GB DMSO 1441

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Author:
missyann0007
ID:
180463
Filename:
GB DMSO 1441
Updated:
2012-10-28 21:56:15
Tags:
Gallbladder
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Description:
Gallbladder anatomy protocol common diseases
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  1. Clinical Symptoms of GB Disease (part 1)
    • Classic- RUQ pain, usually after ingestion of greasy food 
    • Nausea and vomiting
    • Murphy’s sign- rebound tenderness over GB
    • GB attach may cause right shoulder pain
  2. Clinical Symptoms of GB Disease (part 2)
    •  Inflammation causing referred pain in right shoulder blade
    • Jaundice may develop with ductal obstruction, which forces bile into blood
    •  Abnormal liver function test (ducts are block in one lobe
    •  Unexplained acute pancreatitis
  3. Gallbladder facts
    • Patient should fast 8-12 hrs prior to exam
    •  
    • Size- 7-10 cm length
    •  
    • Wall thickness- 1-3 mm (measure parallel to sound beam)
    •  
    • Location- Main lobar fissure- same path as middle hepatic vein
    •  
  4. Recommended Views
    • SUP GB TRAN
    • neck
    • body- measure wall
    • Normal < 3mm
    • fundus
    •  
  5. Recommended Views
    • SUB GB LONG
    • Neck
    • Body
    • Fundus
  6. Recommended Views
    • Repeat GB images on left lateral decubitus patient
    • Demonstrate the CBD- measure
    • *Demonstrate the Mickey’s sign
  7. Normal GB anatomical variants
    • Junction fold- neck, most common
    • Phrygian cap- fundus
    • Hartmann’s pouch- cystic duct and junction fold
    • Dilated cystic duct- tortuous nature of duct
    • Duplication gallbladder- congenital
  8. Very rare GB anomaly
    Two parallel pear- shaped cystic structures in GB fossa
  9. Hydropic/ Mucocele Gallbladder
    • Complete blockage of cystic ducts causes mucocele of the GB
    • Trapped bile is absorbed and replaced with a clear mucinous secretion from the lining of the GB
    • Lab/Symptoms
    • Asymptomatic or epigastric pain, discomfort, nausea, vomiting
    • U/S Findings
    • Dilated tense GB, thin wall
  10. Cholelithiasis
    (bowels/pebble stones)
    • Lab/Symptoms
    • Check bilirubin
    • Increase amylase, abnormal LFT’s (increase alkaline phosphatase), normal AST and ALT
    • U/S Finding
    • Increase GB wall
    • Hyperechoic intraluminal structures with posterior acoustic shadowing
    • Gravity dependent calcification in Gb
    •  
  11. Wall Echo Sign (WES) /
    Double Arc Sign
    • Two parallel, curved, echogenic lines separated by a thin anechoic space with distal acoustic shadowing
    • W= wall (hypoechoic)
    • E= stone (echogenic)
    • S= shadowing (hypoechoic)
    •  
  12. Cholesterolosis/
    Cholesterol Polyp
    • Small benign growths arising from the GB wall
    • Lab/Symptom
    • Asymptomatic
    • U/S Finding
    • Immobile small intralumenal mass
    •  
  13. GB Sludge
    • Echogenic bile
    • Lab/Symptoms
    • No clinical significant
    • Occurs with long period fasting , alcoholism, biliary obstruction
    • U/S Findings
    • Non-shadowing low-amplitude echoes that layer in the dependent part of the GB
    • Creates a fluid filled level
    •  
  14. Timed active sludge/sludge balls
    • Lab/Symptoms
    • Asymptomatic
    • RUQ discomfort intermittent
    • Abnormal LFT’s in association with changes due to obstruction
    • U/S Findings
    • Low-level internal echoes layering in dependent part of GB
    • Alters with patient postion
    • Sludge balls (non-shadowing)
    • Avascular mass with low-level echoes
  15. Adenomyomatosis/ 
    Rokitansky- Aschoff Sinuses
    • Cholesterol crystal lodged within wall
    • Lab/ Symptoms
    • Asymptomatic
    • U/S Findings
    • Gallbladder wall diverticula that contain bile, sludge, or stones
    • Comet-tail artifact from wall
    •  

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