GB

Question 1

GB dimension

Answer 1

Upper limit nml - transverse 4cm, length 10cm, wall thickness 3mm

Question 2

Phrygian cap

Answer 2

when the fundus folds on itself

Question 3

percent of stones that become sx per year

Answer 3

2

Question 4

stones smaller than ___ may not shadow

Answer 4

3mm

Question 5

How to tell Gb full of stones from gas filled bowel loop?

Answer 5

gas produces dirty shadow. loos for WES (wall-echo-shadow) complex. First line is pericholecystic fat (echogenic), 2nd is gb wall (hypo), 3rd is top of stones (echo) *not always seen

Question 6

Mjor ddx for stones

Answer 6

sludge balls - no shadow and may be mobile. Polpys are immobile

Question 7

Floating stones arecomposed of what

Answer 7

cholesterol, IV contrast can increase the spec gravity of bile

Question 8

likely sludge ball which is not mobile wtd?

Answer 8

follow up in several weeks to r/o neoplasm

Question 9

Signs of acute cholecystitis

Answer 9

1. Stones
2. Wall thickening >3mm
3. GB enlargement (4/10)
4. Pericholesytic fluid
5. Impacted stone
6. Murphy’s sign

Question 10

Signs of advanced cholecystitis

Answer 10

1. Pericholecystic fluid
2. Sloughed mucosal membranes
3. Wall abscesses
4. Wall disruption
5. Wall Ulceration
6. Focal wall buldge

Question 11

MC place for pericholesytic fluid?

Answer 11

around fundus

Question 12

% that is acalculous

Answer 12

5

Question 13

Causes of acalculous cholesyticits

Answer 13

Ischemia, ascending infecting, or gb toxicity. often seen after long term TPN or burns/major surgery

Question 14

Emphysematous cholecystitis

Answer 14

Elderly men
Ischemia
Perforation 5x more likely
Manifests as very bright reflections in nondependent portions of gb and dirty shadowing +/- ring down

Question 15

GB carcinoma

Answer 15

Women>men

5y survival < 20% (better if confined to GB, but 80% have portal invasion at dx)

Question 16

US appearance of GB carcinoma

Answer 16

• Intraluminal mass sually ass. w/ stones
• Focal or diffuse wall thickening (15-30%)
• Bulky intraluminal polypoid mass (least common)
• Infiltration of adjacent liver or vessels
• Periportal/pantreatic lymphadenopathy
• bile duct obstruction

Question 17

Ddx for GB carcinoma

Answer 17

Sludge, polyps, focal adenomyomatosis

Question 18

Cholesterolosis

Answer 18

TGs and cholesterol esters deposit in lamina propria.
Not related to chol lvls
Usually planar and not seen on US
Can see polypoid ones which appear as “ball on the wall” - <5-10mm and slender rarely seen stalk.

Question 19

CA w/ greatest tendency to met to GB

Answer 19

Melanoma

Question 20

Polypoid lesion intervention sizes

Answer 20

<5mm - no f/u
5-10mm - monitor
>10mm - surgical removal

Question 21

Adenomyomatosis

Answer 21

mucosa hyperplasia and thickening of muscular layer.
May see rokitansky-aschoff sinuses
May also appearr as diffuse wall thickening or localized mass

Question 22

Rokitansky-Aschoff sinueses

Answer 22

Adenomyomatosis

• mucosal herniation into muscular layer
• often with cholesterol crystals which will have comet tail artifact (seen on near wall with anechoic background)
• may see actual cystic space

Question 23

Biliary causes of wall thickening

Answer 23

Cholecystitis
Adenomyomatosis
Cancer
AIDS cholangiopathy
Sclerosing cholangitis

Question 24

Nonbiliary causes of wall thickening

Answer 24

Edematous states:
Heart failure (will see abn pulsatile venous flow)
Hypoproteinemia
Portal hypertension/cirrhosis (GB wall varices)
_
Adjacent inflammation:
Hepatitis
Pancreatitis

Question 25

Porcelain GB

Answer 25

2/2 chronic irritation
95% with stones
High risk of CA - ppx ectomy
Wall calcifies and will shadow
Ddx includes stone filled GB (wont see back wall, +WES) and emphysematous (dirty shadowing)