Focal GB Wall Thickening - Polyps, Adenomas, Carcinomas, Torsion, Gallstone Ileus, Hydrops, Courvoisier GB (Lecture 8)

TRUE or FALSE: Polyps and gallstones are usually seen together.

FALSE: Polyps and gallstones are NOT usually seen together.

What is the CP for cholesterol gb polyps?

- Asymptomatic

- Diffuse form = "strawberry" gb (cholesterosis) - this is not seen sonographically?

What condition does a "strawberry" gb refer to?

Cholesterol gb polyps

What are the SF for cholesterol gb polyps?

- Usually see multiple small echogenic oval lesions

- Non-shadowing

- Non-mobile

- Don't change in size

What are gb adenomas? What are its SF?

- True benign neoplasms of gb (low chance of malignancy)

- SF: hyperechoic (inc heterogenity = inc size)

What is the CP/pt population for gb carcinomas? What 3 patterns do gb carcinomas exhibit?

- Pt population: older females

- CP: jaundice, RUQ pain, fatty intolerance, weight loss

3 patterns:

- mass fills the gb and invades liver (obliterates gb)

- irregular wall thickening

- intraluminal polypoid mass

What are the SF for gb carcnioma?

- Trapped stone sign: mass trapping gallstone inside gb

- Malignant wall thickening destroying gb wall layers

- Polypoid mass more than 1cm

- Inc size of gb

- Hepatization of gb

What condition is a trapped stone sign associated with?

Gb carcinoma

What is the most common metastases to gb?

Melanoma

When does gb torsion occur? What are its outcomes (HINT: 2)? What is the CP/pt population? What is another name for gb torsion?

- Occurs in pts with gb on a long suspensory mesentery

- Outcomes: if torsion is more than 180 degrees = gangrene/necrosis, obstruction of cystic duct = acute cholecystitis

- CP: same as acute cholecystitis (RUQ pain, inc. WBC, nausea, etc.)

- Pt population: older females

- Alternative name: volvulus

What are the SF for gb torsion/volvulus? (HINT: 2)

- Hugely distended and inflamed gb

- Gb in abn horiztonal position

When is a gb fistula formed?

Drains fluid leaking from perforated gb somewhere else instead of fluid leaking into peritoneal cavity

What is gallstone ileus? What is another name for this condition? When does it usually occur? What is the m/c place it occurs? What is the CP/pt population?

Gallstone ileus/Bouveret Syndrome

- Mechanical obstruction caused by gallstone impaction in any part of GI tract (usually occurs from fistula communications and with stones over 2.5cm)

- M/c obstructs distal ileum

- Pt population: older pt

- CP: progressive abdo pain, vomiting, abdo distension

What are the SF for gallstone ileus?

Rigler's triad

- Small bowel obstruction (gallstone obstructs bowel)

- Pneumobilia (due to fistula communication)

- Ectopic gallstones

What condition is Rigler's triad associated with?

Gallstone ileus/Bouveret syndrome

What are hydrops of the gb? What are its causes (HINT: 3)? What are its CP?

- Distended gb due to the gb being filled w/ mucous secretions (also known as mucocele)

- Causes: longstanding obstruction of cystic duct/neck, fasting, dehydration

- CP: asymptomatic (m/c), chronic discomfort, RUQ pain and palpable mass

What are the SF for hydrops of the gb?

- Distended gb

- ?Thickened wall

- Possibly some sludge

What is a Courvoisier gb? What is its cause?

- Enlarged, distended, palpable, and non-tender gb

- Due to obstruction of CBD, most commonly from malignant neoplasm of pancreatic head

What condition is associated with having a distended gb that is non-tender?

Courvoisier gb