Gallbladder Pathology Didi

Front 1

Weight reduction and reducing intake of fatty foods may sometimes reduce symptoms of _________________.

Back 1

gallbladder disease

Front 2

Which artifact is this?

Back 2

Acoustic shadowing

Front 3

Which artifact is this?

Back 3

Ring down

Front 4

When not sure whether shadowing from the gallbladder is due to bowel gas or gallstones, rolling the patient into a ____________________ position is helpful in making this distinction.

Back 4

left lateral decubitus

Front 5

When imaging the gallbladder in a transverse orientation, a long shadow seen at both edges of the gallbladder is due to which artifact?

Back 5

The refraction artifact

Front 6

The most classic symptom of gallbladder disease is what?

Back 6

Right upper quadrant pain

Front 7

Other common symptoms of gallbladder disease include?

Back 7

1. Positive Murphy's sign

2. With inflammation, pain radiates to the right shoulder.

3. Intolerance of fatty foods or dairy

Front 8

The gallbladder is evaluated for?

Back 8

1. Increased size

2. Wall thickness

3. Presence of internal reflections within the lumen (the inside of it)

4. Posterior acoustic shadowing

Front 9

_____________ is characterized by the presence of bile in the tissues with resulting yellow-green color of the skin, most likely developing from tiny gallstones obstructing the bile ducts.

Back 9

Jaundice

Front 10

The patient on the right would be presenting with which pathology?

Back 10

Jaundice

Front 11

Nonshadowing, echogenic bile that consists of calcium and cholesterol crystals is known as what?

Back 11

Sludge

Front 12

The most frequent cause of sludge (or thick bile) is what?

Back 12

Cholestasis (when the bile cannot flow from the gallbladder to the duodenum)

Front 13

Sludge is a common precursor to _____________?

Back 13

gallstones

Front 14

Sludge is gravity dependent, meaning it should ___________ when the patient is moved around.

Back 14

shift

Front 15

Some gallbladders are so packed with thick bile (sludge) that it may appear as though the gallbladder is __________ and may often be confused for liver parenchyma.

Back 15

isoechoic

Front 16

This gallbladder has become so full of _________ that it has become isoechoic.

Back 16

sludge

Front 17

Sludge creates a ______________ level, which is an interface created when two fluids have different acoustic properties.

Back 17

fluid-fluid

Front 18

This gallbladder is partially filled with normal bile and sludge, which has created an interface between both fluids. This interface is known as what?

Back 18

A fluid-fluid level

Front 19

When sludge forms into the shape of a ball, stone or mass, it is called what?

Back 19

A sludge ball

Front 20

These would be an example of what?

Back 20

Sludge balls

Front 21

Although sludge balls can resemble pathologies such as ___________, they are avascular, meaning they lack _______________.

Back 21

tumors; blood flow

Front 22

A __________ gallbladder is defined as a large, round distended, non-inflamed gallbladder due to total obstruction of the cystic duct.

Back 22

hydropic

Front 23

A ___________, is a mucus filled gallbladder, that arises when the neck of the gallbladder becomes obstructed by gallbladder stones.

Back 23

mucocele

Front 24

Treatment of a mucocele (a mucus-filled gallbladder) consists of what?

Back 24

A cholecystectomy (removal of the gallbladder)

Front 25

This would be an example of which pathology?

Back 25

A mucocele

Front 26

Hydropic gallbladder is consistent with a transverse measurement of what?

Back 26

5.3 cm

Front 27

When detecting a dilated, non-tender GB (hydropic gallbladder), you should look for mass where?

Back 27

At the head of the pancreas

Front 28

A common cause of a small gallbladder is that the patient has ______________.
what are the other causes for a small gallbladder

Back 28

●Eaten
-biliary obstruction
-chronic cholecystitis
-liver disease that destroys liver parenchyma and there for decreases production of bile
- congenital hypoplasia of gallbladder (extremely rare)

Front 29

When a gallbladder is contracted and filled with many stones, it may hardly be visible and have a lot of shadowing posterior to it, forming what?

Back 29

The wall-echo-shadow (WES) sign

Front 30

"Dirty" shadowing from bowel gas is more ___________ than "clean" shadowing from gallstones.

Back 30

echogenic (snowstorm color)

Front 31

This gallbladder is contracted but also full of stones, causing major shadowing. The ___________ helps us confirm the identification of this gallbladder.

Back 31

WES (wall-echo-shadow) sign

Front 32

A _________________ gallbladder is an enlarged gallbladder caused by an obstruction of the distal portion of the common bile duct, usually because of a mass found at the head of the pancreas.

Back 32

Courvoisier

Front 33

Thickening of the gallbladder wall may or may not be associated with gallbladder ___________ in general.

Back 33

disease

Front 34

The gallbladder walls should measure less than ____ to be considered normal.

Back 34

3mm

Front 35

The most common cause of gallbladder wall thickening is ____________________?

Back 35

cholecystitis

Front 36

The arrow would be pointing to what?

Back 36

Pericholecystic fluid

Front 37

Should the gallbladder walls be measured in longitudinal or transverse?

Back 37

Transverse

Front 38

Excess free fluid in the peritoneal cavity is known as what?

Back 38

Ascites

Front 39

Two non-biliary reasons for diffuse wall thickening of the gallbladder are ____________ and ___________________.

Back 39

ascites and acute hepatitis

Front 40

Inflammation of the gallbladder wall with decreased gallbladder function is known as?

Back 40

Cholecystitis

Front 41

There are seven sonographic criteria that define acute cholecystitis. They include?

Back 41

1. Cholelithiasis (especially in the cystic duct)

2. Positive Murphy's Sign

3. Gallbladder wall thickening of greater than 3mm

4. Gallbladder dilatation

5. Sludge

6. Pericholecystic fluid

7. Increased color flow to the cystic artery (which is only visible when pathology is present)

Front 42

On the picture on the right, the arrow is pointing to hypervascularity of which artery?

Back 42

The cystic artery

Front 43

This patient's gallbladder is exhibiting thickened walls, a stone lodged in the cystic duct, sludge, and there appears to be edema within the thickened walls. This would most likely be an example of which pathology?

Back 43

Acute cholecystitis

Front 44

Another name for pus in the gallbladder would be?

Back 44

Empyema of the gallbladder

Front 45

Gas-forming bacteria within the wall and lumen of the gallbladder that eat away at the gallbladder is known as what?

Back 45

Emphysematous Cholecystitis

Front 46

Emphysematous cholecystitis is a ____________________?

Back 46

surgical emergency

Front 47

When the gallbladder becomes so diseased that its blood supply is cut off and it literally dies, this condition is known as what?

Back 47

Gangrenous Cholecystitis

Front 48

Will you have a positive Murphy's sign in a gangrenous gallbladder?

Back 48

No.. the gallbladder is dead.

Front 49

Localized fluid collection within the gallbladder fossa caused by the gallbladder "bursting" open and releasing its contents is known as what?

Back 49

Gallbladder perforation

Front 50

The top yellow arrow is pointing to a localized fluid collection within the gallbladder fossa caused by the gallbladder bursting open. This condition is known as what? what is its mortality rate _________

Back 50

Gallbladder perforation
19-24%

Front 51

In the fasting patient, the most common cause for nonvisualization of the gallbladder is contraction of the gallbladder due to ________________________?

Back 51

chronic cholecystitis

Front 52

Recurrent or chronic inflammatory changes of the gallbladder is known as what?

Back 52

Chronic cholecystitis

Front 53

This patient's gallbladder has experienced recurrent episodes of gallbladder attacks, it's full of stones, and its walls are enlarged. They are intolerant to fattty foods and fried foods. This patient most likely has what pathology?

Back 53

Chronic cholecystitis

Front 54

Chronic cholecystitis is assocated with _____________ 90% of the time.

Back 54

gallstones

Front 55

An abnormal (man-made) passage between two internal organs or structures is known as a what?

Back 55

Fistula

Front 56

______________________ is an acute inflammation of the gallbladder without the presence of gallstones.

Back 56

Acalculous cholecystitis

Front 57

Sludge-like material with a high concentration of calcium found in the gallbladder and usually associated with chronic cholecystitis is known as?

Back 57

Limy Bile syndrome (or Milk of Calcium)

Front 58

Calcification of the gallbladder walls, strongly associated with chronic cholecystitis, is known as?

Back 58

Porcelain gallbladder

Front 59

Patients who have a porcelain gallbladder (calcification of the gallbladder walls) are most at risk for which other pathology?

Back 59

Gallbladder carcinomas

Front 60

This patient's gallbladder's walls are calcified, causing shadowing. This condition is known as what?

Back 60

Porcelain gallbladder

Front 61

Stones within the gallbladder are known as what?

Back 61

Cholelithiasis

Front 62

The three characteristics for diagnosing gallstones within the gallbladder are?

Back 62

1. Echogenic foci
2. Posterior acoustic shadowing
3. Gravity dependent (they move around when patient position is changed
☆ remember that patient may be asymptomatic or have RUQ pain

Front 63

To reduce shadowing produced by stones or bowel gas, you should decrease/increase the frequency of the transducer?

Back 63

Increase

Front 64

Gallstones form when ______________ concentration in the gallbladder is greater than the ability for the bile to make it soluble.

Back 64

cholesterol

Front 65

Gallstones produce ____________ shadowing.

Back 65

clean (the dark type of shadow)

Front 66

Gallstones less than ____ in size will usually not produce shadowing.

Back 66

3mm

Front 67

The arrow is pointing to very tiny gallstones in this gallbladder. These gallstones are not producing shadowing, meaning they are probably less than ____ in size.

Back 67

3mm

Front 68

Cholesterol gallstones with a significantly lower calcium salt content are known as what?

Back 68

Floating gallstones

Front 69

These gallstones are known as what?

Back 69

Floating gallstones

Front 70

An accumulation of lipids within the gallbladder wall is known as what?

Back 70

Cholesterolosis

Front 71

Small, well-defined soft tissue projections attached to the gallbladder wall by a stalk are known as?

Back 71

Gallbladder polyps

Front 72

____________ are the most common "pseudo"tumors of the gallbladder.

Back 72

Polyps

Front 73

What differentiates polyps from gallstones is the fact that polyps do not cause __________? and they are attached to GB wall vs. stones which attach to the dependent portion of GB

Back 73

shadowing

Front 74

Polyps do/do not move when changing patient position.

Back 74

do not

Front 75

Gallbladder polyps greater than _____ in size are usually related to malignant polyps. another reason is multiplicity (many polyps)

Back 75

10mm

Front 76

This would be an example of what? It does not shadow.

Back 76

Gallbladder polyp

Front 77

Overgrowths of the gallbladder wall is known as?

Back 77

Adenomyomatosis

Front 78

Adenomyomatosis involves overgrowths of the RAS within the gallbladder wall, which stands for?

Back 78

Rokitansky-Aschoff sinuses

Front 79

This pathology causes "comet-tails" or ring-down artifacts to form within the gallbladder. This pathology is known as?

Back 79

Adenomyomatosis

Front 80

_____________ are benign neoplasms (growths) of the gallbladder with a potential to become malignant.

Back 80

Gallbladder adenomas

Front 81

An irregular mass that contains low-level echoes within the gallbladder would probably be considered what?
and what is its mortality rate

Back 81

A gallbladder carcinoma
almost 100

Front 82

The arrow is pointing to an irregular, heterogenous mass within the gallbladder. This would best represent which pathology?
The common signs and symptoms are nausua, vomiting, intolerance to fatty foods or it could be asymptomatic.

Back 82

Gallbladder carcinoma

Front 83

These are cysts that cause cystic dilatation and are usually an outpouching of the common bile duct. They are known as what?

Back 83

Choledochal cysts

Front 84

This image represents a cyst located next to the common bile duct. It would most likely be associated with which pathology?

Back 84

Choledocal cyst

Front 85

A rare congenital abnormality that causes the liver to have multiple cystic structures that communicate with the intrahepatic ducts is known as what?

Back 85

Caroli's Disease

Front 86

This would be an example of what?

Back 86

Caroli's Disease

Front 87

Intrapancreatic obstruction causes the entire ______________ duct to be dilated.

Back 87

extrahepatic

Front 88

In a suprapancreatic obstruction, an obstruction located between the _____________ and the porta ___________, the pancreatic duct _________ become dilated.

Back 88

pancreas and the porta hepatis; does not

Front 89

The most common cause of porta hepatic obstructions would be from?

Back 89

Neoplasms

Front 90

In porta hepatic obstructions, the ____________ ducts dilate, but the CBD remains ____________.

Back 90

intrahepatic; normal

Front 91

The presence of gallstones within the bile ducts would be known as?

Back 91

Choledocholithiasis

Front 92

Inflammation of the bile ducts is known as?

Back 92

Cholangitis

Front 93

A specific type of cholangiocarcinoma that occurs at the bifurcation of the common hepatic duct into the left and right hepatic ducts is known as?

Back 93

Klatskin's Tumor

Front 94

When a gallstone becomes impacted in the cystic duct causing the extrahepatic biliary system to obstruct, this condition is known as what?

Back 94

Mirizzi Syndrome

Front 95

Names such as "parallel channels" or "shotgun signs" should remind you of what?

Back 95

Dilated intrahepatic ducts

Front 96

This would be an example of what?

Back 96

Dilated intrahepatic ducts

Front 97

A patient presents with RUQ pain, fever, and elevated white blood cell count. The gallbladder appears enlarged with echogenic debris. This most probably represents which pathology?

Back 97

Empyema of the gallbladder

Front 98

In the fasting patient, what is a common cause for sonographic nonvisualization of the gallbladder?

Back 98

Contraction of the gallbladder due to chronic cholecystitis

Front 99

This would be an example of a gallbladder with?

Back 99

Septations

Front 100

The most common sonographic sign of gallbladder carcinomas is?

Back 100

A fungating, irregular mass that produces low-level echoes within the gallbladder

Front 101

what are the complications of acute cholecystitis

Back 101

Front 102

what are the sonographic finding for a GB perforation

Back 102

1. pericholecystic fluid
2. intraperitoneal collection

Front 103

perforations are found in patients with

Back 103

1. acute or chronic cholecystitis
2. gangrenous gb

Front 104

What are the complications of perforation

Back 104

1. peritonitis
2. Pericholecystic abscess
3. Biliary fistula

Front 105

What is most consistent with gallbladder perforation

Back 105

Pericholecystic fluid seen in conjunction with gallstones and thickened gallbladder wall is most consistent with acute cholecystitis and gallbladder wall perforation

Front 106

what are the lab values for acute cholecystitis

Back 106

Elevated AST, ALT, alkaline phosphate, and increase of direct Serum bilirubin

Front 107

sonographic finding of chronic cholecystitis

Back 107

Front 108

what condition is this

Back 108

xanthogranulomatous cholecystitis

Front 109

focal gallbladder wall thickening in Association with non shadowing soft tissue masses is defined as

Back 109

Metastatic disease of the gallbladder