Lesson 2A (Part 2)

Question 1

AST

Answer 1

Aspartate aminotransferase

- an enzyme

Question 2

When is AST released?

Answer 2

When cells are injured or damaged

Question 3

What is AST used for?

Answer 3

To diagnose liver disease before jaundice occurs

Question 4

What is elevated levels of AST associated with? (3)

Answer 4

1. Cirrhosis
2. Hepatitis
3. Mononucleosis

Question 5

What are 2 types of congenital anomalies/variants of the GB?

Answer 5

1. Duplication
   - rare
2. Multiseptated

Question 6

What is cholelithiasis?

Answer 6

A gallstone disease

Question 7

What are the risk factors of cholelithiasis? (6)

Answer 7

1. Increasing age
2. Female
3. Fecundity(premenopausal women increased estrogen
   - increase risk cholesterol levels and decrease GB contractions
4. Obesity
5. Diabetes
6. Pregnancy

Question 8

What are 2 complications of cholelithiasis?

Answer 8

1. Biliary colic

2. Acute cholecystitis

Question 9

What is the sonographic appearance of cholelithiasis?

Answer 9

Echogenic appearance with strong posterior acoustic shadowing
- small echogenic stones <5mm may not shadow

Question 10

What is a key feature of stones allowing differentiation from polyps?

Answer 10

If they are mobile or not

• mobile = stones
• not mobile = polyps

Question 11

WES

Answer 11

Wall echo shadow

Question 12

How does WES complex work? (3)

Answer 12

1. Gallbladder wall is first visualized in the near field
2. Bright echo of the stone
3. Acoustic shadowing

Question 13

What is milk of calcium bile?

Answer 13

Its is a rare condition where the GB is filled with semisolid calcium carbonate

Question 14

What is milk of calcium bile caused by?

Answer 14

Stasis

Question 15

What does milk of calcium bile rarely cause?

Answer 15

Acute cholecystitis

Question 16

What does milk of calcium bile look like on US?

Answer 16

Forms a bile calcium level

Question 17

How does biliary sludge appear?

Answer 17

1. As amorphous low-level echoes with no acoustic shadowing

2. Normal GB wall

Question 18

What happens to the sludge when you change a persons body position?

Answer 18

It can move

Question 19

What does biliary sludge lack?

Answer 19

Vascularity

Question 20

What can tumefactive sludge (sludge balls) mimic?

Answer 20

Polyps

Question 21

What is biliary sludge also known as? (2)

Answer 21

1. Biliary sand

2. Microlithiasis

Question 22

What are predisposing factors of biliary sludge? (4)

Answer 22

1. Pregnancy
2. Rapid weight loss
3. Prolonged fasting
4. Critical illness

Question 23

What are potential complications of biliary sludge? (3)

Answer 23

1. Biliary colic
2. Acalculous cholecystitis
3. Pancreatitis

Question 24

What are the signs and symptoms of acute cholecystitis? (4)

Answer 24

1. RUQ pain that is constant
2. Epigastric pain
3. RUQ tenderness
4. Nausea/vomiting

Question 25

What is acute cholecystitis caused by?

Answer 25

Stones

- 90% of the time

Question 26

Who is affected more by acute cholecystitis?

Answer 26

Women

• 3x more likely
• <50 year old group

Question 27

What can the impact of stones in the cystic duct or GB neck cause? (8)

Answer 27

1. Obstruction of bile flow
   - intrahepatic duct dilatation
2. Luminal distension
3. Ischemia
4. Superinfection
5. Necrosis
6. Fever
7. Leukocytosis
8. Increased ALP & bilirubin

Question 28

What is the sonographic appearance of acute cholecystitis? (8)

Answer 28

1. Gallstones
2. Thickening GB wall
   - > 3mm
3. Edematous
   - differentiation of layers
4. Distention of GB lumen
   - >4cm transverse
5. Impacted stone of CD or GB
6. Pericholecystic fluid collection
7. Hyperemic wall
   - vascular (peripheral)
8. Intrahepatic duct/CBD dilation