GI Section IV: GB Pathology Part I - The Last Wish

Question 1

Causes of GB wall thickening (>3 cm)

Answer 1

Very non-specific.
Biliary (Cholecystitis, AIDS, PSC…)

or

non-biliary causes (hepatitis, heart failure, cirrhosis, etc….).

Question 2

Gallstones + kids =

Answer 2

Sickle cell

Question 3

Type of gallstones

Answer 3

Cholesterol (common in caucasians)

Pigment (Common in asians)

Question 4

Reasons a stone might not cast a shadow

Answer 4

• It’s not a stone
• It’s a stone, but < 3mm in size
• The sonographer is an amateur
  (Bush league psyche-out stuff. Laughable, man)

Question 5

Acute Cholecystitis

Answer 5

gallbladder is full of dirty stuff = needs to drain

Clogged? (stone) = dilates (pain) = Bile salt concentration = inflammation of GB mucosa (thickened >3 cm) = Bacteria into mucosa = Gangrenous cholecystitis, rupture, abscess = death

Question 6

Cholecystitis should have:

Answer 6

PAin - Murphy’s sign
Stones
Dilatation of GB
Thickened WAll

Question 7

necrosis of the gallbladder wall.

Answer 7

Gangrenous Cholecystitis

Question 8

Why is Murphy’s sign absent in Gangrenous Cholecystitis?

Answer 8

Necrosis of the nerve supply

Question 9

Answer 9

Gangrenous Cholecystitis

Sloughed membranes or “Cobwebs”

Question 10

Answer 10

Emphvsematous Cholecystitis

Question 11

Answer 11

Emphvsematous Cholecystitis

“Dirty shadowing”