Where does the GB lie?
within the GB fissure in line with the main lobar fissure
together divide the liver into L/R
What shape is the GB?
what are the layers of the GB?
Does the GB lie in the peritoneal?
What is the size of the GB?
7-10 cm length
5 cm width
What is the function of the GB?
transports the bile
What is the function of bile?
principle route of excretion of bilirubin & cholesterol
excretion of products of steroid hormones, drugs & poisons
What happens when food enters the duodenum?
Release of cholecystoclain
bile flows freely into 2nd portion of duodenum
What does an increase of direct bilirubin indicate?
What is the capacity of the GB?
What is a Hartmann's pouch?
GB folds back on itself between the junctional fold and the neck
What is a Phrygian cap?
How many people have double GB?
What are Development abnormalities of the GB?
left side (situs inversus)
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
What is Cholecystectomy?
removal of GB
What is normal measurement for the common bile duct after a Cholecystectomy?
10 mm or less
What is the measurement for the CBD
greater than 7 mm abnormal
What happens to the CBD at age 60?
1 mm per decade is added to normal measurement
Where should the measurement be taken on the ducts?
inner to inner
What is Jaundice?
obstruction cause bile to leak into blood
What causes jaundice when an obstruction is not present?
What is hemolysis?
What are indications for a GB scan?
positive Murphy's sign
with inflammation pain radiates to shoulder
intolerance to fatty foods/dairy products
What is Murphy's sign?
What is the Prep for a GB exam?
NPO after midnight
NPO for at least 8-12 hours
What is Choledocholithiasis
stones in ducts
What are the pertinent lab values?
increase in WBC
increase serum Bilirubin (direct)
What positions should be used for a GB exam?
What happens if stones do not move?
impaction could cause rupture
What is Peritonitis?
inflammation of peritoneum
What is Sludge?
What are causes of sludge?
What are the implications of sludge?
indicator of abnormal biliary dynamics
precursor to cholecystitis
predisposes development of cholelithiasis
What are the Sonographic appearance of Sludge?
Low amplitude echoes
What is tumefactive sludge?
Pus in GB
What are the Sonographic appearance of tumefactive Sludge?
does not layer
can resemble a mass
sludge ball appear as mobile round masses
isoechoic when filled
What is Acute Cholecystitis?
Inflammation of the gallbladder.
Sonographic Appearance Acute Cholecystitis
Rounding of Gallbladder
Acute Cholecystitis Presentation
What are the lab values for Acute Cholecystitis?
Abnormal Liver Function Test
What causes Acute Cholecystitis?
inflamation of GB
What is Cholelithiasis?
Sonographic Appearance Cholelithiasis
Hyperechoic intraluminal echoes
Lab Values Cholelithiasis
↑ Serum Amylase
Abnormal Liver Function Test
Five F’s, Obesity
What is pneumobia?
air in biliary tree
What is chronic Cholelithiasis?
recurrent GB attack +3 months
Lab Values of chronic Cholelithiasis
Abnormal Liver Function Test
Sonographic appearance chronic Cholelithiasis
Barely see GB
What is Mirizzi Syndrome?
impacted stone in the cystic duct
Sonographic appearance Mirizzi Syndrome
Shot gun sign
What is Hydrops of the Gallbladder
Mucus filled gallbladder. AKA: Mucocele
Sonographic Appearance Hydrops of the Gallbladder
Presentation: RUQ pain
Lab Values: Abnormal Liver Function Test
Cause: obstruction of cystic duct
Cause Hydrops of the Gallbladder
obstruction of cystic duct
gallbladder enlargement from obstruction at the level of the distal common bile duct.
Sonographic Appearance Courvoisier’s gallbladder
causes Courvoisier’s gallbladder
mass at the head of the pancreas
Rare, Calcium incrustation of the gallbladder wall
Sonographic appearance Porcelain Gallbladder
Thick wall calcification
Presentations of Porcelain Gallbladder
Female, over 60
Inflammation of the bile ducts with pus within the ducts
Sonographic Appearance Cholangitis
Dilated biliary tree
CBD smooth or irregular thickening
Frequent GB attacks
Cholesterol is deposited in the lumen of the gallbladder, Strawberry gallbladder
Cholesterolosis Sonographic Appearance
Polyps (Do NOT shadow)
Benign neoplasms, overgrowth of gallbladder epithelium. Most common of benign neoplasms usually near fundus
Ademomas Sonographic Appearance
Flat elevations in body
Not gravity dependent
hyperplastic change in the gallbladder wall sometimes with papillomas Stones get lodged.
Adenomyomatosis Sonographic appearance
Single or groups
diverticulosis of GB
What are the stones called lodged in the GB wall with Adenomyomatosis
Rare cancer with almost 100% mortality rate
Gallbladder Carcinoma Sonographic Appearance
Heterogeneous solid mass
Dilated biliary bucts
Gallbladder Carcinoma Presentation
women over 60 years
Loss of apetite
intolerance to fatty foods
What is the female to male ratio of Gallbladder Carcinoma?
Gallbladder Carcinoma is the ____ moth common GI malignancy in 60-70 caucasians.
Occurs at the bifurcation of the common hepatic duct.
congenital abnormalities of biliary
ducts from the hilum of the livver to the duodenum are obliterated
Rare congenital recessive abnormality, dilatation of the intrahepatic bile ducts
Caroli’s Disease Sonographic Appearance
beaded appearance to intrahepatic ducts
This is a cystic dilatation of the common bile duct due to an abnormal insertion of the duct into the pancreatic duct.
Choledochal Cysts Sonographic Appearance
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
Choledochal Cysts Presentation
Gallstones, pancreatitis, cirrhosis