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Terms in this set (61)
Gallbladder wall thickness
Measurements for bile ducts
Diameter up to 6mm (2mm). Increases with age and after cholecystectomy.
Measurements of bile ducts after age 50
Increase approximately 1 mm per decade after age 50
Measurements of bile ducts after cholecystectomy
May enlarge to 8-10 mm
Inflammation without stones, 5-10% of cases
Carcinoma of gallbladder
Rare. More common in females age 50-80. Mostly adenocarcinomas. 73-98% associated with gallstones
Carcinoma of gallbladder findings
Asymptomatic. Weight loss, nausea/vomiting, loss of appetite, RUQ pain, jaundice. Elevated bilirubin and alk phos
Carcinoma of gallbladder sono appearance
May be non-specific and vary depending on macroscopic make up of neoplasm. Presence of gallstones within hypoechoic or echogenic mass highly suggestive of carcinoma. Protrusion of a solid, heterogeneous mass into the gb that doesn't move or shadow.
Long standing cystic duct or gb neck obstruction leads to:
Hydrops of gallbladder
Anatomy of biliary tree
Common bile duct, cystic duct, common hepatic duct, left and right hepatic ducts
Anatomy of biliary tree
Right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the CHD
Anatomy of biliary tree
Hepatic duct runs parallel to main portal. CHD joined by cystic duct to form CBD
Connects neck of gb with CHD. Contains spiral valves of Heister (tiny valves that can produce shadow and mimic gallstones)
Obstruction of bile duct. Choledocholithiasis
Vast majority in Ampulla of Vater.
Primary: rare, stones originate in bile duct
Secondary: stone originates in gb and passes through cystic duct to enter bile duct.
Enlarges ductoral system proximal to obstruction, can back bile into liver.
May be asymptomatic. History of jaundice, repeated episodes of RUQ pain, chills/fever. Elevated bilirubin (direct), LFT's and WBC's
Choledocholithiasis sono appearance
Most commonly an echogenic structure in extrahepatic bile duct (down by duodenum). Biliary tree may be dilated
Positive Murphys sign
Acute cholecystitis sign. Hurts you push on gallbladder
Gallbladder location and anatomy
Pear-shaped sac in anterior aspect of RUQ. Divided into neck, body and fundus. Fundus toward inferior
Reservoir for bile. Concentrates bile. When food arrives in duodenum gb contracts to discharge bile.
Hormone secreted into blood by mucosa of upper small intestines; stimulates contraction of gallbladder and pancreatic secretion of enzymes
Normal variant. Fold or kink in the fundus
Biliary causes of gb wall thickening
Acute cholecystitis, adenomyomatosis, cancer, cholangitis
Non-biliary causes of gb wall thickening
Diffuse liver disease (cirrhosis/hepatitis), pancreatitis, congestive heart failure, ascites
Hyperplastic change in gb wall. Proliferation of muscal layer which extends into the muscle layer.
Thickening of bile, causes low level echoes. Gravity dependant, will move to dependant wall.
May be asymptomatic. Possible signs of biliary disease. Normal labs or elevated bilirubin.
Sludge sono appearance
Homogeneous low level, non-shadowing echoes layering in dependant portion of gb. Overdiagnosed, see movement when moving patient
Cancer of gb more common in:
Why you may not see gb
Gas, chronic cholecystitis (shrinks/infection), cholecystectomy, packed gb (stones or shadowing), sludge filled (echogenic), situs inverus, agenesis (born without gb), tumor, patient has eaten
General clinical symptoms of gb disease
Fat intolerance, midepigastric pain, jaundice, abdominal pain, chills and fever
Pus in the gb due to long term obstruction
Rare, life threatening. Gas in wall and lumen of gb. Unknown etiology. Gallstones don't play a role. Gangrene and perforation of gb are complications
Emphysematous sono appearance
Echogenic structures in gb wall and lumen resembling gallstones. Possible hypoechoic area around gb if perforation or gangrene.
Factors predisposing for gallstones
Obesity, diabetes, pregnancy, pancreatitis, biliary tract infection
4 F's of suspected gb disease
Fat, female, forty, fair
Adenomyomatosis or cholesterolosis (cholesterol deposited in gb wall, brighter).
Gallbladder polyps sono appearance
Non-mobile, non-shadowing echogenic mass protruding into lumen of gb. Varied size, single or multiple
Cholesterol deposited into gb wall. Focal presents as polyp attached to gb wall. Diffuse= strawberry GB, lots of dots
Cause of hydrops. Mass in head of pancreas causes bile duct to be blocked. Everything duodenum and up gets blocked and enlarged. Painless jaundice (if seen pick on test)
3 types: cholesterol 80%, mixed 80%, pigmented. Shadowing and movement to dependant wall for diagnosis
Cholelithiasis (gallstones) findings
May be asymptomatic. Nausea/vomiting, occasional jaundice, severe RUQ pain radiating to right shoulder. Elevated serum bilirubin and possibly alk phos
Cholelithiasis (gallstones) sono appearance
Hyperechoic mass with posterior shadowing, moves with patient. Sometimes no shadowing (stones too small). Sometimes all shadow if filled with stones.
Hydrops of gallbladder
Abnormal distention of gb. Dilated and globular. Most commonly stone obstructing cystic duct or gb neck.
Hydrops of gallbladder sono appearance
Globular a/p 4 cm or more
Yellow discoloration of skin or sclera of eye. Caused by increased bilirubin. Most common cause cholelithiasis
Obstructive jaundice findings
Yellow skin or eyes. Itching of skin, RUQ pain, weight loss, dark urine. Elevated bilirubin and alk phos
Obstructive jaundice sono appearance
Depends on severity, duration and cause of obstruction. Dilation of CBD >6mm, CHD >5mm. Increased sonolucent tubular structures (dilated ducts) in peripheral portion of liver
Cystic dilation of CBD. May be result of pancreatic juices refluxing into bile duct
Choledochal cyst sono appearance
Anechoic mass separate from gb, porta hepatis region. Dilated CBD, hepatic duct or cystic duct may be seen entering mass. Associated with gallstones, pancreatitis or cirrhosis
Inflammation of gb. Usually from obstruction of cystic duct by gallstones (90-95% of cases). Acalculous cholecystitis: inflammation without stones 5-10% of cases
Acute cholecystitis findings
RUQ or epigastric pain that radiates to back and increased after greasy food. Nausea and vomiting. Low grade fever
Acute cholecystitis sono appearance
Dilation and rounding of gb. Cystic duct obstruction. 95% of patients have stones. Positive Murphy sign. May have sludge. Thickening of gb wall I'm 50-75% of cases
Results from recurrent attacks of acute cholecystitis. Complications: carcinoma of gb, bile duct stone. Empyema: pus in gb from long term obstruction
Chronic cholecystitis findings
May be asymptomatic. Heartburn/belching. Vague RUQ discomfort
Chronic cholecystitis sono appearance
Gb small or normal size. Possible gallstones and sludge. Thickening of gb wall >3 mm. Gb wall may become calcified
Acute gangrene cholecystitis
Life threatening complication of acute cholecystitis. Diffuse non-layering and non-dependant echogenic density within gb without shadowing. Gb may be thick and edematous. (Swollen and pus)
Calcification of gb wall. Inflammation most likely cause. 95% have stones. RUQ pain, nausea and vomiting. Echogenic gb wall with posterior shadowing, shadowing in gb fossa, gallstones
Malignant neoplasm originates in biliary system. Arise intra or extrahepatic location. Grow along duct or bulky mass in duct. Poor prognosis (185 days post prog)
Cholangiocarcinoma located at junction of right and left hepatic ducts.
Jaundice, abdomen pain. Elevated bilirubin and LFT's
Cholangiocarcinoma sono appearance
Extrahepatic bile duct tumors, arising from CBD, and ampulla carcinomas have the same ultrasonic features as pancreatic tumors. Intrahepatic bile duct tumors have same features as primary tumors of liver.
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