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Clinical Symptoms of GB Disease (part 1)
- Classic- RUQ pain, usually after ingestion of greasy food Nausea and vomitingMurphy’s sign- rebound tenderness over GBGB attach may cause right shoulder pain
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Clinical Symptoms of GB Disease (part 2)
- Inflammation causing referred pain in right shoulder bladeJaundice may develop with ductal obstruction, which forces bile into blood Abnormal liver function test (ducts are block in one lobe Unexplained acute pancreatitis
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Gallbladder facts
- •Patient should fast 8-12 hrs prior to exam
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- •Size- 7-10 cm length
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- •Wall thickness- 1-3 mm (measure parallel to sound beam)
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- •Location- Main lobar fissure- same path as middle hepatic vein
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Recommended Views
- •SUP GB TRAN
- –neck
- –body- measure wall
- •Normal < 3mm
- –fundus
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Recommended Views
- SUB GB LONG
- Neck
- Body
- Fundus
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Recommended Views
- •Repeat GB images on left lateral decubitus patient
- •Demonstrate the CBD- measure
- *Demonstrate the Mickey’s sign
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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
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Very rare GB anomaly
Two parallel pear- shaped cystic structures in GB fossa
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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
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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
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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)
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Cholesterolosis/
Cholesterol Polyp
- •Small benign growths arising from the GB wall
- •Lab/Symptom
- –Asymptomatic
- •U/S Finding
- –Immobile small intralumenal mass
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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
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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
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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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