B) Produces bile
C) Concentrates bile
B - the liver produces bile
What is known as the absence of CHD & cystic duct causing main hepatic ducts to drain into
GB and the GB draining into the CBD?
GB interposition - can cause jaundice and abdominal pain
What is the “most common type of obstructive biliary disease in infants and young children”?
Biliary atresia - more common in males
What SF would exclude atresia?
A) Intraheptaic DD
B) Intrahepatic and extra hepatic DD
C) Hydropic GB
D) Contracted GB
B
What type of choledocal cyst is Caroli’s disease?
A) 2
B) 3
C) 4
D) 5
5
What other abnormalities are associated with Caroli’s?
Medullary sponge kidney, hepatic fibrosis
What abnormality is strongly associated with Caroli’s disease?
A) MCDK
B) Cholelithiasis
C) Medullary sponge kidney
D) Cholecystitis
C
SF of Caroli’s ?
Multiple cysts around porta hepatis. “Beaded appearance”
Name pathologies that cause GB wall thickening.
Cholecystitis, adenomyomatosis, polyps, gallbladder cancer, gallbladder torsion
What pathology will NOT cause GB wall thickening?
A) Adenomyomatosis
B) GB cancer
C) Polyp
D) Sludge
D
Whats another name for a sludge ball?
Tumefactive
What does GB hepatization mean?
Sludge completely fills the GB
What is NOT part of the 6 F’s as a clinical presentation of cholelithiasis?
A) Fair
B) Fat
C) Forty
D) Fifty
D
When there are multiple stones in the GB, what do we call that?
A) WES
B) Gravel
C) Hepatization
D) Tumefaction
Gravel
What is the significance of WES?
GB completely filled with stones, we have to rely on the GB wall to delineate
What is NOT a SF of acute cholecystitis?
A) Hydropic GB
B) GB wall thickening
C) Hyperemia
D) Small cystic artery
D - LARGE cystic artery will be seen
Tumefactive sludge vs biliary slude?
Tumefactive - appears as a ball of sludge and can mimic a mass - use CD to differentiate from a mass
Biliary sludge - layers of sludge within GB lumen
What is the most common cause of acute cholecystitis?
Stone impacted in GB neck or cystic duct
What is another name for empyema cholecystitis?
Suppurative - pus in GB lumen and inflamed - typically in diabetics
What is emphysematous cholecystitis associated with?
Diabetic patient and more common in men
75 year old female patient comes in with RUQ pain and an interolance to fatty foods. Upon scanning you see a thickened, fibrotic GB wall and the GB itself appears contracted. What is the most likely diagnosis?
A) Acute cholecystitis
B) Emphysematous cholesyctitis
C) Acalculous cholecystitis
D) Chronic cholecystitis
D
What is the term for when “all or part of the GB wall is calcified” ?
Porcelain GB - more common in females
What is bouveret syndrome also called?
Gallstone ileus - fistula forms between GB and duodenum and allows stone to pass into small intestine causing bowel obstruction
In Mirrizi syndrome, what will be dilated?
A) Intraheptic ducts
B) Extraheptaic ducts
C) IHDD and EHDD
D) EHDD and hydropic GB
A - since a stone is obstructing GB neck or cystic duct, everything before it will become dilated = IHDD
Where in the GB does perforation typically occur?
A) Neck
B) Body
C) Fundus
D) They are all equal in incidence
C
Cholesterosis is also known as?
Strawberry Gallbladder
Patient presents with jaundice and no other symptoms. Upon scanning, you see a large hydropic GB and a lesion at the pancreatic head. What is the possible diagnosis?
A) Bouveret syndrome
B) Courvoisier GB
C) Mirizzi syndrome
D) Gallstone ileus
B - typically occurs due to a pancreatic malignancy
WHat is known as an “abnormally distended GB filled with thick bile, mucus or pus”?
Hydropic GB
What is NOT a reason for GB wall thickening?
A) GB torsion
B) Cholelithiasis
C) Courvoisier GB
D) Adenomyomatosis
C
Majority of GB cancers are of what kind?
Adenocarcinoma
What is NOT a cause of IHDD with a normal CBD?
A) Klatskins tumor
B) Cholangitis
C) Choledocal cyst
D) Mirizzi Syndome
C
Which of the following with cause proximal dilation of intrahepatic ducts without distal dilation of the CBD?
A) Sclerosing cholangitis
B) Acute pancreatitis
C) Choledocolithiasis
D) Choledocal cyst
A - all the others will also have a dilated CBD
What pathology would you suspect when a patient has 7x the normal limit of ALP?
A) Panc carcinoma
B) Chronic pancreatitis
C) Acute pancreatitis
D) AIDS cholecystopathy
D
