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65 Cards in this Set
- Front
- Back
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Clinical signs and symptoms of gallbladder disease : |
1. RUQ pain after ingestion of greasy foods (most common) 2. Nausea and vomiting 3. Radiating pain to the right shoulder 4. Jaundice |
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Pathologies of the gallbladder & biliary system |
1. Sludge 2. Cholecystitis 3. Cholelithiasis 4. Choledochal cysts 5. Adenomyomatosis 6. Porcelain GB 7. Choledocholithiasis 8. GB carcinoma |
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_: - thickened bile - may be seen in patients with prolonged fasting and with obstruction of the GB |
Sludge |
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Differential diagnosis for sludge in the GB |
1. Hemobilia 2. Neoplasm of the GB |
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Sonographic findings of sludge: |
1. Low level internal echoes layering in the dependant part of the GB 2. Prominent GB size 3. Changes with patients position |
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Sludge |
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Sludge |
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_: - an Inflammation of the gallbladder that may take one of several forms:: acute or chronic, acalculous, emphysematous, gangrenous |
Cholecystitis |
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- most common cause of gallstones - caused by stones being impacted in the cystic duct or in the neck of the GB(hartmanns pouch) - may be serious and include empyema (collection of pus), emphysematous or gangrenous cholecystitis, and perforation |
Acute cholecystitis |
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Clinical presentation of acute cholecystitis |
- acute RUQ pain:: positive murphy's sign and inspiratory arrest upon palpation of GB area - fever - leukocytosis (elevated WBC count) - increased serum, bilirubin, amylase, and alkaline phosphatase levels |
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Differential diagnosis of acute cholecystitis |
- chronic cholecystitis - non fasting GB - acute pancreatitis - GB carcinoma |
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Sonographic findings of acute cholecystitis |
- thick and irregular wall >3 mm - distended gallbladder lumen >4cm - gallstones - impacted stone in hartmanns pouch or cystic duct - positive murphy's sign - increased color Doppler flow - pericholecystic fluid collection |
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Acute cholecystitis |
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Acute cholecystitis |
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_ _ : - most common form of gallbladder inflammation - results of numerous attacks of acute with subsequent fibrosis of the GB wall - clinically, patients may have some transient RUQ pain but not the tenderness as experienced with acute - increased serum amylase - abnormal LFTs |
Chronic cholecystitis |
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Differential diagnosis for chronic cholecystitis |
- cholelithiasis - non fasting GB - acute pancreatitis - GB carcinoma |
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Sonographic findings of chronic cholecystitis |
- contraction of GB - stones - WES sign (GB packed full of stones |
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Chronic cholecystitis |
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_ _ : - is the acute inflammation of the GB in the absence of cholelithiasis - is most likely caused by decreased blood flow through the cystic artery - conditions that produce depressed motility ( e.g. trauma, burns, postoperative patients, HIV, etc) may precede the development of this - extrinsic compression of the cystic duct by a mass or lymphadenopathy may also cause this condition - clinically, the patient has a positive murphy's sign - increased serum amylase - abnormal LFTs |
Acalculous cholecystitis |
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Differential diagnosis of acalculous cholecystitis |
- chronic cholecystitis - non fasting GB - acute pancreatitis - GB carcinoma |
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Sonographic findings of acalculous cholecystitis |
- dilation of the GB - positive murphy's sign - thick GB wall with irregular wall - sludge - pericholecystic fluid |
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Acalculous cholecystitis |
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_ _: - rare complication of acute cholecystitis - rapidly progressive and fatal in 15% of patients - affects more men than women; 50% patients are diabetic; gallstones may not be present in 30% to 50% of patients - associated with the presence of gas forming bacteria in the GB wall and lumen with extension into the biliary ducts - gangrene with associated perforation is a complication - this condition is a surgical emergency |
Emphysematous cholecystitis |
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Differential diagnosis of emphyematous cholecystitis |
- chronic cholecystitis - GB carcinoma |
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Sonographic findings of emphysematous cholecystitis |
- bright echo in anterior wall of GB with ring down or comet tail artifact - may appear as WES sign (if large amounts of gas is present) |
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Emphysematous cholecystitis |
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_ _: - is a serious, painful complication of acute cholecystitis that may lead to perforation - occurs after a prolonged infection, which causes the GB to undergo necrosis - GB wall may be thickened and edematous with focal areas of hemorrhage and necrosis - ulcerations and perforations may be present, resulting in pericholecystic abscesses or peritonitis - gallstones occur in 80% to 95% of patients |
Gangrenous cholecystitis |
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Differential diagnosis of gangrenous cholecystitis |
GB carcinoma |
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Sonographic findings of gangrenous cholecystitis |
- medium to course echogenic densities that fill the GB lumen in absences of duct obstruction. This echogenic material has the following 3 characteristics:: does not cause shadowing, is not gravity dependant, does not show layering affect |
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Gangrenous cholecystitis |
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_: - most common disease of the GB - single, large gallstones or multiple tiny stones - Tiny stones are the most dangerous because they can enter the bile ducts and obstruct the outflow of bile - after a fatty meal, the GB contracts to release bile; if the outflow tract is blocked by gallstones, then pain results |
Cholelithiasis |
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5 Fs for cholelithiasis: |
1. Fat 2. Female 3. Forty 4. Fertile 5. Fair (Other risk factors include pregnancy, diabetes, oral contraceptive use, and diet induced weight loss) |
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Clinical symptoms of cholelithiasis |
- may be asymptomatic until a stone lodges in the cystic duct or common duct - RUQ pain with radiation to the right shoulder after a high fat meal - epigastic pain - nausea - vomiting |
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Differential diagnosis of cholelithiasis |
- duodenal gas - porcelain GB - sludge |
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Sonographic findings of cholelithiasis |
- dilated GB with thick wall - hyperechoic intraluminal echoes with posterior acoustic shadowing - WES (wall echo shadow) sign - gravity dependant calcifications in GB (stones will move when patient rolled into other positions such as LLD) |
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Cholelithiasis |
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Cholelithiasis with sludge |
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WES sign |
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_ _: - congenital, focal, or diffuse cystic dilation of the biliary tree. - may be the result of pancreatic juices refluxing into the bile duct because of an anomalous junction of the pancreatic duct into the distal common bile duct - may be associated with gallstones, pancreatitis, cirrhosis |
Choledochal cyst |
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Clinical symptoms of choledochal cyst |
- jaundice - possible increased bilirubin - pain - fever - abdominal mass (if large enough) |
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Choledochal cyst |
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_ _: - classified as a type V choledochal cyst - multiple cystic structures in the area of the ductal system converge toward the portal hepatis - masses seen as localized or diffusely scattered cysts communicate with the bile ducts - differential diagnosis includes polycystic liver disease - generally a duct >6 mm in diameter is considered borderline; >10mm is dilated |
Caroli's disease |
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Caroli's disease |
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_ : - hyperplastic change in the GB wall (papillomas) - various patient positions and compression show the lesion to be immobile in the GB |
Adenomyomatosis |
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Sonographic findings of adenomyomatosis |
- echogenic papilloma seen with in GB wall with no posterior shadowing - produce comet tail artifact - papilloma maintain initial location with patient position changes |
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Adenomyomatosis |
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_ _: - rare occurrence that is defined as calcium incrustation of the GB wall - associated with gallstones in the majority of patients; a form of chronic cholecystitis - significance: 25% of these patients will develop cancer on the GB wall |
Porcelain GB |
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Sonographic findings of porcelain GB |
- thick and calcified GB wall with shadowing - differential wall include WES sign (gallstones) |
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Porcelain GB |
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_ : - primary is the formation of calcium stones in the bile duct - secondary denotes the majority of stones in the common bile duct have migrated from the GB - common duct stones are usually associated with calculous cholecystitis - increased direct bilirubin and alkaline phosphatase |
Choledocholithiasis |
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Sonographic findings of choledocholithiasis |
- echogenic structure within the common bile duct with posterior shadowing - dilated biliary tree |
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Choledocholithiasis |
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_ _: - primary carcinoma of the GB is rare and is nearly always a rapidly progressive disease with a mortality rate approaching 100% - associated with cholethiasis in approximately 80-90 percent of patients - twice as common as cancer of the bile ducts, and occurs most frequently in women >60 years of age - arises in the body of the GB or rarely in the cystic duct |
GB carcinoma |
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Clinical symptoms of GB carcinoma |
- most patients are asymptomatic until it's too late - increased direct bilirubin |
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Differential diagnosis of GB carcinoma |
Cholecystitis |
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Sonographic findings of GB carcinoma |
- complex appearance - thick and abnormal GB wall - possible dilated biliary ducts with in the liver parenchyma causing the "shotgun" sign |
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GB carcinoma |
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_- rare malignancy that originates within the larger bile ducts (CBD,CHD) |
Cholangiocarcinoma |
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_ _: a specific type of cholangiocarcinoma that can occur at the bifurcation of the common hepatic duct, with involvement of both the central left and right ducts |
Klatskin tumor |
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_: inflammation of the bile ducts |
Cholangitis |
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_: air with in the biliary tree |
Pneumobilia |
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_ _: uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the common hepatic duct |
Mirizzi syndrome |
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Common causes of GB wall thickening |
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_- dilation of the GB |
Hydrops |
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_ _- folding of the fundus |
Phrygian cap |
