Gallbladder Powerpoint

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1

Cholesterolosis

____ is a condition in which cholesterol is deposited within the lamina propria of the gallbladder.

____ is associated with cholesterol stones in 50-70% of patients.

"strawberry gallbladder"

2

Cholesterolsis

With ___ most patients do not show thickening of the gallbladder wall. Small percentage show polyps, which are small, soft tissue projections connected by a stalk to the gallbladder wall. They are usually found in the middle third of the gallbladder and are less than 10 mm in diameter.

3

Adenomyomatosis

Papillomas

____ is a hyperplastic change in the gallbladder wall.

___ may occur singly or in groups and may be scattered over a large part of the mucosal surface of the gallbladder. ___ are not precursors to cancer.

Various patient positions show the lesion to be immobile.

4

Gallbladder Carcinoma

Cholelithiasis

____ is the primary carcinoma of the gallbladder; is rare and nearly always a rapidly progressive disease with a mortality rate approaching 100%.

Associated with ____ in approx. 80-90%.

Twice as common as carcinoma of the bile ducts and occurs most frequently in women greater than 60.

5

Choledochal Cysts

___ can be congenital, focal, or diffuse cystic dilation of the biliary tree.

May be the result of pancreatic juices refluxing into thebile duct because of abnormal junction of the pancreatic duct and CBD causing duct wall abnormality, weakness and outpouching of the ductal walls.

6

Choledochal Cysts

____ are rare and are more common in women than men, with an increased incidence in infants.

May be associated with gallstones, pancreatitis, or cirrhosis

7

Choledochal Cysts

___ symptoms include: abdominal mass, pain, fever and jaundice.

Diagnosis may be confirmed with a nuclear medicine hepatobiliary scan.

___ are classified into 5 types.

8

1

Choledochal Cyst type __ is a fusiform dilations of the CBD.

Most common, along with type 4a.

Associated with a long common channel (greater than 20mm) between the distal bile duct and the pancreatic duct.

9

2

3

Choledochal cyst type __ are true diverticuli of the bile ducts.

Type _ (choledochoceles) are cinfined to the intraduodenoal portion of the CBD.

10

4 A

4B

5

Choledochal cyst type __ are intrahepatic and extrahepatic biliary dilations.

Type __ cysts are confined to the extrahepatic biliary tree.

Type __ have been classified as Caroli's Disease (beaded appearance).

11

Caroli's Disease

___ is a rare congenital abnormality most likely inherited in an autosomal recessive fashion.

___ is a communicating cavernous ectasia of the intrahepatic ducts characterized by congenital segmental saccular cystic dilation of major intrahepatic bile ducts.

12

Caroli's Disease

___ is found in the young adult or pediatric population; may be associated with renal disease or congenital hepatic fibrosis.

Symptoms: recurrent cramplike upper abdominal pain, secondary to biliary stasis, ductal stones, cholangitis, and hepatic fibrosis.

13

Caroli's Disease

Medullary sponge kidney has a strong association to ___.

2 types: Simple classic form and the more common form associated with periportal hepatic fibrosis.

14

Caroli's Disease

___ presents as multiple cystic structures in the area of the ductal system converge toward the porta hepatis. Masses seen as localized or diffusely scattered cysts communicate with bile ducts. Ducts may show a beaded appearance as the extend into the periphery of the liver.

15

Caroli's Disease

___ differential diagnosis includes polycystic liver disease.

Ectasia of the extrahepatic and common bile ducts may be present.

16

6

10

Dilated biliary ducts with a diameter of __ mm requires further investigation.

A patient may have a normal size hepatic duct and still have distal obstruction.

The CBD has a slightly greater internal diameter than the hepatic duct.

A duct of greater than __ mm is dilated.

17

Biliary Obstruction

Most common cause of ___ is the presence of a tumor or thrombus within the ductal system.

May be found in the extrahepatic or intrahepatic ductal pathway.

Sonographic finding of ___ is called "too many tubes" or "shotgun" sign when intrahepatic ducts are dilated.

18

intrahepatic, suprapancreatic, and porta hepatic

3 primary areas for extrahepatic biliary obstruction?

19

Pancreatic carcinoma, choledocholithiasis, and chronic pancreatitis with stricture formation

3 conditions that cause the the majority of biliary obstruction at the level of the distal duct and cause the extrahepatic duct to be entirely dilated?

20

Suprapancreatic Obstruction

___ originates between the pancreas and the porta hepatis. The head of the pancreas, the intrapancreatic duct, amd pancreatic duct are normal with ultrasound.

The most common cause for this obstruction is malignancy or adenonpthy at this level.

21

Porta Hepatic Obstruction

___ is usually the result of a neoplasm.

In patients with obstruction at this level, ultrasound will show intrahepatic ductal dilation and a normal common duct.

Hydrops of the gallbladder may be present.

22

Cholangiocarcinoma

___ is another cause of obstruction that is a rare malignancy that originates within the larger bile ducts (usually the common duct or common hepatic duct)

23

Intrahepatic Cholangiocarcinoma

____ is the second most common primary malignancy of the liver. Incidence of this tumor has risen, secondary to increasing numbers of patients with liver cirrhosis and hepatitis C infection.

These tumors are often unresectable with a poor prognosis.

24

Intrahepatic Cholangiocarcinoma

____ sonographic findings include a large hepatic mass; hypoechoic to hyperechoic; and heterogeneous texture or hypovascular solid mass

Biliary ductal dilation is associated with these obstructive masses in 1/3 of cases.

25

Hilar Cholangiocarcinoma

___ begins in the right or left bile duct and then extends into the proximal duct and distally into the common hepatic duct and contralateral bile ducts.

Tumor may extend outside of the ducts to involve the adjacent portal vein and arteries. Chronic obstruction leads to atrophy of the involved lobe.

26

Hilar Cholangiocarcinoma

___ symptoms include jaundice, pruritus, and elevated cholestatic liver parameters.

Majority of patients die within 1 year of diagnosis.

27

Klatskin tumor

___ is a specific type of cholangiocarcinoma that can occur at the bifurcation of the common hepatic duct, with involvement of both the central left and right ducts. A nonunion of the right and left ducts without an obstructing mass imaged is characteristic for a ___.

Sonographic: isolated intrahepatic duct dilation

28

Mirizzi Syndrome

___ is an uncommon cause for extrahepatic biliary obstruction because of an inpacted stone in the cystic duct, which creates extrinsic mechanical compression of the common hepatic duct.

Presents with painful jaundice. Sonographically dilation is seen with a normal sized common duct and a large stone in the neck or cystic duct.

29

Spokes of a wheel

Acoustic enhancement

Dilated ducts look similar to the ____.

Dilated ducts have ___.

30

Primary Choledocholithiasis

___ is the formation of calcium stones in the bile duct.

These stones may result from sclerosing cholangitis, Caroli's disease, parasitic infections, chronic hemolytic diseases, and prior biliary surgery

31

Secondary Choledocholithiasis

___ denotes the majority of stones in the common bile duct have migrated from the gallbladder.

Common duct stones are usually associated with calculous cholecystitis.

32

Hemobilia

___ is bleeding into the biliary tree.

___ main cause is biliary trauma secondary to biliary procedures or liver biopsies. Other causes include cholangitis, cholecystitism vascular malformations, abdominal trauma, and malignancies.

Symptoms: pain, bleeding and jaundice

33

Hemobilia

___ sonographic appearance depends on the length of time the blood has been present. Acute hemorrhage will appear as fluid with low-level internal echoes. Blood clots may move in the duct with extension into the gallbaldder.

34

Pneumobilia

___ is air within the biliary tree secondary to biliary intervention, biliary-enteric anatomoses, or common bile duct stents.

May be caused by emphysematous cholecystitis, inflammation from an impacted stone in the CBD, and prolonged acute cholecystitis, which may lead to erosion of the bowel.

35

Pneumobilia

____ sonographically presents as bright, echogenic linear structures that follow the portal triads. The posterior dirty shadow and reverberation artifact is seen. Movement of air bubbles with change in position should be noted.

36

Cholangitis

___ is an inflammation of the bile ducts. It may be identified as oriental sclerosing cholangitis. Other forms include AIDS cholangitis, and acute obstructive suppurative cholangitis.

37

Cholangitis

__ symtoms: malaise and fever, followed by sweating and shivering, RUQ pain, and jaundice. In severe cases, patient is lethargic, prostrate and in shock.

Lab values show leukocytosis and elevated serum alkaline phosphatase and bilirubin.

38

Ascariasis

___ is a disease caused by the parasitic roundworm, Ascaris lumbriocoides, which uses a fecal-oral route of transmission.

The worm may be 20-30 cm long and 6 cm in diameter.

39

Ascariasis

___ worms grow in the small bowel before entering the biliary tree through the ampulla of vater then causes acute biliary obstruction.

The patient may be asymptomatic or have biliary colic, pancreatitism or biliary symptoms.

40

Metastases of the Biliary Tree

___ most common tumor sites that can spread to the biliary tree are from the breast colon and melanoma. Can affect the intrahepatic and extrahepatic ductal systems.

Sonographically: presents similar to cholangiocarcioma.