Gallbladder Pathology Flashcards
Hartman’s pouch
fold in the neck of the gallbladder
Phrygian cap
fold in the fundus of the gallbladder
what is a complete septation of the gallbladder?
complete septation of the gallbladder is where the gallbladder has walls formed within itself
what is the potential concern for a gallbladder septations?
gallstones since the walls make it hard for bile to move around, so bile sits and become calcified
removal of the gallbladder
cholecystectomy
what happens to bile after the gallbladder is removed?
bile will go directly into the intestines. This can cause a lot of bowel issues for people who have gotten their gallbladder out since all the bile they produces goes straight to their bowels.
what are the normal measurements of the GB?
the normal measurements of the GB are
- 3cm TRV
- AP <7-10cm longitudinal
- wall thickness should be less than 3mm
what are the landmarks for the GB?
the GB should be located in the RUQ near the MLF and portal vein
what are the clinical symptoms of gallbladder disease
the clinical symptoms of gallbladder disease include RUQ pain after eating greasy foods, N/V, gallbladder attack, or jaundice
define sludge
thickened bile from bile stasis, which is when bile sits still for a long period of time
what patients are at risk for developing sludge?
patients with hyperalimentation therapy and with obstruction of the GB
what is the sonographic appearance of sludge or sludgeballs
sludgeballs appear more echogenic and dense compared to normal bile. it looks like a ball inside the GB that moves around freely within the GB
what are some causes of GB wall thickening
GB wall thickening is caused by cholecystitis, gallbladder perforation, gallbladder carcinoma, hepatitis and cirrhosis, ascites, renal failure, and right heart failure
what is cholecystitis?
cholecystitis is inflammation of the gallbladder
define acute cholecystitis
acute cholecystitis is caused by gallstones being impacted in the cystic duct or in the neck of the gallbladder.
what is the most common cause of acute cholecystitis?
gallstones
clinical signs of acute cholecystitis
- acute RUQ pain (+ murphy’s sign)
- fever
- N/V
- leukocyotsis
- increased serum bilirubin and alkaline phosphate levels
what are the complications of acute cholecystitis?
may be serious and include empyema, emphysematous, or gangrenous cholecystitis, and perforation
what is the sonographic appearance of cholecystitis?
The sonographic appearance of acute cholecystitis:
- Wall > 3mm
- Distended gallbladder lumen > 4cm
- Gallstones
- Impacted stones in cystic duct of neck/ Hartman’s pouch of the gallbladder
- Positive murphy’s sign
- Increased doppler flow
- Pericholecystic fluid collection
define cholelithiasis
cholelithiasis is where a single, large gallstone or tiny gallstones are collected within the gallbladder
what is the danger of cholelithiasis?
tiny stones in the gallbladder are the most dangerous because they can enter the bile ducts and obstruct the outflow of bile
who is at risk for gallstones?
gallstones are most common in the 5fs
1) fat
2) female
3) forty
4) fertile
5) fair-skinned
what are the symptoms of gallstones?
- RUQ pain
- radiation of pain to the shoulder after a high-fat meal
- epigastric pain
- N/V when the symptoms become acute
gallstones may also be asymptomatic until the stone lodges into the cystic or common bile duct
what is a rare complication of acute cholecystitis?
emphysematous cholecystitis
what is emphysematous cholecystitis?
rapidly progressive and 15% fatal in patients. it is associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts
what are the risk factors of emphysematous cholecystitis?
- more present in men
- 50% of patients are diabetic
- gallstones may not be present in 30% to 50% of patients
what is the sonographic appearance of emphysematous cholecystitis?
depends on the amount of gas within the wall of the gallbladder
- if the gas is intraluminal, a prominent and bright echo is demonstrated along the anterior wall with a ring down or comet-tail artifact directly posterior to the echogenic structure.
define gangrenous cholecystitis
Gangrenous cholecystitis is a serious and painful complication of acute cholecystitis that my lead to perforation. It is where the gallbladder dies
when can gangrenous cholecystitis occur?
this can occur after a prolonged infection, and causes the gallbladder to undergo necrosis
what is the sonographic appearance of gangrenous cholecystitis?
-thickened GB wall and edematous with focal areas of exudate, hemorrhage, and necrosis. ulcerations and perforations may be present, resulting in the pericholecystic abscess or peritonitis
define acalculus cholecystitis
the acute inflammation of the GB without the presence of cholelithiasis
who is at risk for acalculus cholecystitis?
those who have depressed gastric motility; postoperative patients, trauma, burns, HIV, etc.
how does acalculus cholecystitis appear on US?
thickening of GB wall, edema, and inflammation
define chronic cholecystitis
the most common form of GB inflammation. it is the result of numerous GB attacks of acute cholecystitis with subsequent fibrosis (thickening) of the GB wall.
what are the clinical symptoms of chronic cholecystitis?
transient RUQ pain but no tenderness like with acute
define porcelain gallbladder
a rare occurrence where calcium is incrusted into the gallbladder wall
what are the risk factors of porcelain gallbladder?
- most common in females
- usually found as a mass or by accident in an exam
why is porcelain gallbladder a concern?
because 25% of patients with porcelain gallbladder develop cancer on the gallbladder wall
what is the sonographic appearance of porcelain gallbladder?
bright echogenic echo is seen on a region of the gallbladder with posterior shadowing (WES sign)
define cholesterolosis
a condition in which cholesterol is deposited within the lamina propria of the gallbladder
what is another name for cholesterolosis?
“strawberry bladder” because the mucosa resembles a strawberry
what is the sonographic appearance of cholesterolosis?
echogenic lines within the lumen of the gallbladder and attached to the walls on the inside of the gallbladder. these appear like the inside of a cave.
define polyp
polyps are small, well-defined soft-tissue projections connected by the stalk to the gallbladder wall
what is the sonographic appearance of a polyp?
polyps appear as echogenic balls/masses attached to the inside wall of the gallbladder; looks like the inside of a cave
define adenomyomatosis
a hyperplastic change in the gallbladder wall. papilloma may occur singly or in groups and may be scattered over a large part of the mucosal surface of the gallbladder.
what is the sonographic appearance of adenomyomatosis
cause a “ring down” appearance within the gallbladder that looks like the inside of a cave.
what is the most common type of gallbladder cancer?
adenocarcinoma
risk factors for gallbladder cancer?
gallbladder cancer is associated with 80% to 90% of patients with cholelithiasis
what is the sonographic appearance of gallbladder cancer?
gallbladder cancer causes the thickening and rigidity of the gallbladder walls adenocarcinoma appears more echogenic compared to the surrounding tissues, it also appears ill-defined
