The Gallbladder
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
