Gallbladder

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created 5 years ago by Annabelle
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updated 5 years ago by Annabelle
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1

Where does the GB lie?

within the GB fissure in line with the main lobar fissure

together divide the liver into L/R

2

What shape is the GB?

Pear shaped

3

what are the layers of the GB?

serosa

submucosa

Muscular layer

inner epithelium

4

Does the GB lie in the peritoneal?

mostly intraperitoneal

5

What is the size of the GB?

7-10 cm length

5 cm width

6

What is the function of the GB?

concentrate bile

stores bile

transports the bile

7

What is the function of bile?

emulsify fat

principle route of excretion of bilirubin & cholesterol

excretion of products of steroid hormones, drugs & poisons

8

What happens when food enters the duodenum?

Release of cholecystoclain

sphincter relaxes

GB contracts

bile flows freely into 2nd portion of duodenum

9

What does an increase of direct bilirubin indicate?

distal obstruction

10

What is the capacity of the GB?

50 ml

11

What is a Hartmann's pouch?

GB folds back on itself between the junctional fold and the neck

12

What is a Phrygian cap?

bent fundus

13

How many people have double GB?

1:4000

14

What are Development abnormalities of the GB?

agenesis

hourglass shape

intrahepatic

floating

left side (situs inversus)

15

explain the biliary tree

L & R hepatic ducts merge to form the Common Hepatic ducts

Common Hepatic ducts merge with the Cystic duct to form the Common bile duct

16

What is Cholecystectomy?

removal of GB

17

What is normal measurement for the common bile duct after a Cholecystectomy?

10 mm or less

18

What is the measurement for the CBD

6 mm

greater than 7 mm abnormal

19

What happens to the CBD at age 60?

1 mm per decade is added to normal measurement

20

Where should the measurement be taken on the ducts?

inner to inner

21

What is Jaundice?

obstruction cause bile to leak into blood

22

What causes jaundice when an obstruction is not present?

hemolysis

23

What is hemolysis?

RBC destruction

24

What are indications for a GB scan?

RUQ pain

positive Murphy's sign

with inflammation pain radiates to shoulder

Nausea, vomiting

intolerance to fatty foods/dairy products

Jaundice

25

What is Murphy's sign?

card image
26
card image

Shotgun sign

27

What is the Prep for a GB exam?

NPO after midnight

NPO for at least 8-12 hours

28

What is Choledocholithiasis

stones in ducts

29

What are the pertinent lab values?

increase in WBC

increase serum Bilirubin (direct)

Alkaline Phosphatase

30

doch

duct

31

chole

GB

32

lithia

stones

33

What positions should be used for a GB exam?

supine

LLD

34

What happens if stones do not move?

impacted

impaction could cause rupture

35

What is Peritonitis?

inflammation of peritoneum

possible death

36

What is Sludge?

Echogenic bile

-calcium bilirubinate

-cholesterol cystals

37

What are causes of sludge?

obstruction

prolonged fasting

(IV feeding)

38

What are the implications of sludge?

indicator of abnormal biliary dynamics

precursor to cholecystitis

predisposes development of cholelithiasis

39

What are the Sonographic appearance of Sludge?

Non-shadowing

Low amplitude echoes

40

What is tumefactive sludge?

Pus in GB

41

What are the Sonographic appearance of tumefactive Sludge?

Non-shadowing

does not layer

can resemble a mass

sludge ball appear as mobile round masses

isoechoic when filled

42

What is Acute Cholecystitis?

Inflammation of the gallbladder.

43

Sonographic Appearance Acute Cholecystitis

Dialation

Rounding of Gallbladder

Thick Wall

Stones

Pericholecystic Fluid

44

Acute Cholecystitis Presentation

RUQ Pain

45

What are the lab values for Acute Cholecystitis?

↑Serum Amylase

Abnormal Liver Function Test

46

What causes Acute Cholecystitis?

inflamation of GB

47

What is Cholelithiasis?

gallstones

48

Sonographic Appearance Cholelithiasis

Dilation

Thick Walls

WES sign

Gravity dependent

Posterior shadowing

Hyperechoic intraluminal echoes

49

Lab Values Cholelithiasis

↑ Serum Amylase

↑Alkaline Phosphatase

↑Bilirubin

Abnormal Liver Function Test

50

causes Cholelithiasis

Five F’s, Obesity

51

What is pneumobia?

air in biliary tree

52

What is chronic Cholelithiasis?

recurrent GB attack +3 months

53

Lab Values of chronic Cholelithiasis

↑ AST

↑ ALT

↑Alkaline Phosphatase

↑Bilirubin

Abnormal Liver Function Test

54

Sonographic appearance chronic Cholelithiasis

Barely see GB

Shadow

55

What is Mirizzi Syndrome?

impacted stone in the cystic duct

56

Sonographic appearance Mirizzi Syndrome

Shot gun sign

57

What is Hydrops of the Gallbladder

Mucus filled gallbladder. AKA: Mucocele

58

Sonographic Appearance Hydrops of the Gallbladder

Enlarged gallbladder

Thin walls

Presentation: RUQ pain

Lab Values: Abnormal Liver Function Test

Cause: obstruction of cystic duct

59

Cause Hydrops of the Gallbladder

obstruction of cystic duct

60

Courvoisier’s gallbladder

gallbladder enlargement from obstruction at the level of the distal common bile duct.

61

Sonographic Appearance Courvoisier’s gallbladder

Enlarged gallbladder

Thin walls

62

causes Courvoisier’s gallbladder

mass at the head of the pancreas

63

Porcelain Gallbladder

Rare, Calcium incrustation of the gallbladder wall

64

Sonographic appearance Porcelain Gallbladder

Thick wall calcification

Shadowing

eclipse

65

Presentations of Porcelain Gallbladder

Asymptomatic

Female, over 60

66

Cholangitis

Medical Emergency

Inflammation of the bile ducts with pus within the ducts

67

Sonographic Appearance Cholangitis

Dilated biliary tree

CBD smooth or irregular thickening

Sludge

Hepatic abscess

68

Cholangitis presentations

Malaise

Fever

69

Cholangitis causes

ERCP

Frequent GB attacks

70

Cholesterolosis

Cholesterol is deposited in the lumen of the gallbladder, Strawberry gallbladder

71

Cholesterolosis Sonographic Appearance

Polyps (Do NOT shadow)

multiple, tiny

72

Cholesterolosis AKA

Strawberry Gallbladder

73

Ademomas

Benign neoplasms, overgrowth of gallbladder epithelium. Most common of benign neoplasms usually near fundus

74

Ademomas Sonographic Appearance

hyperechoic

Flat elevations in body

Near fundus

Not gravity dependent

No shadow

75

Adenomyomatosis

hyperplastic change in the gallbladder wall sometimes with papillomas Stones get lodged.

76

Adenomyomatosis Sonographic appearance

Single or groups

Comet tail

Fixed

No shadow

Comet tail

77

Adenomyomatosis AKA

diverticulosis of GB

78

What are the stones called lodged in the GB wall with Adenomyomatosis

Rokitansky-Aschoff sinuses

79

adeno

gland

80

sarcoma

connective tissue

81

Gallbladder Carcinoma

Rare cancer with almost 100% mortality rate

82

Gallbladder Carcinoma Sonographic Appearance

Heterogeneous solid mass

Thick wall

Dilated biliary bucts

stones

shotgun sign

83

Gallbladder Carcinoma Presentation

stones

women over 60 years

Loss of apetite

intolerance to fatty foods

RUQ mass

Pain

belching

84

What is the female to male ratio of Gallbladder Carcinoma?

4:1

85

Gallbladder Carcinoma is the ____ moth common GI malignancy in 60-70 caucasians.

5th

86

Klatskins tumor

Occurs at the bifurcation of the common hepatic duct.

87

Biliary atresia

congenital abnormalities of biliary

ducts from the hilum of the livver to the duodenum are obliterated

88

Caroli’s Disease

Rare congenital recessive abnormality, dilatation of the intrahepatic bile ducts

89

Caroli’s Disease Sonographic Appearance

beaded appearance to intrahepatic ducts

90

Choledochal Cysts

This is a cystic dilatation of the common bile duct due to an abnormal insertion of the duct into the pancreatic duct.

91

Choledochal Cysts Sonographic Appearance

True cyst

Dilated cystic CBD

Diverticulum of CBD

CBD in duodenum

Dilated CBD and CHD

Appearance of a true cyst

Large, cystic mass in the porta hepatis

92

Choledochal Cysts Presentation

Gallstones, pancreatitis, cirrhosis