Medsurg GB study guide - Lecture Information overview PDF

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Med Surg Study Guide – Gallbladder RUQ pain 1. 2. 3. 4. 5.

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Length of gallbladder? a. 7-10 cm Diameter measurement of the CBD? a. Up to 6mm, some references will say 7mm. Increase 1mm per decade of life CHD measurement? a. 4 mm A larger than average CBD might be seen in a. Older patients or with cholecystectomy What part of CBD is distal and which is proximal? What part will be larger? a. Distal CBD is towards pancreas (inferior) and proximal CBD is towards liver (superior). b. The CBD is smaller more proximal towards liver Best practice for measuring GB wall? And in what plane? a. Anterior wall in transverse plane Sonographic appearance of GB a. Anechoic lumen, thin well defined smooth walls, echogenic walls Measurement of gb wall? a. Under 3mm What are the types of GB folds? a. Phrygian cap – fold in fundus b. Hartmans pouch – fold in neck What is a junctional fold? a. Fold between body and neck in an area called infundibulum, looks echogenic The system for classifying duplicate GBs is called? a. Harlaftis Classification What are the types of duplicate gb according to harlaftis classification? a. Type 1 – split primordium b. Type 2 – accessory Type 1 – Split Primordium contains which types of GB ? Describe what each looks like? a. V shape – single cystic duct entering CBD b. Y shape - separate cystic ducts that fuse before joining CBD c. septate – just a septum on the inside of gb

14. Describe type 2 accessory gb and the different types of accessory gbs. a. They are 2 gb with 2 separate cystic ducts b. H shape – individual cystic ducts drain separate into biliary tree c. Right or left hepatic duct trabecular type - one will drain into one of the hepatic ducts 15. What is the most common type of Type 1 Split Primodrium? a. Y shape 16. What is most common for type 2 accessory duct? a. H shape 17. Classification of GB is better visualized with which type of exam and why? a. MRI; US doesn’t allow adequate visualization of cystic duct; can see duplicate gb but not which type

18. What is the most common disease of GB? a. Cholelithiasis 19. What are the stones usually composed of? a. Cholesterol 20. What are the five F’s? a. fat, forty, female, forty, flatulent 21. What are other risk factors of cholelithiasis? a. Pregnancy, diabetes, oral contraceptives, diet induced weight loss, family history, sedentary lifestyle, TPN (total parenteral nutrition) 22. Clinical findings of cholelithiasis? a. Asymptomatic, RUQ pain (increased after fatty meal), epigastric pain, N/V, pain radiating to shoulder 23. Cholelithiasis are mostly asymptomatic, true or false? a. True 24. Sonographic findings of cholelithiasis? a. Echogenic focus or foci, posterior shadowing, move when pt changes positions, WES sign 25. What is the WES sign? a. Wall echo shadow sign. hyperechoic wall, echogenic stone, shadow immediately posterior to echo. Contracted gb filled with stones, cannot see anechoic lumen 26. What are some differential diagnosis for cholelithiasis? a. Duodenal gas b. Porcelain GB c. Surgery clips d. Biliary track air e. Ligamentum teres

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f. polyps g. Sludge ball h. Folds or septum in GB What is porcelain gallbladder? a. Walls of gb are calcified so they appear hyperechoic What is sludge and how does it occur? a. Echogenic bile/viscous bile that is stasis. Can occur from prolonged fasting, obstruction by stone can cause back up and become stasis What is sludge composed of? a. Calcium bilirubinate and cholesterol crystals Clinical findings of sludge? a. Classic biliary symptoms (RUQ pain, epigastric pain, N/V, pain radiating to shoulder or asymptomatic Sonographic appearance of sludge? a. Low to medium level echoes in dependent portion, no shadowing, layer and move slowly with patient position change, sludge ball or tumefactive sludge How can you differentiate between mass and sludge ball/tumefactive sludge? a. Put on color doppler and there will be no flow with absence of internal vascularity. Will also not have a shadow

33. Differential dx for sludge? a. Pseudosludge b. Gb neoplasm c. Intraluminal transducer artifact 34. What is pseudosludge and how does it occur? a. Artifact that looks like sludge. b. Side lobes/grating lobes often with curved boundary of the gb. Redirects the echos from adjacent structures 35. What can you do to rule out pseudosludge? a. Roll patient or use another scanning angle – sludge will move and pseduosludge remains perpendicular to the sound beam 36. What are the 4 kinds of cholecystitis? a. Acute, chronic, calculous, acalculous 37. What is the most common cause of acute cholecystitis? a. Cholelithiasis that creates cystic duct obstruction 38. Is acute cholecystitis more common in men or women? a. Women 39. Clinical findings of acute cholecystitis? a. Ruq pain, epigastric pain radiates to back, N/V, fever, leukocytosis 40. What labs will be abnormal with acute cholecystitis? a. Increased amylase 41. If theres an increase of amylase and lipase what is the disease? a. Pancreatitis 42. Bilirubin and alkaline phosphaste abnormality would indicate a. CBD obstruction 43. Sonographic findings for acute chole a. Cholelithiasis present (usually) b. Thickened GB wall c. + murphy’s sign d. Sludge e. Pericholecystic fluid f. Enlarged gb 44. Etiology of acalculous cholecystis? a. Postoperative, trauma, burn patients, patients with TPN 45. Acalculous cholecystitis is more common in women or men? a. men 46. Differential diagnosis for acute chole a. Chronic cholecystitis b. Nonfasting gb c. Gallbladder carcinoma 47. How does chronic cholecystitis occur? And what happens? a. From multiple attacks of acute cholecystitis, results in fibrosis across wall 48. Clinical findings of chronic chole a. Lack tenderness, asymptomatic, RUQ pain, heatburn, belching

49. Sonographic findings of chronic chole a. Small GB or normal, thick wall, cholelithiasis, WES sign 50. Differential DX of chronic cholecystitis? a. Nonfasting gb, carcinoma of gb 51. What are complications of acute cholecystitis? a. Emphysematous cholecystitis b. Gangrenous cholecystisis c. Perforation 52. What is emphysematous cholecystitis? a. Gas invades GB wall, lumen ,biliary ducts. Ischemica of gb wall and subsequent bacterial invasion 53. Sonographic appearance of emphysematous cholecystitis? a. Air in gb wall and lumen shows as echogenic areas with or without reverberation artifact 54. What are the types of reverb artifacts? a. Ring down (small gas), comet tail, dirty shadow (more gas) 55. Presence of Reverb depends on a. How much gas 56. What are the stages of emphysematous? a. Stage 1: gas in lumen b. Stage 2: wall c. Stage 3: pericholecystic tissue 57. Thick GB wall, focal areas of exudate, hemorrhage and necrosis describe which pathology? a. Gangrenous cholecystitis 58. Gangrenous cholecystitis may lead to GB____ associated with increased _____ and _____ a. Perforation ; morbidity; mortality 59. Sonographic appearance of gangrenous cholecystitis? a. Thick wall, intraluminal echoes, pericholecystic fluid, striations across gb wall, focal areas of exudate 60. What clinical signs of gangrenous cholecystitis? a. More generalized abdominal pain instead of positive murphys 61. Perforation usually occurs ___ to _____ after inflammation a. Several days to several weeks 62. Most common site of perforation? a. Fundus 63. Mortality rate of perforation? a. As high as 24% 64. Clinical signs of perforation? a. Abd pain, leukocytosis, fever 65. What is the hole sign? a. The actual site in the GB that is perforated 66. Sonographic signs of perforation? a. Gb wall thickening, gallstones, hole sign, free floating gallstones in ascites that surround liver, pericholecystic abscess 67. A group of degenerative and proliferative conditions of gb?

a. Hyperplastic cholecystosis 68. Hyperplastic cholecystosis has an increased risk in (males or females) and is (bengin or malignant)? a. Females, benign 69. What are the types of hyperplastic cholecystosis? a. Adenomyomatosis and cholesterolosis 70. Adenomyomatosis is _____ or ______ hyperplasia of GB _____ and extends into _____ resulting in _______ a. Diffused or localized; muscosa; muscular layer; diverticula 71. Three main layers of gb? a. Serosa or adventitia – echogenic b. Muscularis or fibromusclular - hyperechoic c. Mucosa (inner) - more echogenic 72. Clinical findings of hyperplastic ? a. Asymptomatic, similar to gallstone symps 73. Sonographic appearance of hyperplastic a. Anechoic or echogenic foci within gb wall – rokitansky-aschoff sinuses b. Shadowing or comet tail artifact from diverticula c. Gb wall thickness d. May be with gallstones 74. Rokitanky-Aschoff sinuses are where in GB a. Deep within muscle wall 75. What is cholesterolosis? a. Deposition of cholesterol across gb wall 76. Strawberry gallbladder is with localized or diffuse ? a. Diffuse 77. The size of the cholesterol deposits can range from what sizes a. 2-10mm 78. Sonographic appearance of cholesterolisis? a. Small hyperechoic cholesterol polyps arising from gb wall, no shadow and they are immobile, may have comet tail artifact 79. Most common cancer of biliary tract? a. GB carcinoma / adenocarcinoma 80. Where is gb carcioma most commonly located? a. Fundus 81. Risk factors for carcinoma of gb? a. Gallstones, chronic cholecystitis, porcelain gb, some blood groups 82. Carcinoma of gb is more common in a. Females and elderly 83. Clinical findings of gb carcinoma a. Nonspecific in early stages, weight loss, anorexia, ruq pain, jaundice, n/v, hepatomegaly 84. Survival rage for late diagnosis? a. 6 months 85. Sonographic appearance?

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a. Heterogenous polypoid lesion with irregular margins b. Localized wall thickening c. Mass replacing gb d. Calcification of gb wall e. Color doppler shows flow and differentiates from sludge Stones in the bile duct is known as a. Choledochalithiasis Clinical signs of choledochalithisasis? a. Jaundice, elevated bilirubin when there’s obstruction , ruq pain Sono appearance a. Echogenic foci with post shadow in bile duct, with or without dilation of duct Cholangiocarinoma is a _______ anywhere in ______ a. Rare malignant disease anywhere in biliary tract Clinical findings a. Painless jaundice, pruitis, abd pain, anorexia, weight loss, elevated bilirubin, abnorm LFTs, + carcinoembryonic antigen (tumor marker) Sono appearance a. Mass arising from ducts, liver mass, gb may be collapsed, mass disrupting right and lefgt ducts Inflammation of the bile ducts is which pathology? a. Cholangitis Causes of cholangitis a. Ductal structures, parasitic infestations, bacterial infection, stones, neoplasm Clinical findings a. Fever, abdominal pain, jaundice Sonographic appearance a. Biliary dilation, thickened duct walls

Kahoot 1. Which of following is not a characteristic of Y shape duplicate gb a. Separate cystic ducts b. Type 1 split primordium c. Fuse prior to joining cbd d. Type 2 accessory duct D

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What are you looking for when asked to rule out choledocholithiasis? a. Inflammation of gb wall b. Stones in bile duct c. Calcified gb wall d. Contracted gb filled with stones

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Which bile duct tumor can be located intrahepatic or extrahepatic in its origin? a. Cholangiocarcinoma b. Adenomyomatosis c. Angiosarcoma d. Cholestrolosis A

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What is the normal diameter of the gb wall? a....