Gallbladder pathology

Sono non visual

PT not NPO

???

Contracted gb wt stones

Absent

Porcelain gb

Sludge filled

Gb neoplasm filled lumen

Ectopic gb (wrong location)

Gas

Chronic cholecystitis (gb inflammation)

NPO - nil per os

Nothing by mouth

Small GB

Not NPO

Chronic cholecystitis

Hepatitis & Cirrhosis (decre. Gb vol. due to hepatocyte injury bile prod. decre.

Hypoplasia

Enlarged GB (hydrops)

Prolonged fast

IV hyperalimentation (too much fluid)

Cystic d obs. (can’t empty)

Courvoisiers GB

Diabetes (long insulin resistance)

Post vagotomy (cut vagus nerve)

Courvoisiers GB

enlg due to distal CBD obs.

Due to malignancy in panc hd ca, common duct, ca, duodenal ca, ampulla cater (2nd pt of duodenum) ca

Painless jaundice, elev serum bilirubin, abnorm LFTs

Gb wall thickness intrinsic (inside/direct) causes

Acute cholecystitis (diffuse)

Chronic cholecystitis (diffuse)

Gangrenous cholecystitis (asymmetrical)

Emphysematous cholecystitis (asymmetrical)

Adenomyomatosis (focal or diffuse)

Polyp (focal)

GB ca : primary or metastatic (focal)

Focal

Diffuse

Asymmetrical

GB wall thickness extrinsic(outside) causes (most cs diffuse thickening)

Rt side heart failure

Acute hepatitis

AIDS

Sepsis

As iris due to hypoalbumemia

Renal failure

GB wall thickness physiologic causes

Contracted GB after eating

Sludge

combo of calcium bilirubinate granules & cholesterol crystals

Sludge symptoms

RUQ pain, nausea, vomitting

Sludge causes

Biliary stasis secondary to prolong fast

Hyperalimentation (Pt not moving)

Cystic duct obstruction

Acute or chronic cholecystitis

Sludge sono

mobile/gravity dependent, non shadowing, low echo lumen

Tumefactive Sludge

longstanding causing sludge to not move, appears fluffier & organized (resemble pseudo tumor & gb neoplasm)

Sludge Ball

org of sludge into round, mobile, echogenic, non shadowing ball

Cholelithiasis risk factors

pregnancy, gestational diabetes, diet

estrogen therapy, oral bc

Female, Fat, Fertile, Flatulent, Forty, Fair

Cholelithiasis (gall stones) symptoms

RUQ pain, radiates to RT shoulder (fatty meals)

nausea, vomiting

may be asymptomatic

Diarrhea means not a gallstone

Cholelithiasis lab

ALP may be elevated if CD or CBD obstr.

non obstr. all values normal

Cholelithiasis sono

solitary or multiple

1.) strong echogenicity

2.) posterior shadowing

3.) mobile/ gravity dep

Cholelithiasis false positive structures

bowel gas, junct folds/ valves of heister, gb edge shadowing, past cholecystectomy scarring/ surg clips (confuse with contracted)

Cholelithiasis treatment

diet restrictions (low fat)

cholecystectomy (by laproscopy, early interv)

Cholelithiasis complications

1/3 pt develop acute calculous cholecystitis

high association with gb carcinoma

Acute Cholecystitis

inflammation of gb wall with vary degr necrosis & infection (caused by inflamed wall, also causes ulceration, swell, edema)

Necrosis

Dead tissue

Calculous acute cholecystitis

most common

Acalculous Acute cholecystitis