Unit 7 - [P1] Benign Pathology of the GB

What is sludge in the GB?

• Thick bile

• Layering of bile particles

When looking at sludge in the GB, what is important about the GB position?

• Gravity dependent

• Dependent with position changes

Where might you find sludge, other than the GB?

In nearby ducts (CD, CHD, CBD)

What is this image showing?

Sludge in the GB

What is this image showing?

Sludge in transverse GB

What is this image showing?

Sludge in sagittal GB

What is this image showing?

Sludge in transverse GB

What is this image showing?

Sludge in transverse GB

What are the biliary causes of wall thickness?

• Cholecystitis

• Adenomyomatosis

• Cancer

• AIDS

• Cholangiopathy

• Sclerosing cholangitis

What are the non-biliary causes of wall thickness?

• Non-fasting

• Diffuse liver disease

  • Cirrhosis & Hepatitis

• Ascites

• Pancreatitis

• Portal Hypertension

• Heart failure

What is this image showing?

Ascites around the GB

What is this image showing?

Wall Thickness

What are the differential diagnoses for a thickened GB wall?

• Cholecystitis

• Acute Cholecystitis

• Carcinoma

• Gangrene

What is Cholecystitis?

Inflammation of the GB

What are the forms of Cholecystitis?

• Acute

• Chronic

• Acalculous

• Emphysematous

• Gangrenous

What are the symptoms for Acute Cholecystitis?

• RUQ pain

• + Murphy’s sign

What is the sonographic appearance of Acute Cholecystitis?

• Usually thickened, irregular wall

• Distended GB (bigger)

• Gallstones may or may not be present

• Pericholecystic fluid

• May demonstrate color flow in the wall

What is another name for having gallstones throughout the GB?

Calculous Cholecystitis

What is another name for having NO gallstones throughout the GB?

Acalculous Cholecystitis

What is pericholecystic fluid (abscess)?

Bile leaks from the gallbladder and forms a fluid-filled area around it

In relation to Acute Cholecystitis, if localized thickening is found. What other differential diagnosis should you consider?

• Abscess

• Carcinoma

What is this image showing?

Cholecystitis

What is this image showing?

Acute Cholecystitis

What lab work may possibly be increased with Acute Cholecystitis?

• Serum Bilirubin

• Alk Phos

• Serum Amylase

• WBC

To R/O Cholecystitis, what NEEDS to be done?

Patient MUST be fasting, or GB may be just partially contracted

What is this image showing?

Swollen / Edematous GB

What is this image showing?

Swollen / Edematous GB

What is Emphysematous Cholecystitis?

Gas-forming bacteria in GB wall

What is the prognosis for Emphysematous Cholecystitis?

• Rare complication

• Rapidly progressive & may be fatal (15%)

What lab work may prove Emphysematous Cholecystitis

Abnormal LFTs

What are the US findings for Emphysematous Cholecystitis?

• Bright echo in area of GB with ring down or comet tail artifact

• May appear as WES

What is Gangrenous Cholecystitis?

• Thickened wall

• Ulcerations / perforations

In Gangrenous Cholecystitis, ___-___% are gallstones or gravel.

80-95%

What lab work may prove Gangrenous Cholecystitis

Abnormal LFTs

What are the US findings of Gangrenous Cholecystitis?

• Echogenic material

• Does not shadow

• Is not gravity dependent

• Does not layer

What is this image showing?

Gangrenous Cholecystitis

What is this image showing?

Gangrenous Cholecystitis

What is this image showing?

Gangrenous Cholecystitis

GB Perforations may occur with…

• Gangrenous cholecystitis

• Acute cholecystitis

• Chronic cholecystitis

When looking at GB Perforations what should you watch for?

Continuity of GB wall

What results from GB perforations?

Pericholecystic fluid collections

What is this image showing?

GB Perforations

What is Acalculous Cholecystitis?

• Acute inflammation without Cholelithiasis

• + Murphy’s sign

What lab work may prove Acalculous Cholecystitis

• Abnormal LFTs

• Increased Amylase

What are the US findings of Acalculous Cholecystitis without gallstones?

• GB wall irregular & thickened (> 4 to 5 mm)

• Echogenic sludge

• Dilated GB

• Pericholecystic fluid or sub-serosal edema

What is this image showing?

Gallbladder