DMS| Abdomen| CH 3 Gallbladder

The gallbladder wall should measure not more than

3 mm

gallbladder wall thickness should not exceed:

3 mm

The diameter of the gallbladder should not exceed:

5 cm

normal range of gallbladder size

8 to 10 cm in length 4-5 cm in diameter

gallbladder sludge sonographic findings

A collection of low level, nonshadowing, dependent echoes within the gallbladder lumen

gallbladder polyp

AKA cholesterol polyp a projection of tissue from the gallbladder wall that protrudes into the lumen of the gallbladder tend to be less than 10 mm

useful lab values for gallbladder

ALP ALT GGT WBC

Clinical findings of biliary stones

Asymptomatic, biliary colic, abdominal pain after fatty meals, epigastric pain, N/V, pain that radiates to the shoulders

Sonographic findings of porcelain gallbladder

Calcification of the gallbladder wall recognized by an echogenic curvilinear structure within the GB fossa with shadowing Calficied posterior wall of the GB is helpful to differentiate porcelain from WES sign Signs of chronic cholecystitis and gallstones may be present

A 71 year old patient presents to the emergency department with painless jaundice adn an enlarged, palpable gallbladder. These findings are highly suspicious for:

Courvoisier gallbladder

focal tenderness over the gallbladder with probe pressure describes

Courvoisier sign

Sonographic findings of gangrenous cholecystitis

Gallstones, loss of the sonographic Murphy sign, GB wall thickening with possible perceptible wall tear, focal wall necrosis, bulges of the GB wall, sloughed membranes, and ulcerative craters, GB loses its typical shape, pericholecystic fluid, sludge

___ is often associated with acute cholecystitis

Leukocytosis

Labs associated with acute cholecystitis

Leukocytosis Elevated ALP and ALT Bilirubin may also be elevated if in ducts

Clinical findings of acute cholecystitis

RUQ tenderness epigastric or abd pain leukocytosis elevated ALP, ALT, GGT, bilirubin fever radiating shoulder pain N/V

Which of the following is associated with cholelithiasis and is characteristically found in Africans or people of African descent?

Sickle cell disease

At which level of the gallbladder is the junctional fold found?

The neck

gallbladder sludge clinical findings

Typically asymptomatic Any reason for biliary stasis (e.g. total parenteral nutrition, extended fasting)

clinical findings of gallbladder carcinoma

Weight loss, RUQ pain, jaundice, N/V, hepatomegaly, possible elevated ALP, ALT, GGT and bilirubin

Kawasaki disease

a condition associated with vasculitis and can affect the lymph node, skin, and mucous membranes; AKA mucocutaneous lymph node syndrome

emphysematous Cholecystitis

a form of acute cholecystitis that is caused by gas-forming infection invading GB lumen, wall or both

comet tail artifact

a form of reverberation artifact which there is a band of echoes that taper distal to a strong reflector

Cholelithiasis typically consist of:

a mixture of cholesterol, calcium bilirubinate, and calcium carbonate

emphysematous

abnormal distention of an organ with air or gas

A 32 year old female patient presents with vague abdominal pain. The sonographic investigation of the gallbladder reveals a focal area of gallbladder wall thickening that produces comet tail artifact. These findings are consistent with

adenomyomatosis

postprandial

after a meal

Which of the following would not be a lab finding typically analyzed with suspected GB disease: ALP, ALT, Bilirubin, alpha-fetoprotein

alpha fetoprotein

leukocytosis

an elevated white blood count

hydropic gallbaldder

an enlarged gallbladder; also referred to as mucocele of the gallbladder caused by a blockage of the cystic duct or other parts of the biliary tree

normal sonographic appearance of the gallbladder

anechoic pear shaped in long anechoic circle in trans

Which of the following would be least likely to cause focal gallbladder wall thickening?

ascites

What is the most likely clinical finding of adenomyomatosis?

asymptomatic

adenomyomatosis

benign hyperplasia of the gallbladder wall associated with Rokitansky-Aschoff sinuses

Tumefactive sludge can resemble the sonographic appearance of

callbladder carcinoma

chronic choecystitis

cholecystitis that results from the intermittent obstruction of the cystic duct by gallstones

What hormone causes the gallbladder to contract?

cholecystokinin

What would not be a finding of acalculous cholecystitis?

cholelithiasis

The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with:

cholesterolosis

Intermittent obstruction of the cystic duct by a gallstone results in:

chronic cholecystitis

cholesterolosis

condition that results from the disturbance in cholesterol metabolism and accumulation of cholesterol typically within a focal region of the gallbladder wall; may be diffuse and referred to as a strawberry gallbladder

sonographic findings of chronic cholecystitis

contracted gallbladder WES sign gallstones wall thickening

The direct blood supply to the gallbladder is the

cystic artery

the gallbladder is connected to the biliary tree by the

cystic duct

Bile flows from the gallbladder through the _____ and into the _____ .

cystic duct; common bile duct

Sonographic findings of cholelithiasis

echogenic, mobile, shadowing structures within the lumen of the gallbladder Stones that lodge within the cystic duct or neck of the gallbladder may not move WES Wall-Echo-Shadow) sign may be present

The champagne sign is associated with

emphysematous cholecystitis

The sequela of acute cholecystitis that is complicated by gas within the gallbladder wall is

emphysematous cholecystitis

The middle layer of the GB wall is the

fibromucosal layer

Hepatization of the gallbladder occurs when the gallbladder:

fills with sludge

pericholecystic fluid

fluid around the gallbladder

spiral valves of Heister

folds located within the cystic duct that prevent it from collapsing and distending

a nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represents a

gallbladder carcinoma

Empyema of the gallbladder denotes

gallbladder filled with pus

emphysematous cholecystitis can lead to what two things that can be fatal?

gallbladder perforation sepsis

All of the following are sources of diffuse gallbladder wall thickening except: acute cholecystitis, AIDS, hepatitis, gallbladder polyp

gallbladder polyp

Diabetic patients suffering from acute cholecystitis have an increased risk for developing:

gallbladder torsion

Phrygian cap

gallbladder variant when the gallbladder fundus is folded onto itself most common variant

What is/are cholelithiasis

gallstones

cholelithiasis

gallstones

Sonographic findings of acute cholecystitis

gallstones Positive Murphy Sign Gallbladder wall thickening gallbladder enlargement pericholecystic fluid sludge

Gallbladder Carcinoma is rare and usually always associated with:

gallstones and may also contain gallstones within the mass

Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes

gangenous cholecystitis

acute cholecystitis can progress to:

gangrenous cholecystitis, gallbladder perforation

Sonographic findings of GB polyps

hyperechoic , nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen "Ball on the Wall"

gangrenous cholecystitis

includes focal wall necrosis, bulges of the GB wall, sloughed membranes and ulcerative craters Perforation, or ruptures of the GB have a high mortality rate

clinical findings of chronic cholecystitis

intolerance to fatty foods b/c of subsequent abd pain nontender gallbladder

most common cause of acute cholecystitis

lodged gallstone in the cystic duct or neck of the GB

Which structure is useful landmark for identifying the gallbladder

main lobar fissure

landmark to locate gallbladder

main lobar fissure

fundus of the gallbladder

most common location for gallstones to collect

The innermost layer of the gallbladder wall is the

mucosal layer

Which part of the gallbladder is involved in Hartman pouch?

neck

sonographic findings of gallbladder carcinoma

nonmobile, hypoechoic mass within the GB lumen that measures > 1 cm, diffuse or focal gallbladder wall thickening, irregular mass that may completely fill the GB fossa, invasion of the mass into surrounding liver tissue

Risk factors for cholelithiasis

obesity, pregnancy, increases parity, gestational diabetes, estrogen therapy, oral contraceptives, rapid weight lose programs, hemolytic disorder, Crohn disease, total parenteral nutrition

Murphy sign

pain directly over the gallbladder with applied probe pressure

biliary colic

pain located in the right upper quadrant in the area of the gallbladder

acalculous cholecystitis is more often associated with what types of patients?

pediatric, recently hospitalized or immunocompromised

Where is the gallbladder located?

posterior to the right lobe of the liver within the gallbladder fossa

Porcelain gallbladder

results from the calcification of the GB wall that is usually linked to gallstones and chronic cholecystitis. Clinically asymptomatic

chronic cholecystitis

results from the intermittent obstruction of the cystic duct by gallstones, resulting in multiple bouts of acute cholecystitis

champagne sign

reverberating or ring down artifact from rising gas bubbles towards the wall of the GB present in emphysematous cholecystitis

The cystic artery is most often a direct branch of the

right hepatic artery

The outermost layer of the GB wall is the

serosal layer

wall-echo shadow (WES) sign

shadowing from the gallbladder fossa produced by a gallbladder that is completely filled with gallstones

cystic artery

supplies blood to the gallbladder

Courvoisier gallbladder

the clinical detection of an enlarged, palpable gallbladder caused by a biliary obstruction in the area of the pancreatic head; typically caused by a pancreatic head mass

The neck of the gallbladder is contiguous with:

the cystic duct

total parenteral nutrition

the feeding of a person intravenously

cholcystokinin

the hormone produced by the duodenum that causes the gallbladder to contract

acalculous cholecystitis

the inflammation of the gallbladder without associated gallstones

choledocholithiasis

the presence of a gallstone or gallstones within the biliary tree

empyema

the presence or collection of pus

acute cholecystitis

the sudden onset of gallbladder inflammation

cholecystectomy

the surgical removal of the gallbladder

tumefactive sludge

thick sludge

Rokitansky-Aschoff sinuses

tiny pockets within the gallbladder wall caused by adenomyomatosis Can contain cholesterol crystals that produce comet tail artifact

Which is not a risk factor for the development of gallstones: phrygan cap, pregnancy, total parenteral nutrition, oral contraceptives

total parenteral nutrition

hepatization of the gallbladder

tumefactive sludge completely fills the gallbladder, causing it to appear isoechoic to the liver tissue