Lesson 2A (Part 3) Flashcards
Who does GB perforation occur in?
5-10% of patients with acute cholecystitis due to prolonged inflammation
What is the sonographic appearance of GB perforation? (5)
- Focal defect in wall and deflation of GB
- Loss of normal shape
- Pericholecystic fluid collection
- abscess type stranding - Perforation extends into adjacent liver parenchyma
- forming abscess - Cystic liver lesion around GB fossa
- suggests a pericholecystic abscess
Perforated GB
Opening in the wall
Who is emphysematous cholecystitis more common in? (2)
- Men
2. Diabetics
What is the sonographic appearance of emphysematous cholecystitis? (4)
- Frequently acalculus
- Higher incidence of perforation
- Gas
- forming bacteria after ischemic event appears as gas in lumen and wall - Echogenic line with posterior dirty shadow or reverberation artifact “Ring Down Artifact”
What may be present in emphysematous cholecystitis?
Pneumobilia
Pneumobilia
Air in ducts
Who is acaulous cholecystitis common in?
Critically ill
- elderly men
Why is acaulous cholecystitis difficult to asses?
Because it has the same signs that are commonly seen in the critically ill without cholecystitis
What is absence with acaulous cholecystitis?
A positive murphy’s sign
- on pain meds (dont feel anything)
What can help in the diagnosis of acaulous cholecystitis?
Cholescintigraphy
What is torsion of the gallbladder?
Twisting of cystic artery or duct
How common is torsion of the gallbladder?
Rare
- acute
What are the symptoms of torsion of the gallbaldder? (5)
- RUQ pain
- Epigastric pain
- RUQ tenderness
- Nausea/vomiting
- Positive murphy’s sign **
same as acute cholecystitis
What is the sonographic appearance of torsion of the gallbladder?
- Massively distended and inflamed gallbladder
- Gallbladder lies in an unusual horizontal position
- Death of local tissues may occur if torsion is >180 degrees
What is the usual treatment for torsion of the gallbladder?
Surgery
Porcelain gallbladder
Calcification of the gallbladder
What is the sonographic appearance of porcelain gallbladder? (4)
- Wall is thickly calcified
- Dense posterior acoustic shadowing
- WES complex is absent
- Presence of stones
What can porcelain gallbladder represent a form of?
Chronic cholecystitis
Who is porcelain gallbladder common in?
Females
- in their 60s
What is advised as a treatment option for porcelain gallbladder?
Resection
What type of polypoid mass is more common?
A benign one
Are benign polypoid masses multiple of singularity?
Multiple
Are malignant polypoid masses multiple of singularity?
Singularity
What is the size of benign polypoid masses?
< 10mm
What is the size of malignant polypoid masses?
> 10mm
What happens to benign polypoid masses during a follow up exam?
Nothing
- they stay the same size and dont change
What happens to malignant polypoid masses during a follow up exam?
They rapidly change in size
What are polypoid masses a type of?
Gallstone disease
What do polyps do?
They protrude the lining of teh gallbladder
Are polyps moble?
No
