The Gallbladder

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emphysematous

abnormal distention of an organ with air or gas

hypoalbuminemia

abnormal low level of albumin in the blood; albumin is a protein produced in the liver

postprandial

after a meal

leukocytosis

an elevated white blood cell count

hydropic gallbladder

an enlarged gallbladder; also referred to a mucocele of the gallbladder

sequela

an illness resulting from another disease, trauma, or injury

Hartmann pouch

an outpouching of the gallbladder neck

clinical findings of polyps

asymptomatic

adenomyomatosis

benign hyperplasia of the gallbladder wall

cystic artery

blood supply to the gallbladder

chronic cholecystitis

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

Crohn disease

chronic inflammatory bowel disease that leads to thickening and scarring of the bowel walls leading to chronic pain and recurrent bowel obstructions

suppurative cholecystitis

complication of acute cholecystitis characterized by pus accumulation within the gallbladder

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

what type of patients is emphysematous cholecystitis most often discovered in

diabetic patients

pericholecystic fluid

fluid around the gallbladder

spiral valves of Heister

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

sickle cell disease

form of hemolytic anemia typically found in Africans or people of African descent; characterized by dysfunctional sickle-shaped red blood cells

cholelithiasis

gallstone(s)

landmark for the gallbladder fossa

main lobar fissure

what is the most common metastatic disease of the gallbladder

malignant melanoma... but it is hard to differentiate between primary gallbladder cancer

Murphy sign

pain directly over the gallbladder with applied probed pressure

biliary colic

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

chyme

partially digested food from the stomach

common bile duct

portion of the biliary tree that lies distal to the union of the cystic duct with the hepatic duct

What is a strong indicator of acute cholecystitis

presence of gallstones and a positive sonographic Murphy sign

wall-echo-shadow sign

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

hepatization of the gallbladder

situation in which the gallbladder is completely filled with tumefactive sludge, causing the gallbladder to appear isoechoic to the liver tissue

what does the gallbladder do

store and concentrate bile that is produced by the liver

porcelain gallbladder

the calcification of all or part of the gallbladder wall

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

cystic duct

the duct that connects the gallbladder to the common hepatic duct

champagne sign

the effect of dirty shadowing, reverberation, or ring down artifact caused by gas or gas bubbles produced by bacteria within the nondependent gallbladder wall

total parenteral nutrition

the feeding of a person intravenously

cholecystokinin

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

acalculous cholecystitis

the inflammation of the gallbladder without associated gallstones

hyperalimentation

the intravenous administration of nutrients and vitamins

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

parity

the total number of completed pregnancies that have reached the age of viability

gallbladder torsion

the twisting of the vascular supply to the gallbladder

tumefactive sludge

thick sludge

Rokitansky-Aschoff sinuses

tiny pockets within the gallbladder wall

gallbladder disease causes elevation in what labs

- ALP - ALT - bilirubin - GGT - WBC

sonographic findings of acalculous cholecystitis

- Positive sonographic Murphy sign - gallbladder wall thickening - pericholecystic fluid - sludge

clinical findings of gangrenous cholecystitis and gallbladder perforation

- RUQ pain - Epigastric or abdominal pain - Leukocytosis - Possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction) - Fever - pain that radiates to the shoulders - nausea and vomiting

clinical findings of acalculus cholecystitis

- RUQ tenderness - epigastric or abdominal pain - Leukocytosis

clinical findings of acute cholecystitis

- RUQ tenderness - epigastric or abdominal pain - Leukocytosis - Possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction) - Fever - Pain that radiates to the shoulder - nausea and vomiting

Difference between shadowing from WES sign and shadowing from porcelain gallbladder

- WES sign shadowing: posterior wall lis obscured by shadowing gallstones within the gallbladder - calcified posterior wall of gallbladder is helpful to differential porcelain gallbladder

hyperplastic cholecystosis includes

- adenomyomatosis and cholesterolosis

clinical findings of porcelain gallbladder

- asymptomatic

clinical findings of gallbladder sludge

- asymptomatic - any reason for biliary stasis (total parenteral nutrition, extended period of fasting)

clinical findings of cholelithiasis

- asymptomatic - biliary colic - abdominal pain after fatty meals - epigastric pain - nausea and vomiting - pain that radiates to the shoulder

sonographic findings of porcelain gallbladder

- calcification of gallbladder wall - calcified posterior wall of gallbladder differentiates porcelain gallbladder from WES sign - signs of chronic cholecystitis and gallstones may be present

calculus cholecystitis is most commonly found in what type of patients

- children - recently hospitalized patients - patients who are immunocompromised

Gallbladder polyps

- cholesterol polyps are the most common type of polyps, they measure less then 10mm and result of an accumulation of cholesterol and triglycerides within the gallbladder wall, causing an elevation in the gallbladder mucosal layer - some polyps have stalks others cannot be seen and are known as "the ball on the wall sign" - most of the time are benign

causes of non visualization of the gallbladder

- choleystectomy - WES sign - postprandial - chronic cholecystitis (collapse and fibrosis of gallbladder) - ectopic location - agenesis - hepatization of gallbladder (caused by tumefactive sludge - air filled gallbladder or emphysematous cholecystitis

gallbladder neck

- contiguous with the cystic duct

sonographic findings of chronic cholecystitis

- contracted gallbladder - WES sign - gallstones - wall thickening

clinical findings of emphysematous cholecystitis

- diabetic patient - RUQ pain possibly without Murphy sign - fever - can progress to sepsis

sonographic findings of emphysematous cholecystitis

- dirty shadowing reverberation or rind down artifact emanating from gallbladder wall or gallbladder lumen - Champagne sign

The six F's (higher incidence of gallstones if...)

- fat - female - fertile, - flatulent - fair - forty

sonographic findings of Adenomyomatosis

- focal or diffuse thickening of the gallbladder wall - comet tail artifact that projects from the gallbladder wall into the lumen of the gallbladder

what is the most common cancer of the biliary tract

- gallbladder carcinoma... but it is rare

sources of focal gallbladder wall thickening

- gallbladder polyp - adenomyomatosis - gallbladder carcinoma - adhered gallstone

sonographic findings of acute cholecystitis

- gallstones (evaluate neck and cystic duct for a possible lodged stone) - Positive sonographic Murphy sign - Gallbladder wall thickening - Gallbladder enlargement - Pericholecystic fluid - Sludge

sonographic findings of gangrenous cholecystitis and gallbladder perforation

- gallstones (evaluate neck and cystic duct) - loss of sonographic Murphy sign - gallbladder wall thickening with a possible perceptible wall tear - focal wall necrosis, bulges of gallbladder wall, sloughed membranes, and ulcerative craters - gallbladder loses its typically shape - pericholecystic fluid - sludge

sonographic findings of polyps

- hyperechoic - non shadowing - nonmotile mass that projects from the gallbladder wall into the gallbladder lumen

mucosal layer

- innermost layer of the gallbladder - consists of multiple folds and rugae

clinical findings of chronic cholecystitis

- intolerance to fatty foods because of subsequent abdominal - nontender gallbladder

location of gallbladder

- intraperitoneal - posterior to the right lobe of the liver

Phrygian cap

- most common variant of the gallbladder - gallbladder fundus is folded onto itself

gallbladder fundus

- most dependent portion of the gallbladder - common location for gallstones

Three layers of the gallbladder

- mucosal layer (innermost layer) - fibromuscular layer (middle layer) - serosal layer (outer layer)

sonographic findings of gallbladder carcinoma

- nonmotile mass within the gallbladder lumen that measures greater then 1 cm diffuse or focal gallbladder wall thickening - irregular mass that may completely fill the gallbladder fossa - invasion of the mass into surrounding liver tissue

septated gallbladder

- normal variant of the gallbladder - appears as thin separations within the gallbladder

bilobed gallbladder

- normal variant of the gallbladder - hourglass appearance

Hartmann Pouch

- normal variant of the gallbladder - outpouring of gallbladder neck

Junctional fold

- normal variant of the gallbladder - prominent fold located at the junction of the gallbladder neck

risk factors and predisposing conditions for cholelithiasis

- obesity - pregnancy - increased parity - gestational diabetes - estrogen therapy - oral contraceptive use - rapid weight loss programs - hemolytic disorder - Crohn disease - total parenteral nutrition

clinical findings of gallbladder enlargement

- palpable gallbladder - could suffer from painless jaundice (Courvoisier gallbladder) - possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction)

sources of diffuse gallbladder wall thickening

- postprandial - actute cholecystitis - chronic cholecystitis - adenomyomatosis - hepatic dysfunction (hepatitis, cirrhosis) - benign ascites - hypoalbuminemia - AIDS cholangiopathy - congestive heart failure - gallbladder carcinoma

clinical findings of gallbladder carcinoma

- weight loss - RUQ pain - Jaundice - Nausea and vomiting - Hepatomegaly - possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction)

Which of the following would not be a laboratory finding typically analyzed with suspected gallbladder disease

Alpha-Fetoprotein

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

Courvoisier gallbladder

The middle layer of the gallbladder wall is the

Fibromuscular layer

Hepatization of the gallbladder occurs when the gallbladder

Fills with sludge

normal gallbladder measurements

GB wall: no more then 3mm - length: 8-10cm - diameter: no more then 4-5 * if over 4cm in diameter in transverse plane, concern for obstruction

peritonitis

Inflammation of the peritoneal lining

The innermost layer of the gallbladder wall is the

Mucosal layer

The cystic artery is most often a direct branch of the

Right hepatic artery

sonographic findings of gallbladder sludge

a collection of low level, non shadowing, dependent echoes within the gallbladder lumen

Kawasaki disease

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

hemolytic anemia

a condition that results in the destruction of red blood cells

junctional fold

a fold in the neck of the gallbladder

comet tail artifact

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

hyperplastic cholecystosis

a group of proliferative and degenerative gallbladder disorder which includes both adenomyomatosis and cholesterolosis

sepsis

a life-threatening condition causes by the body's response to a systemic infection


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