ABD I - GB Pathology

3mm

GB wall thickness

Rokitansky-Aschoff sinuses

Rugae or pocketlike invaginations of the epithelium into the muscularis

Cholelithiasis

Single, large gallstone or multiple tiny stones (most common)

Obstruction

Tiny stones are the most dangerous because they

Fat, female, forty, fertile, and fair

5 F’s of cholelithiasis

Cholelithiasis sonography

Hyperechoic stones with posterior shadowing (>3mm)

WES sign

GB packed with stones as sign for chronic cholecystitis

Sludge

Thick echogenic bile caused by bile stasis and is asymptomatic

Sludge sonography

Non-shadowing and mobile with low to mid level echoes

Hepatization of GB

When GB is completely filled with sludge the GB can be isoechoic to liver

Diffuse GB thickening

often not suggestive of primary GB disease with the exception of acute cholecystitis

Focal GB thickening

Is suggestive of primary GB disease

Porcelain GB

GB wall becomes calcified, rare

25%

There is an association of between GB carcinoma and Porcelain GB

Porcelain GB

markedly hyperechoic GB wall, hyperechoic semi lunar appearance with shadowing in the GB fossa

Polyps

polypoid masses projecting into the GB lumen

Polyp sonography

non-shadowing echogenic masses projecting into the GB lumen, are FIXED

Hyperplastic GB wall

Represented by a variety of degenerative and proliferative changes of the gallbladder

Cholesterolosis and adenomyomatosis

Two types of hyperplastic conditions of GB

Adenomyomatosis

Non inflammatory but hyperplastic change in GB wall causing thickening

Adenomyomatosis

Hyperechoic, non movable hyperplastic diverticuli cause elevation appearance (comet-tail artifact)

RokitanskyAschoff sinuses

Adenomyomatosis can have multiple cystic spaces owing to unusually large

Cholesterolosis (strawberry GB)

Abnormal build up & deposition of lipids within the lamina propria forming tiny nodules on the surface of the mucosal lining

Cholesterolosis sonography

Single or multiple non shadowing fixed echogenic masses projection into GB lumen and doesn’t demonstrate thick wall

Hydropic Gb (mucolcele)

Obstruction of the cystic duct or GB neck with abnormal distention of GB (globuar) and trapped bile is reabsorbed

Hydropic sonography

dilated GB, thin walls, evaluate for stone in neck or cystic duct

Courvoisier’s sign

enlarged painless GB from extrahepatic mass compressing CBD associated with adenocarcinoma

Cholecystitis

inflammation of the gallbladder caused by stone friction irritating the mucosa layer and allowing bacteria into wall

Acalculus cholecystitis

occurs in patients who have been fasting, diabetic, sepsis, post trauma, surgery

Acute cholecystitis

Stones being impacted in the cystic duct or neck of GB (Hartmann’s pouch)

Cholecystitis sonogrpahy

Impacted stone, Murphy’s Sign, thicked wall, hypoechoic halo, pericholecystic fluid, intraluminal changes, distended lumen, enlarged cystic artery

Gangrenous cholecystitis

caused by infection of absence of blood supply leading to necrosis or sloughed mucosa and wall may bleed causing abscess or pericholecystic fluid

Emphysematous cholecystitis

Infection of gas-forming organisms

Emphysematous cholecystitis sonography

Ring down or comet tail artifact or dirty shadowing with highly reflective air

Gangrenous cholecystitis

Echogenic densities filling the gallbladder lumen

15%

Emphysematous Cholecystitis is fatal in _____ of patients

surgical emergency

Emphysematous cholecystitis is a

Acalculus cholecystitis

Acute inflammation of the gallbladder in the absence of cholelithiasis

cystic artery

Acalculous cholecystitis is most likely caused by decreased blood flow through

Positive murphy sign

In acalculous cholecystitis the patient clinically has a

Chronic cholecystitis

Most common form of GB inflammation that results of numerous attacks of acute cholecystitis with subsequent fibrosis GB wall

RUQ pain

Symptoms of chronic cholecystitis

Sonography of cholecystitis

thickened irregular fibrotic GB wall that’s disrupted or ulcerated, GB is shrunken/contracted

Torsion

A rare condition associated with a mobile GB with a long suspensory mesentery

Torsion sonography

GB is massively inflamed and distended and cystic artery or duct may become twisted

Primary gb caarcinoma

Rare, rapidly progressive disease with a 100% mortality rate from tumor infiltrating gb locally or diffusely and causes thickening and rigidity of wall

Symptoms of gb carcinoma

RUQ pain, palpable mass, NV, loss of appetite

Primary gb carcinoma sonography

Thick irregular wall, irregular mass in GB lumen mimic polyp or sludge ball with hypervascularity