Gallbladder Physiology, Cholelithiasis, Sludge, Porcelain GB, Adenomyomatosis (Lecture 6)

List the flow of bile from the liver to the duodenum.

1. IH ducts --> rt + lt hepatic ducts

2. Rt + lt hepatic ducts = CHD

3. CHD + cystic duct = CBD

4. CBD + main pancreatic duct into ampulla of vater in 2nd part of duodenum

What does the GB do?

Stores and concentrates bile

What hormone causes the GB to contract?

CCK

What is cholestasis?

Decreased flow thru IH canaliculi

(if untreated, can lead to fibrosis and ultimately biliary cirrhosis)

What does an elevated SAP indicate?

Biliary obstruction

What type of bilirubin is elevated with biliary obstruction?

Elevated conjugated bilirubin

What is a normal GB wall thickness?

- Non-fasting = 3mm

- Fasting = 2mm

(anything above is abn)

What is the m/c gb pathology?

Cholelithiasis

What is cholelithiasis?

Stones in the gallbladder made up of cholesterol (80%) and bilirubin (20%)

What is the pt population and CP for cholelithiasis?

- Pt population: women (inc. age, obesity, diabetes, pregnancy, oral contraceptive use)

- CP: asymptomatic (m/c), jaundice, biliary colic (pain), indigestion, nausea, vomitting

What are the SF for cholelithiasis?

- Mobile stones with strong posterior shadow

- W.E.S complex (gb wall, echo from stone, post shadow)

What pathology does a W.E.S complex correlate to?

Cholelithiasis

How can you differentiate between a polyp and gb stone?

- Stones = mobile, cause posterior shadowing, in dependent portions of gb

- Polyp = non-mobile, no shadowing

How are gb stones treated?

- Lithotripsy

- Laparoscopic cholecystectomy

What is sludge/sand/mircolithiasis? List 1 contributing factor

Thickened concentrated bile

Contributing factors:

- pregnancy

- rapid weight loss

- starvation

- critical illness

- longterm TPN (total parenteral nutrition)

What is the CP for sludge?

Asymptomatic

What are the SF for gb sludge?

- Low level echoes

- Gravity depended

- Mobile (can be very slow)

- Sludge may accumulate into a ball

What is a porcelain gb? How does it occur? What is the CP and pt population?

- Calcification of the GB wall due to chronic inflammation/fibrosis

- CP: asymptomatic or gallstone symptoms

- Pt population: older females (60 yr old)

What are the SF of a porcelain gb?

- Hyperechoic semi circle

- Dense posterior shadow

- CANNOT see gb wall (NO WES complex)

What is adenomyomatosis? Where in the gb is is m/c present?

- Benign hyperplastic proliferation of smooth muscle and luminal epithelium, creating invaginations of the mucous epithelium into the muscle layer (Rokitansaky-Aschoff (RA) sinuses)

- M/c in fundus

What is the CP for adenomyomatosis?

Asymptomatic

What are the SF for adenomyomatosis?

- Tiny echogenic foci w/ comet tail artifact (cholesterol crystals caught in RA sinuses) ---> most common

- Focal mass like area (adenoma) containing cystic spaces or echogenic foci w/ ringdown