URR 23 Flashcards
1
Q
most common cause of increased GB wall thickness
A
acute cholecystitis
2
Q
most common cause of acute cholecystitis
A
stones in the gallbladder neck or cystic duct
3
Q
associated with gallstones; 90% of causes; more common in females
A
calculous cholecystitis
4
Q
no associated stones; more common in men
A
acalculous cholecystitis
5
Q
Acalculous cholecystis is caused by:
A
bile stasis
decreased gallbladder contraction
abnormal fluid levels in the body
infection
IADS
post-surgery or trauma
chronic total parenteral nutrition
6
Q
___, ____, and ____ all cause fluid formation/retention in the body
A
CHF
renal failure
end stage cirrhosis
7
Q
Edema of the GB wall causes:
A
tissue stratification
8
Q
Symptoms of acute cholecystitis:
A
positive Murphy sign
fever
nausea
vomiting
9
Q
Lab testing acute cholecystitis
A
increased bilirubin, ALP, WBC, LFT, PT
10
Q
Acute cholecystitis can lead to:
A
hydrops
perforation
gangrene
empyema
abscess formation
11
Q
Acute cholecystitis appears with ____ wall thickening >3mm
A
diffuse
12
Q
hypoechoic gb wall (halo sign); pericholecystic fluid; overdistended lumen; positive murphy sign; hypervascular of the wall with prominence of the cystic artery
A
acute cholecytisis
13
Q
recurrent gb inflammation
A
chronic cholecystitis
14
Q
Clinical symptoms of chornic cholecystitis include:
A
intermittent fever and RUQ pain
15
Q
Chronic cholecystitis is associated with production of:
A
milk of calcium bile
16
Q
What is milk of calcium bile?
A
high levels of calcium bicarbonate, phophate, and bilirubinate
17
Q
another name for Milk of Calcium bile
A
limy bile
18
Q
Chronic cholecystitis is associated with:
A
porcelain gb
gb carcinoma
19
Q
small, contracted gb wiithout pericholecystic fluid/inflammation; thickened wall without hypervascularity; usually stones present; can see layering of sludge walls
A
chronic cholecystitis
20
Q
Complications of Cholecystitis
A
empyema
emphysematous cholecystitis
perforation
membranous gangrene cholecystitis
abscess
ascending cholangitis
21
Q
pus in gallbladder
A
empyema
22
Q
Empyema results from ___ or ____
A
unresolved gb inflammation
complete gb obstruction
23
Q
Clinical symptoms of empyema
A
RUQ pain
fever
vomiting
24
Q
Lab testing with empyema
A
increased bilirubin, WBC, LFT
25
diffuse internal echoes that do not layer or shadow; thick wall; pericholecystic fluid; stones possible
empyema
26
bacteria infect the inflamed gb
emphysematous cholecystitis
27
Empysematous cholecystitis is more common in ___ and ___
men
diabetics
28
thickened gb wall; enlarged gb with echogenic foci with ringdown artifact within lumen
emphysematous cholecystitis
29
In emphysematous cholecystitis, bacteria produce gas within the debris which causes the:
reverberation artifact
30
In emphysematous cholecystitis, bacteria in the wall can also produce air that causes ____ and ____ artifacts
dirty shadowing
reverberation
31
Clinical symptoms of Emphysematous cholecystitis
RUQ pain
fever
leukocytosis
32
In emphysematous cholecystitis, there is a high of:
gb perforation
33
leads to localized fluid collection in GB fossa
GB perforation
34
GB perforation can lead to ___ and ____
peritonitis
abscess formation
35
caused by infection or GB ischemia
membranous gangrene cholecystitis
36
Membranous gangrene cholecystitis leads to ____ that demonstrates perfusion defects on color Doppler
tissue necrosis
37
irregular thickened walls; possible abscess formation; intraluminal membranes
membranous gangrene cholecystitis
38
calcification of all or part of the gallbladder wall
porcelain gallbladder
39
linear microcalcifications form in the mucosal layer or muscularis of gallbladder wall
porcelain gb
40
rare; chronic inflammation and stones seen in 95% of cases; symptoms similar to chronic cholecystitis
porcelain gb
41
Porcelain gb is associated with increased risk of:
gallbladder carcinoma
42
gb wall very echogenic; mild wall shadowing, but posterior wall still visible, stones may also be present
porcelain gb
43
inflammation of the bile ducts
cholangitis
44
causes of cholangitis
ductal stones
HIV
bacterial or parasitic infection
45
#1 cause of cholangitis
ductal stones
46
Cholangitis is common in what part of the world?
asia
47
Clinical symptoms of cholangitis include:
RUQ pain
intermittent fever
chills
biliary colic
jaundice
48
Charcot triad
fever
ruq pain
jaundice
49
Lab testing with cholangitis
increased direct bilirubin, alkaline phosphatase, GGTP, and/or LFT
amylase and lipase can be elevated if pancreatic ducts involved
leukocytosis
50
nearly always associated with bile duct obstruction; bile infected by gram negative bacteria
bacterial cholangitis
51
Bacteria can enter the biliary system during an invasive procedure, such as an ERCP
bacterial cholangitis
52
Bacterial cholangitis is a _____, report immediately
critical finding
53
caused by liver flukes, ascariasis
parasitic cholangitis
54
may see worms within the ducts as echogenic tortuous structures
parasitic cholangitis
55
Bile duct infection that occurs with advanced HIV infection
HIV cholangitis
56
chronic inflammation and fibrosis of the biliary ducts
primary sclerosing cholangitis
57
With primary sclerosing cholangitis, most patients have ____ or ____
inflammatory bowel disease
ulcerative cholitis
58
Primary sclerosing cholangitis is most commonly seen in:
younger male patients
59
Primary sclerosing cholangitis is associated with:
cirrhosis
liver failure
cholangiocarcinoma
60
Sclerosing cholangitis with a mass in the liver tissue should cause suspicion of:
cholangiocarcinoma
61
Ductal wall thickness is abnormal when it measures over
2 mm
62
Visible wall layers of the biliary duct; diffusely thickened internal ductal wall layers with increased echogenicity of outer ductal wall layer; choledocholithiasis; hepatic abscess
primary sclerosing cholangitis
63
Primary sclerosing cholangitis can lead to massively dilated intrahepatic and extrahepatic ducts up to
3-4 cm
64
Most cases of cholecystitis also have:
a. pancreatitis
b. cholelithiasis
c. adenomyomatosis
d. adenocarcinoma
b
65
How is systemic wall thickening differentiated from inflammation with cholecystitis?
a. magnitude of wall thickening
b. extent of the wall thickening
c. presence of absence of wall hypervascularity
d. presence of absence of stones
c
66
All of the following findings of acute cholecystitis, except:
a. halo sign
b. pericholecystic fluid
c. contracted GB lumen
d. hypervascularity of the wall with prominence of cystic artery
c
67
Which of the following is associated with chronic cholecystitis??
a. transverse GB >5 cm
b. wall hypervascularity
c. marked increase in white blood cell count
d. milk of calcium bile
d
68
Which of the following terms describes pus formation in the gallbladder?
a. empyema
b. emphysematous cholecystitis
c. perforation
d. cholangitis
a
69
Which of the following terms describes air formation in the gallbladder wall?
a. empyema
b. emphysematous cholecystitis
c. perforation
d. cholangitis
b
70
What acoustic artifact is seen with Emphysematous Cholecystitis?
a. refraction
b. side lobe
c. reverberation
d. mirror image
c
71
How is porcelain gb differentiated from cholelithiasis?
a. presence or absence of wall hypervascularity
b. demonstration of the posterior wall of gb
c. presence of absence of wall thickening
d. demonstration of posterior shadowing
b
72
Chronic cholecystitis can lead to ____, which can lead to ____.
a. adenocarcinoma, cholecystitis
b. perforation, myocardial ischemia
c. cirrhosis, Budd Chiari syndrome
d. porcelain gb, adenocarcinoma
d
73
Which of the following is not part of the Charcot Triad?
a. RUQ pain
b. fever
c. hypertension
d. jaundice
c
74
Which of the following is elevated with cholangitis?
a. direct bilirubin
b. white blood cell count
c. alkaline phosphatase
d. all the above
d
75
What type of cholangitis is a critical finding?
a. bacterial
b. parasitic
c. primary sclerosing
d. all the above
a
76
Most patients with ____ have inflammatory bowel disease or ulcerative colitis?
a. bacterial cholangitis
b. HIV cholangitis
c. primary sclerosing cholangitis
d. parasitic cholangitis
c
77
The normal biliary ductal wall thickness should not exceed a minimum of ____
a. 2 mm
b. 3 mm
c. 4 mm
d. 5 mm
a
78
also known as limy bile
milk of calcium bile
79
GB filled with calcium carbonate in a thick pasty form
milk of calcium bile
80
Milk of calcium bile is associated with:
gb stasis
81
lumen filled with highly echogenic material WITH SHADOWING; layering of bile/calcium with change of patient position; may see floating stones in thick debris
milk of calcium bile
82
also known as biliary sand or microlithiasis
sludge
83
stagnation of bile within gb
sludge
84
Precursor to stones
sludge
85
small balls of sludge that are similar in appearance to a mass
tumefactive sludge
86
Sludge is related to:
poor or absent gallbladder function
alcoholism
pregnancy
prolonged fasting
low fat diet or total parental nutrition
87
Lumen filled with internal echoes
layering of contents with change of patient position
does NOT SHADOW
sludge balls
gb sludge
88
sludge balls
tumefactive sludge
89
GB filled with sludge that is isoechoic to the liver
hepatization of the GB
90
stones in the gb
cholelithiasis
91
Ductal stones usually occur from:
the gb passing a stone into the biliary tree
92
What are gallstones composed of?
calcium carbonate
bilirubinate
cholesterol
93
Risk factors for cholelithiasis include
obesity
oral contraceptives
estrogen therapy
pregnancy
impaired gb function
prolonged fasting
total parenteral nutrition
diabetes
high cholesterol
crohn disease
hemolytic disease
94
The accelerated breakdown of red blood cells into excess bilirubin causes increased risk for:
stone formation
95
Clinical symptoms of cholelithiasis include
Radiating ruq pain that occurs several hours after eating
right shoulder or back pain
pain has sudden onset and lasts 1-3 hours
nausea/vomiting
96
Lab testing for cholelithiasis
increased ALP, conjugated bilirubin, GGTP
No increase in AST with an isolated biliary obstruction
conjugated bilirubin may be detected on urinalysis
97
Cholelithiasis + >3mm =
cholecystitis also
98
most common cause of acute cholecystitis is
stone in gb neck and cystic duct
99
two most common causes of biliary tree dilatation
stones
extrinsic compression from pancreatic mass
100
_____ in the cystic duct may cause shadowing that simulates the appearance of a stone
Spiral valves of Heister
