Normal Pathology

How many people doe Cholelithiasis affect each year?

1-10 percent of the population

Reaches peak in the 6-7th decade

Who is Cholelithiasis predominantly in?

Mostly in women 2;1 ratio

increases with age

What ethnicity are mostly affected and who can be a prime candidate for Cholelithiasis?

European,North American,asian,subsaharian african

Prime candidates are fat,forty,female,fair,fertile

What are the Factors that stones form in the GB?

Bile

Inflammation due to bacteria,obesity,preganacy,

What are the stones composed of?

Cholesterol,calcium,bilirubinate,bile pigment and calcium

-(80% cholesterol and pigment

-(10% pigmet

-10(Pure Cholestrol

With Cholelithiasis can patents be asymptomatic and symptomatic?

yes

Sympomatic(25%)

What can people that are symptomatic present with due to Cholelithiasis?

RUQ pain,Epigastric pain

RUQ pain going through the sholder

Neasea,vomiting,belching,bloating,heartburn

What is the Collins Sign?

Patients may demonstrate the pain that radiates from the scapula and placing it from back and thumb that points upward

What is Cholelithiasis in children and factors?

-hemolytic anemias(sickle cell 27-30%)

-Thalassemia(23%)

-Cystic fibrosis

-Crohn’s disease

What is the U/S appearance of Cholelithiasis?

-Echogenic Foci

-gravity that can change where the stones are lodged

-Floats in the GB

-can cause pancreatitis

What does the GB sludge be also seen as?

Echogenic bile

Biliary sand

Thickening bile

Gb Sludge can be cause by stasis of bile due to?

-obstruction of bile flow

-fasting and weight loss

-hyperalimentation

-cholecystitis

-Sickel cell anemia

-bone marrow

-pregnancy

-ceftriaxone

What are the sludge complications?

-Stone Formation

_Biliary Colic

-Acalculus Cholecystititis

-Pancreatitis

What is the sonographic finding of US?

homogenous low level echoes

isochoic to liver

GB filled with sludge

does not cast shadow

sludge balls

pseudoslidge that causes slice thickness

What is GB Acute cholecystitis?

causes by obstruction of the cystic duct or GB neck by a stone(90%)

when can Gb Acute Cholecystitis occur and be presentt with?

40-60 year

and can occur at any age

RUQ or epigastric pain

leukcytosis

Murphys Sign

vomiting

fever

nausea

What is the Sonographic Acute pathology in Acute Cholecystitis?

-GB wall thickness is less than 3mm

-Ap diameter can exceed 5cm

-hypoechoic rim

-pericholycystic fluid

-gallstones may be present 90-95%

What is Gb Chronic Cholectstitis?

Due to the result of acute cholecystitis

What can Chronic cholecystitis cause?

GB enlargement,contraction or shrinkage

What can Chronic Cholecystitis be a precursor for?

GB carcinoma

Choledocholithisis

What can asymptomtomatic patients present with?

RUQ pain

vomiting

Intollernance to fatty food

belching

epigastric discomfort

What can Chronic cholectitis present with sonographicall?

Gb shrunken

GB thicken more than 3mm

Stone shadowing

Present with the WES Sign(echoes from stones in the GB)

What is a Porcelain gallbladder?

Calcification of the GB wall

Wha is Porcelaine GB be associated with and be more common in?

95% of cases

5:1 F-M

What is Porcelain GB caused by?

-Obstruction of the Cystic duct

-infections

-Irratation of the GB wall

What are Porcelain Gb sonographically?

-hyperechoic

What is Gb Hydrops?

abnormal distension of the GB with fluid,mucus or pus

What may GB Hydrops be caused by?

Obstruction of the Gb neck or cystic duct

hyperlimentation

hepatitis

streptococcal infection

biliary statis

What is the sonographic finding of Hydrop?

Enlarged GB

Gb is ovoid

GB wall thin

can be present in the check or cystic duct

What is GB Adenomas?

Most common Gb benignn tumor

The soft tissue projecting into the Gb lumen

What percent of GB masses are solitary and can be multiple?

Solitary(10%)

<1 cm diameter

Patients with GB Adenomas can be asymptomatic and present with RUQ pain?

Yes

What is the Sonographic appearance of the GB adenomas?

hyperechoic

attach the the Gb wall and does not move

What is the GB Polyps?

masses that project in the GB lumen and originate in the mucosal surface

What are the most common Gb Polyps?

Cholesterol polyps

(mostly prevent un 40-50)

Most common in women)

What can GB Polyps be associated with?

Peutz-Jeghers syndrome

Sonographically what can Gb Polyps appears as?

non shadowin,non mobile echogenic masses in the lumen

What is Peutz Jeghers syndrome?

characterized by Polyps seen in the small intestine,colon,stomach,mouth and esophagus

What is GB cholesterolosis?

abnormal amount of cholesterol in macrophages in the lamina propria

What can the Gb cholesterolosis be confused with?

strawberry Gb or a spotty one

Who is GB Cholesterolosis most common in and associated with?

Common in men over 40

Associated with gallstones in 50% of cases

What is GB carcinoma?

5th most common malignant tumor

are GB carcinoma the most common malignant tumor of the biliary tract?

Yes

What are most of the carcinomas?

adenocarcinomas

What percent of malignancies does Gb carcinoma account for and most common in?

1-3% malignancies

common in women 50-80

What are Gb Carcinomas mostly associated with?

Gallstones(80-90 % times)

Chronic cholecystitis

Porcelain GB(25%)

How many GB carcinoma spread?

through the lymphatic system

blood vessels

spread though ducts

What can patients wti GB carcinoma be associated with?

weight loss

aneroxia

RUQ pain

neasea

vomiting

jaundice

RUQ mass

What is Adenomyomatosis?

Benign hyperechoic cholecystitis of Gb wall

What is the commonality of Adenomyomatosis?

Common in 9% of cases

normally seen in the 5th decade in women

What do patients with Adenomyomatosis usually associated with?

Chronic billary inflammation (seen with stones 25-75 % of the times)

What is the pathology of Adenomyomatosis?

Hyperplasia of the walls as Rokitansky Aschoff penetrate the muscular walls(traps cholestrol in it)

How can Adenomyomatosis be seperated?

Diffuse

Fundal

Segmental

What artifact does Adenomyomatosis appear as?

echogenic foci that is ringdown

What can GB carcinoma be seen as sonograpicaly?

hypoechoic or hyperechoic

Focal hyperechoic or hyperechoic mass

Where can the Lymphadenopathy be seen in?

in the porta hepatis

What is the metastatic disease of the GB?

The mets invade through the GB

(causing blood

What do mets appear as sonographically?

Focal thinking of the Gb

Intraluminal polypoid masses of the Gb

loss of definition of the Gb wall

What is Mirrizi syndrome

partial obsrtructio of the CHD due to stone

What are patients to present with due to Mirrizi syndrome?

RUQ pain

Jaundice

With Mirrizi syndrome where is there usually a dialation?

occurs proximal to the stone(a normal CBD is seen distal to the stone)

What are other causes of Diffuse thickening?

Ascites,Renal diesese,hypoalubunemia,hypoproteninemia,hepatitis,CHF,AIDS

What is Billiary Obstructive jaundice?

discolarazion of the skin

What is the most common cause of Biliary Obstruction jaundice?

Choledocholithiasis

What are the symptoms of Obstructive jaundice?

weight loss

jaundice

hepatomegaly

RUQ pain

Increase bilirubin

blood in stool

dark urine

itching of the skin

increased alkaline phosphate