Pathologial conditions of the gallbladder

what are some indications for a GB exam

1. Rt shoulder pain

2. positive murphy sign

3. nausea

4. vomiting

5. jaundice

6. loss of appetitie

7. abnormal LFTs

with GB imaging you want the ____ frequency when possible

highest

what are some exam limitations for the GB

1. bowel gas

2. artifact (reverberation)

3. pt cant hold breath

4. pt ate

5. obesity

what is the normal GB length measurement

8-12 cm

what is the normal GB wall thickness

3 mm

what is the normal CBD AP measurement

0.1-0.7 cm

the GB neck is ____ and the fundus is _____

superior, inferior

what are 3 common normal variants of the GB

phrygian cap, junctional fold, and hartmanns pouch

1. phrygian cap

2. junctional fold

phrygian cap occurs at what part of the GB

fundus

what GB variant is this

phrygian cap

what GB variant is this

double gallbladder

GB lumen should have what echogenicity

anechoic

the GB wall should be measured on the ____ border when the wall is _____ to the transducer

anterior, perpendicular

what are rokitansky-aschoff sinuses

rugae or pocket like invaginations of the epithelium into the muscularis

what should you associate rokitansky-aschoff sinuses with

adenomyomatosis

Rugae or pocketlike invaginations of the epithelium into the muscularis

rokitansky-aschoff sinuses

what is viewed bewteen the RPV and the GB

main lobar fissure

rupture is most common at what part of the GB

fundus (it has the least amount of blood supply)

what is the most common dz of the GB

cholelithiasis (GB stones)

_____ can be single large stones or multiple tiny stones

cholelithiasis

are large singular stones or tiny multiple stones more dangerous in the GB

tiny stones (can enter bile ducts and obstruct bile flow)

_____ can lead to stone formation

bile stasis

what are the five F’s associated with cholelithiasis risk factors

fat, female, forty, fertile, and fair

what are 4 clinical symptoms for cholelithiasis

1. RUQ pain

2. Epigastric pain

3. Nausea and vomiting

4. elevated serum bilirubin

does gallstones cause shadowing

yes (gallstones attenuate and reflect causing shadowing)

when you identify gallstones on an exam and then decube the pt the gallstones are expected to _____

move (they are mobile and gravity dependent)

what positions can you move the patient in to evaluate the mobility of gallstones

erect, decubed

gallstones may not shadow if they are ____

small (<3mm)

when using color, gallstones will ____

have no blood flow to them

cholelithiasis

cholelithiasis

what sonographic sign is this

WES sign (wall echo shadowing)

what does the WES sign indicate

GB packed with stones

the WES sign is associated with what kind of cholecystitis

chronic cholecystitis

what sonographic sign is this

WES sign

What is sludge

thick viscous bile

what are the clinical symptoms associated of sludge

asymptomatic (could have classic biliary symptoms)

what causes sludge

bile stasis, obstruction of flow, cholecystitis, sickle cell anemia

sludge is a normal finding in patients who are ______

fasting for a prolonged period of time

does sludge cause shadowing

no

when you identify sludge on an exam and then decube the pt the sludge is expected to _____

move

if the GB is completely filled with sludge the GB can be isoechoic to liver called ______

hepatization of GB

sludge can form solid masses called _____

sludge balls

sludge

sludge

sludge (hepatization of gb)

sludge (sludge balls)

diffuse GB wall thickening is usually not caused by an issue with the GB itself except for _______

acute cholecystitis

what are 5 causes of diffuse GB wall thickening

1. renal failure

2. pancreatitis

3. acute cholecystitis

4. hepatitis

5. CHF

what are 5 causes of focal GB wall thickening

1. adenomyomatosis

2. carcinoma

3. adenoma

4. gangrenous cholecystitis

5. mets

GB wall thickening

rare condition where GB wall becomes calcified

porcelain gb

porcelain gallbladder is associated with ___ in the majority of patients

gallstones

porcelain GB is common in older ____

women

there is a ___% association between porcelain GB and GB carcinoma

25%

porcelain GB

is this a porcelain GB or a WES sign

WES sign

____ are masses projecting into the GB lumen

polyps

what is the most common thing polyps are made of

cholesterol polyps

what are the clinical symptoms for polyps

asymptomatic

do polyps cause shadowing

no

when you identify polyps on an exam and then decube the pt the polyps are expected to _____

not move

polyp

over growth of the GB wall is called ____

hyperplastic GB wall

Hyperconcentration, Hyperexcitability, Hyperexcretion are all dengenerative and proliferative changes of the GB related to ______

hyperplastic GB wall

what are 2 hyperplastic conditions of the gallbladder

cholesterolosis and adenomyomatosis

a non-inflammatory hyperplastic condition of in GB wall causing thickening

adenomyomatosis

what is the clinical symptoms of adenomyomatosis

biliary colic

Hyperechoic, non movable hyperplastic diverticuli within the GB wall cause elevation appearance in wall

adenomyomatosis

adenomyomatosis can appear as crystal depostis which result in comet tail artifiact but it could also appear as _____

multiple cystic spaces (usually near the fundus)

adenomyomatosis

adenomyomatosis

adenomyomatosis (comet tail artifact)

abnormal build up and deposition of lipids within the lamina propria of the GB which form tiny nodules on the surface of the mucosal lining

strawberry GB

GB stones present ____% of the time with strawberry GB

50-70%

strawberry GB is common in ____

males (over 40)

what are strawberry GB clinical symptoms

asymptomatic (or biliary symptoms)

strawberry GB

strawberry GB

when you identify cholesterolosis/strawberry GB on an exam and then decube the pt the echogenic masses are expected to _____

not move

hydropic GB (mucocele) is associated with obstruction of the _____

cystic duct or GB neck

globular appearance of GB with abnormal distention

hydropic GB (mucocele)

what causes hydropic GB (mucocele)

prolonged total obstruction of cystic duct (bile gets reabsorbed)

hydropic GB is obstruction of the _____ while courvoisier’s GB is obstruction of the ______

neck or bile duct, distal CBD

An enlarged, usually painless GB, indicates an extrahepatic mass compressing the CBD

courvoisier’s sign

inflammation of the GB

cholecystitis

what are the 5 forms that cholecystitis can take

1. acute

2. chronic

3. acalculous

4. emphysematous

5. gangrenous

what is acalculus cholecystitis

inflammation of the GB without presence of stones

cholecystitis

cholecystitis

describe this sonographic image

edematous GB in pt with acute cholecystitis, thickened edematous walls

acute cholecystitis (acalculus cholecystitis)

what is the arrow pointing to

pericholecystic fluid

inflamed fat (secondary to inflammation)

inflamed fat (secondary to inflammation)

what are 2 complications of acute cholecystitis

gangrenous cholecystitis and emphysematous cholecystitis

serious, painful necrosis develop in GB wall, sloughed mucosa of wall. Wall may bleed causing an abscess. Pericholecystic fluid and air. May rupture causing pericholecystic collection and peritonitis. caused by infection or absence of blood supply

gangrenous cholecystitis

Gb becomes infected with GAS-FORMING organisms. Gas has ring down or comet tail artifact or dirty shadowing. Highly reflective air may also be seen

emphysematous cholecystitis

gangrenous cholecystitis