GB Flashcards
GB dimension
Upper limit nml - transverse 4cm, length 10cm, wall thickness 3mm
Phrygian cap
when the fundus folds on itself
percent of stones that become sx per year
2
stones smaller than ___ may not shadow
3mm
How to tell Gb full of stones from gas filled bowel loop?
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
Mjor ddx for stones
sludge balls - no shadow and may be mobile. Polpys are immobile
Floating stones arecomposed of what
cholesterol, IV contrast can increase the spec gravity of bile
likely sludge ball which is not mobile wtd?
follow up in several weeks to r/o neoplasm
Signs of acute cholecystitis
- Stones
- Wall thickening >3mm
- GB enlargement (4/10)
- Pericholesytic fluid
- Impacted stone
- Murphy’s sign
Signs of advanced cholecystitis
- Pericholecystic fluid
- Sloughed mucosal membranes
- Wall abscesses
- Wall disruption
- Wall Ulceration
- Focal wall buldge
MC place for pericholesytic fluid?
around fundus
% that is acalculous
5
Causes of acalculous cholesyticits
Ischemia, ascending infecting, or gb toxicity. often seen after long term TPN or burns/major surgery
Emphysematous cholecystitis
Elderly men
Ischemia
Perforation 5x more likely
Manifests as very bright reflections in nondependent portions of gb and dirty shadowing +/- ring down
GB carcinoma
Women>men
5y survival < 20% (better if confined to GB, but 80% have portal invasion at dx)
US appearance of GB carcinoma
- 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
Ddx for GB carcinoma
Sludge, polyps, focal adenomyomatosis
Cholesterolosis
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.
CA w/ greatest tendency to met to GB
Melanoma
Polypoid lesion intervention sizes
<5mm - no f/u
5-10mm - monitor
>10mm - surgical removal
Adenomyomatosis
mucosa hyperplasia and thickening of muscular layer.
May see rokitansky-aschoff sinuses
May also appearr as diffuse wall thickening or localized mass
Rokitansky-Aschoff sinueses
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
Biliary causes of wall thickening
Cholecystitis Adenomyomatosis Cancer AIDS cholangiopathy Sclerosing cholangitis
Nonbiliary causes of wall thickening
Edematous states: Heart failure (will see abn pulsatile venous flow) Hypoproteinemia Portal hypertension/cirrhosis (GB wall varices) _ Adjacent inflammation: Hepatitis Pancreatitis
Porcelain GB
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)
