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abdomen > Gallbladder Disease test 3 > Flashcards

Gallbladder Disease test 3 Flashcards

0
Q

what is the most important hx question to ask before beginning a study on the GB?

A

when is the last time the patient had anything to eat?

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1
Q

What are the clinical symptoms of GB disease?

A

RUQ pain -especially after fatty meals

nausea and vomiting

right shoulder and mid epigastric pain

jaundice

chills

fever

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2
Q

what is sludge?

A

concentrated (thickened) bile

bile stasis (the stoppage of bile from flowing)(not moving)

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3
Q

what are the symptoms of a patient with GB sludge?

A

asymptomatic

associated GB disease

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4
Q

How does sludge appear sonographically?

A

soft echoes layered in dependent part of gb that change with patient position

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5
Q

What is GB sludge dependent on?

A

gravity dependent

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6
Q

what are some factors that cause GB sludge?

A

prolonged fasting

hyper alimentation therapy

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7
Q

What can tumefactive sludge resemble?

A

mass

psuedotumor (color doppler can help determine)

long standing biliary obstruction

may or may not move when patient position is changed

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8
Q

what are sludge balls?

A

medium level echogenic masses

sticky - may not move like stones

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9
Q

What is a normal GB wall thickness?

A

< 3mm

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10
Q

How should you measure the GB wall?

A

measure on the transverse image at the anterior wall that is perpendicular to the transducer

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11
Q

what is the cholelithiasis etiology?

A

abnormal bile composition

stasis

infection

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12
Q

what are the stages of gallstone formation?

A

saturation of bile

nucleation

growth

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13
Q

what are gallstones composed of?

A

cholesterol

calcium bilirubinate

calcium carbonate

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14
Q

What is the most common disease of the GB?

A

cholelithiasis

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15
Q

What sizes can gallstones be?

A

large

tiny

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16
Q

why are tiny gallstones dangerous?

A

they can obstruct the bile flow in the ducts

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17
Q

what are the 6 F’s of cholelitiasis?

A

fat

female

forty

fertile

fair

flatulent

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18
Q

What are factors that cause cholelithiasis?

A

obesity

diabetes

pregnancy

oral contraceptive

estrogen replacement

pancreatitis

biliary infection

alcohol cirrhosis

diet induced

rapid weight loss programs

total parenteral nutrition

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19
Q

What percentage of cholelithiasis envokes no clinical manifestations?

A

80%

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20
Q

what is a serious consequence of cholelithiasis?

A

obstruction of the cystic duct or CBD with resulting GB hydrops

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21
Q

What is Bouveret’s Syndrome?

A

gastric outlet obstruction caused by gallstone in the pylorus or proximal duodenum

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22
Q

what do we see sonographically with cholelithiasis?

A

gallstones

increased GB size

WES sign - completely filled with gallstones (cannot see lumen)

decubitus

acoustic shadowing

acoustic impedance of the gallstones

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23
Q

sonographically, what do stones > 3mm do?

A

cast a shadow

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24
Q

what are floating stones?

A

a layer of stones “floating” on a thick bile layer of sludge

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25
Q

if you suspect gallstones, what should you do with the patient?

A

roll them and see if the stones move

want to make sure you aren’t seeing Heister’s valve it’s near the neck

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26
Q

what is the WES sign?

A

Wall Echo Shadow (bright wall, no lumen, lg shadow)

indicates a packed bag

characterized by two curvilinear, parallel echogenic lines separated by a thin hypoechoic space and acoustic shadowing distal to the echogenic line in the far field

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27
Q

what is cholecystitis?

A

inflammation of the GB

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28
Q

What are the different forms of cholecystits?

A

acute

chronic

acalculous

emphysematous

gangrenous

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29
Q

What is Murphy’s sign?

A

hypersensitivity with deep palpitation in the sub costal area when a patient takes in a deep breath that may produce inspiratory arrest

John B. Murphy 1903

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30
Q

what is acute cholecystitis?

A

caused by stones being impacted in the cystic duct or in the neck of the gallbladder (hartmann’s pouch)

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31
Q

what is the most common cause of acute choelcystitis?

A

gallstones

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32
Q

What accompany’s acute cholecystitis?

A

cholelithiasis

cystic duct obstruction or neck of the GB obstruction

typically females

positive Murphy’s

fever

leukocytosis

Abnormal LFT’s

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33
Q

What are the five causes of acute cholecystitis?

A

obstruction of the cystic duct

impacted stone

extrinsic pressure

microorganisms

pancreatic reflux

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34
Q

How does acute cholecystitis appear sonographically?

A

thickened wall

edema-halo

enlarged - trv gb >5cm

pericholecystic fluid

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35
Q

What is chronic cholecystitis?

A

most common form of GB inflammation

contraction of GB

coarse wall thickening

WES sign

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36
Q

What are the symptoms of chronic cholecystitis?

A

intermittent RUQ pain

intolerance to fatty, fried food

intermittent nausea and vomiting

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37
Q

What is acalculous cholecystitis?

A

acute inflammation of the GB

absence of cholelithiasis

positive Murphy’s Sign

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38
Q

What condition has decreased blood flow in the cystic artery?

A

acalculous cholecystitis

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39
Q

What condition causes extrinsic compression of the cystic duct by a mass?

A

acalculous cholecystitis

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40
Q

What are the sonographic findings of acalculous cholecystitis?

A

GB wall thickened

sludge

pericholecystic fluid

abnormal LFT’s

increase serum amylase

increase WBC

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41
Q

What is emphysematous cholecystitis?

A

acute cholecystitis

gas forming bacteria AIR IN THE WALL and lumen into ducts

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42
Q

what condition has a relationship to diabetes?

A

emphysematous cholecystitis

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43
Q

what condition may lead to gangrene with associated perforation?

A

emphysematous cholecystitis

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44
Q

what are the symptoms of emphysematous cholecystitis?

A

fever

pain

infection

surgical emergency

45
Q

How does emphysematous cholecystitis appear sonographically?

A

prominent bright echo along the anterior wall

ring down or comet tail artifact

46
Q

what is gangrenous cholecystitis?

A

necrosis-absent blood supply

may lead to perforation

thickened and edematous wall

hemorrhage

abnormal LFT’s

47
Q

what are some other considerations for gangrenous cholecystitis?

A

ulcerations

pericholecystic abscesses

peritonitis

gallstones or fine gravel

painful complication

48
Q

what condition sonographically has medium to coarse echogenic densities?

A

gangrenous cholecystitis

not shadowing

not gravity dependent

not layering

49
Q

What is a benign neoplasm of the GB?

A

adenoma

cholesterolosis

adenomyomatosis

50
Q

What is cholesterolosis?

A

cholesterol deposited in the GB wall

51
Q

What condition has the Strawberry GB?

A

cholesterolosis

52
Q

What is the most common pseudo tumor of the GB?

A

cholesterolosis polyps

53
Q

How are cholesterolosis polyps attached to the GB?

A

with a stalk

less than 10 mm

54
Q

Do multiple cholesterolosis polyps of the wall of the GB shadow?

A

nope!

55
Q

What is adenomyomatosis?

A

hyperplastic change

papillomas

over the mucosal surface

56
Q

what are adenomyomatosis papillomas?

A

may occur singly or in groups

may be scattered over a large part of the mucosal surface of the GB

not a precursor to cancer

57
Q

With adenomyomatosis what will various patient positions and compression allow?

A

to show the lesion to be immobile in the GB

58
Q

When you have multiple papillomas demonstrated along the anterior wall of the GB what will it cause?

A

“ring down” echoes to occur

comet tail

59
Q

With adenomyomatosis where will you find W shaped (ring down or comet tail) reverberation?

A

between diverticula (pockets) Rokitanski-Aschoff sinus

in the wall

60
Q

What is porcelain GB?

A

CAN LEAD TO CANCER

rare

GB wall calcified

gallstones

asymptomatic

because it’s a calcified wall it can be seen on x-ray

61
Q

What is Gallbladder Cancer?

A

Primary is rare

mortality rate near 100%

tumor infiltrates and often invades the liver through tissue, ducts of Luschka and lymph channels

62
Q

Where does metastatic GB Ca come from?

A

may occur from melanoma

63
Q

with GB Ca what duct might get compressed?

A

obstruction of the cystic duct due to compression

64
Q

How does GB Ca appear sonographically?

A

heterogenous solid mass

dilated ducts (double barrel)

most common biliary malignancy

65
Q

What is metastatic GB disease?

A

primary of stomach, pancreas and ducts

focal thickening of the duct

intraluminal mass

66
Q

With metastases to the biliary tree what are the most common tumor sites that can spread to the biliary system?

A

breast

colon

melanoma

67
Q

what two ductal systems do metastases affect?

A

intrahepatic and extrahepatic ductal systems

68
Q

sonographically, the appearance of metastases is similiar to that of _________________.

A

cholangiocarcinoma

69
Q

What is intrahepatic cholangiocarcinoma?

A

the second most common primary malignancy of the liver

cancer within the duct

often unresectable with a poor prognosis

70
Q

which tumor has a rising insidence, secondary to increasing number of patients with liver cirrhosis and hep C?

A

cholangiocarcinoma

71
Q

What are dilated biliary ducts?

A

generally a duct > 6mm is considered borderline

> 10mm is dilated

72
Q

What is Courvoisier?

A

obstruction of the CBD due to pancreatic mass

enlarged?? slide 91

73
Q

what is cholecystomegaly?

A

hydropic GB

enlarged GB without wall thickening

obstruction of duct

74
Q

What is an extra hepatic obstruction?

A

intrapancreatic

pancreatic Ca

choledocholithiasis

chronic pancreatitis

75
Q

What is a suprapancreatic extra hepatic obstruction?

A

between pancreas and porta hepatis

head of pancreas and duct are normal

76
Q

What is a porta hepatic extra hepatic obstruction?

A

neoplasm

hydrops of the GB

77
Q

What is Klatskin’s tumor?

A

specific cholangiocarcinoma at the junctionof the right and left hepatic duct

78
Q

what is Mirizzi syndrome?

A

impacted stone in the cystic duct or GB neck

79
Q

Inflammation of the pancreas may cause the common duct to ________.

A

dilate

80
Q

carcinoma of the head of the pancreas may cause obstruction of the _________ ________ ________.

A

common bile duct

81
Q

What might you be able to see inside the common duct if the duct is dilated?

A

stones

82
Q

What is obstruction?

A

indicated in diameter is > 11mm

83
Q

what is cholangitis?

A

inflammation of the bile ducts

84
Q

what are the clinical symptoms of cholangitis?

A

fever

malaise

sweating and shivering

can lead to shock

85
Q

Sonographically/lab values for cholangitis?

A

increases ALK PHOS and Bili

thickened ductal wall

post enodoscopic retrograde cholangiopancreatography (ERCP)

86
Q

What is ascariasis?

A

disease is caused by the parasitic roundworm, ascaris lumbricoides

uses a fecal-oral route of transmission

the worms grow in the small bowel before entering the biliary tree through the ampulla

case acute biliary obstruction

87
Q

what is choledocholithiasis?

A

stone in CBD

associated with calculous cholecystitis

impacted stones in the ampulla of vater

elevated direct bili and alk phos

88
Q

What is hemobilia?

A

blood in the biliary tree

89
Q

what is the main cause of hemobilia?

A

biliary trauma secondary to percutaneous biliary procedures or liver biopsies

90
Q

what are other causes of hemobilia?

A

cholangitis

cholecystitis

vascular malformations

abdominal _____________slide 110

malignancies

91
Q

what is pneumobilia?

A

air within the biliary tree

92
Q

In a patient with an acute abdomen, pneumobilia may be caused by…

A

emphysematous cholecystitis

inflammation from an impacted CBD

93
Q

What are choledochal cysts?

A

CONGENITAL conditions involving cystic dilatation of bile ducts

pancreatic juices refluxing into the bile duct

rare

more common in females

congenital - infants to ten years

94
Q

what is choledochal cysts associated with?

A

gallstones

pancreatitis

cirrhosis

95
Q

what are the clinical symptoms of choledochal cysts?

A

abdominal mass

pain

fever

jaundice

confirmed with nuc med scan

96
Q

What is type I choledochal cysts classification?

A

a fusiform dilation of the common bile duct

97
Q

what are type II choledochal cysts?

A

true diverticuli of the bile ducts

98
Q

what are type III choledochal cysts?

A

choledochoceles

confined to the intraduodenal portion of the common bile duct

99
Q

what is type IVa choledochal cysts?

A

intrahepatic and extrahepatic biliary dilations

100
Q

what is type IVb choledochal cysts?

A

confined to the extrahepatic biliary tree

101
Q

What are type V choledochal cysts?

A

classified as caroli’s disease

KNOW THIS ONE!!!!

102
Q

What is caroli’s disease?

A

rare congenital disorder that classically causes saccular ductal dilatation

103
Q

with what condition do multiple cystic structures in the area of the ductal system converge toward the porta hepatis?

A

caroli’s disease

104
Q

in what condition are masses seen as localized or diffusely scattered cysts communicate with bile ducts?

A

caroli’s disease

105
Q

in what condition do ducts show a beaded appearance as they extend into the periphery of the liver

A

caroli’s disease

cysts in the liver

106
Q

What is biliary atresia?

A

ducts are obliterated (no ducts from birth)

congenital

neonatal

107
Q

With what diseases would you find GB wall diffuse thickening?

A

normal contracted GB

ascites

acute hepatitis, cirrhosis

CHF

renal disease

AIDS

pancreastitis

108
Q

When would you find GB wall focal thickening?

A

adenomyomatosis

polyp

adenoma

carcinoma

metastatic

109
Q

WHat is the most common intrinsic factor cause thickening of the gallbladder wall?

A

cholecystitis

110
Q

What is the most common extrinsic cause of GB wall thickening?

A

hepatitis and cirrhosis

renal failure

right heart failure

abdomen (11 decks)

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