Unit 7 - [P2] Benign Pathology of the GB

Part Two

What is Cholelithiasis?

Gallstones

Gallstones can be a range of sizes, what sizes cause the most problem?

Tiny stones —> may lead to duct obstruction

What are the clinical findings of Cholelithiasis?

• RUQ pain

• Radiating to right shoulder

• Back & chest pain

What lab work may be increased by Cholelithiasis?

• Bilirubin

• Amylase

• Alkaline Phosphatase

What are the differential diagnoses for Cholelithiasis?

• Gas in duodenum

• Porcelain GB

• Surgical clips

• Sludge

• Polyps

What are the 5 F’s that correspond with Cholelithiasis?

1. Female

2. Fat

3. Forty

4. Fertile

5. Fair

What are the US finding for Cholelithiasis?

Bright reflector(s) with posterior acoustic shadowing

With Cholelithiasis, how does it respond to different positions?

• Moveable

• Dependent

• Floating

What is this image showing?

Small gallstone

What is this image showing?

Gallstones

Floating stones are made up of _______

Cholesterol

What is this image showing?

Longitudinal GB with a layer of “floating” stones along a thick layer of bile sludge

What is this image showing?

Transverse GB with a layer of “floating” stones along a thick layer of bile sludge

What does the WES sign stand for?

Wall echo shadow

WES sign can be described as a …

GB packed with stones

What are the false positives when diagnosing Cholelithiasis?

• Polyp

• Adenomyomatosis

• Sludge Ball

• Duodenal gas

• Surgical clips

• Biliary air

• Porcelain GB

• GB agenesis

What are the false negatives when diagnosing Cholelithiasis?

• Contracted GB

• Stone in duct/neck

• Very small stones

• Geographic location/technique

• Sludge Ball

• Gallstones in fundal cap

What is this image showing?

GB sludge ball

What is a Porcelain Gallbladder?

Calcium incrustation of GB wall

A Porcelain Gallbladder is associated with _________

Gallstones

Porcelain Gallbladder is more common in _________ over __________.

Women > men

What are the symptoms for a Porcelain Gallbladder?

Often asymptomatic

In a Porcelain Gallbladder __% develop _________ of the GB wall.

25%, cancer

What are the US findings of a Porcelain Gallbladder?

GB wall thickly calcified with shadowing

What are the differential diagnoses for Porcelain Gallbladder?

• Gallstones with Emphysematous Cholecystitis

• WES sign

What is this image showing?

A Porcelain Gallbladder

What is Hyperplastic Cholecystosis?

A disease entity characterized by a functional abnormality of the gallbladder without specific anatomic changes

What are the two different types of Hyperplastic Cholecystosis?

• Cholesterolosis

• Adenomyomatosis

What is Cholesterolosis?

Cholesterol is deposited under lining of mucosa membrane

What is another title for Cholesterolosis?

Strawberry GB

What may Cholesterolosis be associated with?

• Cholesterol polyps

• GB polyps

What do Cholesterol polyps look like when associated with Cholesterolosis?

• Attached by a stalk

• < 10mm

• Usually multiple

• Do not shadow

• Remain fixed to wall

What is this image showing?

Non-mobile, non-shadowing, echogenic irregularity of the GB wall

What are Papillomas?

Noncancerous, outward-growing lumps that might cause problems in some locations

What is Adenomyomatosis?

Benign papilloma’s in the GB wall

• Single or in a group

What are the US findings of Adenomyomatosis?

• Small echogenic structure(s) in GB wall

• Ring down or comet tail artifact

• Do not move with change in positions or compression

What is this image showing?

Adenomyomatosis in sagittal of the GB

What is this image showing?

Adenomyomatosis in transverse of the GB

What is the most common pseudotumor of the gallbladder?

Polyp

What is the US findings of a polyp?

• Adherent to wall of GB

• No shadowing

• Will not move with change in pt. positions

What is this image showing?

Polyps

What is an Adenoma?

Benign neoplasm with premalignant potential

What are the US findings of an Adenoma?

• Usually solitary

• Almost always near fundus

• Homogeneously hyperechoic

• GB wall may be thickened

If the GB wall is thickened adjacent to an Adenoma, what should you suspect?

Malignancy

What is a differential diagnosis for an Adenoma?

Adenomyomatosis

What are these images showing?

An Adenoma