Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring 2014 - ABD TEST 3 - GALLBLADDER ✔️ > Pathology > Flashcards

Pathology Flashcards

0
Q

What is an important question to ask the patient before scanning the GB?

A

The last time they have had anything by mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Clinical symptoms of GB disease…

A 
RUQ pain especially after fatty meals
Nausea & vomiting
Right shoulder & midepigastric pain
Jaundice
Chills & fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is sludge?

A

Concentrated bile - soft echoes layered in dependent part of GB that will change with patient position

Gravity dependent

Asymptomatic or with associated GB disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes sludge?

A 
Thickened bile
Bile stasis (doesn't move)
Prolonged fasting or hyper alimentation therapy (feeding tube)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can resemble a mass or psuedo tumor when related to sludge?

A

Tumefactive sludge - use color Doppler - long standing biliary obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe a sludge ball…

A

Medium level echogenic masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the normal thickness of the GB wall?

A

Less than 3 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where do you measure the thickness of the GB wall?

A

Anterior wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Cholelithiasis?

A

GB stones; can be large or small

Tiny stones are dangerous because they can obstruct the bile flow in the ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cholelithiasis etiology…

A

Abnormal bile composition
Stasis
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stages of gallstone formation…

A

Saturation of bile
Nucleation (forming a blob)
Growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gallstone composition…

A

Cholesterol
Calcium bilirubinate
Calcium carbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common GB disease?

A

Cholelithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cholelithiasis clinically…list the “F’s”

A 
Fat
Female
Forty
Fertile
Fair
Flatulent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of Cholelithiasis…

A 
Obesity
Diabetes
Pregnancy
Oral contraceptives
Estrogen replacement
Pancreatitis
Biliary infection
Alcohol cirrhosis
Diet induced
Rapid weight loss program
Feeding tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What % of Cholelithiasis evokes no clinical manifestations?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a serious consequence in obstruction of the cystic duct or CBD?

A

GB hydrops - getting bigger from fluid build up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Bouveret?

A

Gastric outlet obstruction caused by gallstone in the pylorus or proximal duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cholelithiasis sonographically…

A 
Gallstones
Increased GB size
Decubitus
Acoustic shadowing
Acoustic impedance of gallstones
WES sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the WES sign?

A

Completely filled with gallstones

No lumen…all shadow

Wall Echogenic Shadowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When will you see floating gallstones?

A

Prolonged fasting, air, oral cholecystogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do you need to make sure your not confusing for gallstones?

A

GB valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is cholecystitis?

A

Inflammation of the GB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 5 forms of cholecystitis?

A 
Acute
Chronic
Acalculous
Emphysematous
Gangrenous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a Murphy’s sign?

A

A hypersensitivity with deep palpitation in the sub costal area when a patient takes in a deep breath that may produce inspiratory arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe acute cholecystitis…

A 
Cholelithiasis
Cystic duct obstruction or neck of GB obstruction (Hartmann's Pouch)
Females
\+ Murphy's
Fever
Leukocytosis
Abn LFTs 
Pancreatic reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The most common cause of acute cholecystitis is ___________.

A

Gallstones - impacted & extrinsic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute cholecystitis sonographically…

A

Thickened wall
Edema-halo
Enlarged (greater than 5 cm trans)
Pericholecystic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe chronic cholecystitis…

A

Contraction of GB
Coarse wall thickening
WES sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common form of GB inflammation?

A

Chronic cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clinical symptoms for cholecystitis…

A

Intermittent RUQ pain
Intolerance to fatty, fried food
Intermittent nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Acute inflammation of the GB is ___________.

A

Acalculous cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acalculous cholecystitis is absent of ___________.

A

Gallstones - Cholelithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical workup of acalculous cholecystitis…

A

+ Murphy’s
Abn LFTs
Increased amylase
Increased WBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Acalculous cholecystitis sonographically…

A

Decreased blood flow in the cystic artery
Extrinsic compression of the cystic duct by a mass
GB wall thickened
Sludge
Pericholecystic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe emphysematous cholecystitis…

A

Acute cholecystitis
Gas forming bacteria in wall and lumen into ducts
Relationship to diabetes
May lead to gangrene with associated perforation
Surgical emergency
Fever, pain, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Emphysematous cholecystitis sonographically…

A

Prominent bright echo along the anterior wall

Ring down or comet tail artifact

37
Q

Gangrenous cholecystitis sonographically…

A

Absent blood supply - necrosis
Thickened and edematous wall
Hemorrhage
Gallstones or fine gravel

38
Q

Describe gangrenous cholecystitis…

A 
May lead to perforation
Abn LFTs
Ulcerations
Pericholecystitis abscesses
Peritonitis
Painful complications
39
Q

Gangrenous cholecystitis has a medium to coarse echogenic densities which means not ___________, not ___________, not ___________.

A

Shadowing
Gravity dependent
Layering

40
Q

Name 3 types of benign neoplasm.

A

Adenoma
Cholesterolosis
Adenomyomatosis

41
Q

Describe cholesterolosis…

A 
Cholesterol deposited in the GB wall
STRAWBERRY GB
Polyps (most common psuedo tumor of GB)
Attached with a stalk
Less than 10 mm
Do not shadow
42
Q

Describe adenomyomatosis…

A

Hyperplastic change
Papillomas
Over the mucosal surface

43
Q

Adenomyomatosis is a ___________ change in the GB wall.

A

Hyperplastic

44
Q

With adenomyomatosis, ___________ may occur singly or in groups and may be scattered over a large part of the mucosal surface of the GB.

A

Papillomas

45
Q

Papillomas are not a precursor to ___________.

A

Cancer

46
Q

With adenomyomatosis, various patient positions and compressions show the ___________ to be ___________ in the GB.

A

Lesion

Immobile

47
Q

Adenomyomatosis sonographically…

A

Ring down or comet tail

W shaped reverberation between diverticula Rokitanski-Aschoff sinuses

48
Q

Describe porcelain gallbladder…

A 
RARE
GB wall calcified
Calcium incrustation
Gallstones
Asymptomatic
25% progress to CA**
49
Q

Primary GB CA is ___________.

A

Rare

50
Q

What is the mortality rate if GB CA infiltrates other organs?

A

Near 100%

51
Q

What is GB CA?

A

Obstruction of the cystic duct from compression

Metastatic may occur from melanoma

52
Q

GB CA sonographically…

A

Heterogenous solid mass
Dilated ducts
Most common biliary malignancy

53
Q

Describe metastatic disease…

A

Primary of stomach, pancreas, & ducts
Focal thickening of the duct
Intraluminal

54
Q

Most common tumor sites that can spread to the biliary system are from the ___________, ___________, & ___________.

A

Breast
Colon
Melanoma

55
Q

Metastases can affect the ___________ and ___________ ductal system.

A

Intrahepatic

Extrahepatic

56
Q

On sonography, the appearance of metastases is similar to that of ___________.

A

Cholangiocarcinoma

57
Q

___________ is the second most common primary malignancy of the GB.

A

Cholangiocarcinoma

*poor prognosis

58
Q

With cholangiocarcinoma, cancer is within the ___________.

A

Ducts

59
Q

What 2 liver diseases are associated with cholangiocarcinoma?

A

Liver cirrhosis

Hepatitis C

60
Q

Generally a biliary duct measures ___________. A dilated duct measures ___________.

A

Greater than 6 mm

Greater than 10 mm

61
Q

What is courvoisier?

A

Obstruction of the CBD due to pancreatic mass

Enlargement of the GB

62
Q

What is cholecystomegaly?

A

Hydropic GB

Enlarged GB without wall thickening

Obstruction of duct

63
Q

What are the 3 extra hepatic obstruction? Describe.

A

Intrapancreatic - pancreatic ca, choledocholthiasis, chronic pancreatitis

Suprapancreatic - between pancreatic & porta hepatis, head of pancreas & duct are normal

Porta hepatic - neoplasm, hydrops of the GB

64
Q

___________ is a specific cholangiocarcinoma at the junction of the right and left hepatic duct.

A

Klatskin’s tumor

65
Q

___________ is when there is an impacted stone in the cystic duct or GB neck.

A

Mirizzi Syndrome

66
Q

What will you see in a parasagital scan when there is an obstruction?

A 
Alteration at PV
Irregular walls of the ducts
Stellate confluence
Acoustic enhancement
Peripheral ductal dilatation
67
Q

___________ is an inflammation of the bile ducts.

A

Cholangitis

*increased pressure in the biliary tree with pus

68
Q

Clinical symptoms of cholangitis…

A

Fever
Malaise
Sweating and shivering
Can lead to shock

69
Q

3 types of cholangitis…

A

Oriental sclerosing cholangitis
AIDS cholangitis
Acute obstructive suppurative cholangitis

70
Q

Lab values and sonographical appearance of cholangitis…

A

Increased Alk Phos and bili

Thickened ductal wall

71
Q

What is ERCP?

A

(Post) endoscopic retrograde cholangiopancreatopgraphy - this procedure can give you an inflection (cholangitis)

72
Q

___________ is a disease caused by the parasitic roundworm, which uses a fecal-oral route of transmission.

A

Ascariasis

73
Q

With ascariasis, the worm grows in the ___________ before entering the biliary tree though the ___________. This will cause ___________.

A

Small bowel

Ampulla of Vater

Acute biliary obstruction

74
Q

Describe choledocholthiasis…

A

Stones in CBD
Associated with acalculous cholecystitis
Impacted stones in the ampulla of Vater
Elevated direct bili and Alk Phos

75
Q

___________ is when there is blood in the biliary tree.

A

Hemobilia

76
Q

The main cause of hemobilia is ___________.

A

Biliary trauma

77
Q

___________ is air within the biliary tree.

A

Pneumobilia

78
Q

Pneumobilia may be caused by what 2 things?

A

Emphysematous cholecystitis

Inflammation from an impacted stone in the CBD

79
Q

Describe choledocholthiasis cysts…

A

CONGENITAL conditions involving cystic dilatation of bile ducts
Pancreatic juices refluxing into the bile ducts
Rare
Females - infants to 10 years
“Outpouching of the GB”

80
Q

What is choledochal cysts associated with?

A

Gallstones
Pancreatitis
Cirrhosis

81
Q

Clinical symptoms of choledochal cysts…

A 
ABD mass
Pain
Fever
Jaundice
Confirmed with nuc med scan
82
Q

How many classification types of choledochal cysts are there?

A

6 types

83
Q

What is choledochal cysts type V?

A

Cysts have been classified as Caroli’s disease

84
Q

Choledochal cysts in the RUQ:

_________ of the CBD
_________ from the CBD
_________ of the CBD

A

Dilatation

Diverticulum

Invagination

85
Q

_________ is a rare congenital disorder that classically causes saccular ductal dilatation.

A

Caroli’s disease

86
Q

_________ will have multiple cystic structures in the are of the ductal system towards the _________.

A

Caroli’s disease

Porta hepatis

87
Q

Caroli’s disease sonographically…

A

Ducts may show a BEADED appearance as they extend into the periphery of the liver

88
Q

Describe biliary atresia…

A

Ducts are obliterated

Congenital

Neonatal

89
Q

_________ cause thickening of the GB wall from inside the GB…“chole-“ will be attached to explanation.

_________ cause thickening of the GB wall from outside the GB…other organs involved.

A

Intrinsic - cholecystitis

Extrinsic - hepatitis & cirrhosis

97
Q

What can cause GB wall diffuse thickening…

A 
Normal contracted GB
Ascites
Acute hepatitis, cirrhosis
CHF
Renal disease
AIDS
Pancreatitis
98
Q

What can cause GB wall focal thickening…

A 
Adenomyomatosis
Polyp
Adenoma
Carcinoma
Metastatic

Spring 2014 - ABD TEST 3 - GALLBLADDER ✔️ (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions