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Abdomen Pathology > GB & Biliary Pathology > Flashcards

GB & Biliary Pathology Flashcards

1
Q

Clinical symptoms of GB pathology include…

A
  • RUQ epigastric pain (most classic symptom)
  • right shoulder pain
  • nausea and vomiting
  • jaundice
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2
Q

GB wall thickening greater than ___ mm is abnormal.

A

3mm

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3
Q

Sonographic appearance of sludge in GB…

A
  • non shadowing
  • homogeneous material which layers and shifts with patient position
  • sludge balls (tumefactive sludge)
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4
Q

Normal wall thickness is under ___ mm

A

3

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5
Q

Most common cause of gallbladder wall thickening is …

A

cholecystitis

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6
Q

Inflammation of the GB that may have one of several forms. acute or chronic, acalculous, emphysematous, or gangenous

A

Cholecystitis

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7
Q

Gallbladder wall inflammation is usually due to ________ obstruction by a gallstone.

A

cystic duct

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8
Q

symptoms and findings of acute Cholecystitis…

A
  • acute RUQ pain, plus positive Murphy’s sign, fever, and leukocytosis
  • gallstones
  • enlarged GB (hydrops) even after a fatty meal
  • sludge
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9
Q

_________ stimulates contraction of GB and releases the sphincter of Oddi

A

cholecystokinin

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10
Q

Most common disease of the GB and may consist of a single large stone or hundreds of tiny stones.

A

Cholelithiasis

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11
Q

factors that may lead to the development of gallstones include….

A

-pregnancy -diabetes, oral contraceptives -hemolytic disease -diet-induced weight loss and total parenteral nutrition

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12
Q

sonographic criteria for Cholelithiasis included…

A
  • a mobile
  • strongly echogenic structure
  • with posterior acoustic clean shadowing
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13
Q

When the gallbladder is completely filled with stones from chronic cholecystitis. only be able to image the anterior border of the GB. “wall echo shadow”. also called “the double arc”. You will see

  • wall
  • then echo
  • then shadow
A

“WES” sign

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14
Q

The presence of both thickened bile and thin, watery bile can cause the appearance of __________

A

“floating gallstones”

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15
Q

Complications of acute Cholecystitis

A
  • emphysematous cholecystitis
  • Gangrenous cholecystitis
  • Empyema (collection of pus in the pleural space)
  • Gallbladder perforation
  • Pericholecystic abscess
  • Pancreatitis
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16
Q

Rare complication of acute cholecystitis due to GB wall ischemia and infection. More common in diabetic men due to neuropathy. Infection with presence of gas forming bacteria in GB wall and lumen with extension into the biliary ducts. comet-tail (reverberation) due to gas

A

Emphysematous Cholecystitis

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17
Q

Tissue loss due to decreased blood supply. Serious and painful. Associated with perforation, focal areas of exudate, hemorrhage and necrosis

A

Gangrenous Cholecystitis

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18
Q

sonographic findings of Gangrenous Cholecystitis…

A
  • presence of diffuse echogenic densities filling the GB lumen in the absence of bile duct obstruction
  • echogenic material with non-shadowing, not gravity dependent and does not show a layering effect
  • irregular GB wall (adematous pockets)
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19
Q

gangrenous

A

tissue loss due to decreased blood supply

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20
Q

signs suggestive of gangerous cholecystitis include:

A

assymetric wall, thickening, wall striations, pericholecystic fluid

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21
Q

complication of acute cholecystitis;

localized fluid collection in the GB fossa, complications include: peritonitis, pericholecystic abscess, biliary fistula

A

Gallbladder Perforation

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22
Q
  • purulent material within the gallbladder due to bacteria-containing bile associated with acute cholecystitis
  • initiated with obstruction of the cystic duct
  • same symptoms of acute + fever and leukocytosis
A

Empyema

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23
Q
  • acute cholecystitis without the presence of gallstones
  • possibly due to decreased cystic artery blood flow or reflux of pancreatic enzymes into the GB
  • associated with conditions that produce depressed motility
    • MURPHY’S SIGN
A

Acalculous

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24
Q
  • rare condition found more in elderly women
  • symptoms of acute cholecystitis
  • massively inflamed and distended GB, possible twisting of the cystic artery and duct (twisting > 180 degrees increases risk for gangrenous GB)
  • surgical intervention for treatment
A

Torsion of the Gallbladder

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25
Q

caused by transient obstruction of the GB neck or cystic duct by a stone. sonographic findings are -the same appearance as acute cholecystitis -thickened walls -sludge and an obstructing cystic duct stone may be present

A

Chronic Cholecystitis

26
Q
  • Rare
  • calcification of the GB wall
  • associated with cholelithiasis and chronic cholecystitis
A

Porcelain Gallbladder

27
Q

higher incidence in older females, increased risk of cancer of the GB wall***
echogenic echo with posterior shadowing

A

Porcelain Gallbladder

28
Q

differential diagnosis for porcelain gallbladder

A

WES sign

29
Q
  • sludge-like material with a high concentration of calcium
  • **associated with chronic cholecystitis and gallstone obstruction of the cystic duct
  • may be seen as a fluid layer that results in distal acoustic shadowing
  • “sludge that shadows”
A

Milk of the Calcium Bile

30
Q
  • small, non-shadowing intraluminal soft tissue masses

- fixed and do not change positions within the gallbladder

A

GB Polyps

31
Q
  • lipids are deposited in the gallbladder wall
  • also know as “strawberry gallbladder
  • vary in size and can be as large as 1cm
  • usually multiple, do not shadow, and are NOT mobile
A

Cholesterolois

32
Q
  • benign neoplasms of the GB with premalignant potential
  • usually occurs as a solitary lesion
  • homogenously hyperechoic
A

Adenoma

33
Q

** comet-tail is associated with ______

A

Adenomyomatosis

34
Q
  • hyperplastic changes involving the GB wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula
  • diverticula within the GB wall (Rockitansky-Aschoff sinuses or RAS)
  • comet-tail* (icicle look)
A

Adenomyomatosis

35
Q

Hydrops of the GB is also known as ______

A

mucoclele of the GB

36
Q
  • round distended, non inflamed gallbladder due to obstruction of the cystic duct
  • bile is reabsorbed and the GB is filled with an anechoic secretion from the mucosa
  • asymptomatic and presenting as a palpable RUQ mass
A

Hydrops of the GB

37
Q

Sonographic appearance of hydrops…

A
  • obstructing stone noted in enlarge but non-tender gallbladder
  • Courvoisier GB (enlarged, non-diseased GB associated with a mechanical obstruction of the CBD of from an extrahepatic mass. ex. pancreatic cancer*
38
Q
  • associated with gallstones
  • increased risk with procelain GB
  • metastatic GB carcinoma (secondary to melanoma)
  • usually un-resectable due to late detection
A

Gallbladder Carcinoma

39
Q
  • congenital anomalies of the bile ducts consisting of cystic dilatation of the intra and extrahepatic bile ducts
  • caused by reflux of pancreatic secretions into the bile duct
  • may appear as true cyst in the RUQ with or without apparent communication with the biliary system.
A

choledochal cysts (aneurysm of the CBD)

40
Q

classifications of choledochal cysts

A
  • localized cystic dilation of the CBD
  • diverticulum from the common bile duct
  • invagination of the CBD into the duodenum
  • dilation of entire CBD and CHD
41
Q
  • rare congenital abnormality of segmental saccular cystic dilation of major intrahepatic bile ducts
  • found in younger adults or pediatrics
  • associated with renal disease or congenital hepatic fibrosis
A

Caroli’s Disease (type V)

42
Q

CHD is considered dilated above ____ mm

A

10

43
Q

5 ways to differentiate intrahepatic bile ducts from portal veins

A
  • alteration in normal appearance of the portal triad
  • irregular wall of dilated bile ducts
  • stellate confluence
  • acoustic enhancement behind dilated ducts
  • peripheral duct dilation
44
Q

distal common bile duct obstruction…

A

the entire system distends including the gallbladder

45
Q

common hepatic obstruction…

A

only proximal ducts will distend. the gallbladder will be contracted

46
Q

Obstruction at the junction of the right and left hepatic ducts…

A

intrahepatic ducts dilate

47
Q

most common level of obstruction…

A

cystic duct

48
Q

with billiary obstruction what is elevated?

A

serum alkaline phosphate and conjugated or direct bilirubin levels are elevated

49
Q

two most common causes of biliary obstruction?

A

gallstones and carcinoma of the head of the pancreas.
other causes… -choledochaolithiasis -cholangiocarcinoma -cholanitis -Mirizzi syndrome -choledochal cysts -gallbladder carcinoma

50
Q

Orginates within the large bile ducts- usually CHD or CBD

A

Cholangiocarcinoma (Bile duct carcinoma)

51
Q
  • type of cholangiocarcinoma,
  • located at the hepatic hilum (junction of the right and left bile duct)
  • results in intrahepatic but not extrahepatic biliary dilation
A

Klatskin’s tumor

52
Q
  • extrahepatic biliary obstruction (due to impacted stone in the cystic duct causing ectrinsic mechanical compression of the common hepatic duct***)
  • painful jaundice
A

Mirizzi’s syndrome

53
Q

sonographic findings of Mirizzi’s syndorme

A
  • intrahepatic bile duct dilataion (above cystic duct)
  • a normal sized CBD
  • a large stone in the neck of the GB or cystic duct
  • a smooth curved segmental stenosis of CHD
54
Q
  • stones in the bile duct, ** most common cause of extrahepatic obstructive jaundice
  • *ductal stones especially if ductal dilatation is present
A

Choledocholithiasis

55
Q

sonographic findings of choledocholithiasis

A
  • echogenic structure in extrahepatic duct

- dilated biliary tree

56
Q

air in the biliary tract

A

Pneumobilia

57
Q
  • infection and inflammation in the biliary ducts

- increase in alkaline phosphatase and conjugated or direct bilirubin

A

Cholangitis

58
Q

more than 50% sclerosing cholangitis patients will have _______

A

ulcerative colitis

59
Q

sonographic findings of cholangitis**

A
  • wall of the intrahepatic bile ducts may be thickened in a smooth or irregular fashion
  • liver and bile ducts reveals localized irregular dilation of the intrahepatic bile ducts and unusual intraluminal soft-tissue protrusion into the bile ducts and portal radicals
60
Q
  • **absence of the extrahepatic biliary tree (from the hilum of the liver to the duodenum)
  • gallbladder is present 20% of the time
  • associated with polysplenia syndrome
  • sonographically seen as two-vessel portal triad (portal vein and hepatic artery)
A

Biliary atresia (seen in infants)

61
Q
  • **developmental congenital abnormality of the biliary tract characterized by multifocal segmental dilation of the intrahepatic bile ducts
  • type of choledochal cyst
  • findings include multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts.
A

Caroli’s Disease

Abdomen Pathology (9 decks)

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