Gallbladder Diagnosis

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Questions and Answers

What is the purpose of scanning the patient in the hands/knees position?

To identify gallstones in the bile ducts

To reliably diagnose gallstones in the gallbladder

To remove excessive bowel gas that may obscure the gallbladder (correct)

To diagnose pyogenic infection in the gallbladder

Why may ultrasound not always be reliable in recognizing stones in the bile ducts?

Because the ultrasound beam is not strong enough to penetrate the bile ducts

Because the ultrasound frequency is not suitable for detecting stones in the bile ducts

Because the stones are too small to produce an acoustic shadow (correct)

Because the stones are hidden by the surrounding tissues

What does the presence of fine dependent echoes that move slowly with a change in the patient's position indicate?

Pyogenic debris

Gallbladder sludge (correct)

Blood clots

Gallstones

What is the most common cause of non-mobile internal echoes with shadowing?

Impacted calculus Signup and view all the answers

Why is it important to scan the liver for cysts?

To exclude hydatid membranes Signup and view all the answers

What can produce fine dependent echoes that move slowly with a change in the patient's position?

Gallbladder sludge Signup and view all the answers

What is a limitation of ultrasound in diagnosing gallbladder disease?

It cannot detect gallstones in the bile ducts Signup and view all the answers

What is a common cause of mobile internal echoes without shadowing?

Gallbladder sludge Signup and view all the answers

What is the primary reason for a gallbladder to not be visualized by ultrasound?

The patient has a congenital absence of the gallbladder Signup and view all the answers

What is the normal width of a gallbladder?

Less than 4 cm in width Signup and view all the answers

What should be done if the gallbladder does not appear thickened on US, but there is no clinical evidence of cholecystitis?

Give the patient a fatty meal and repeat the ultrasound examination Signup and view all the answers

What is the sign of a stone or other obstruction in the common bile duct on a transverse scan?

A target sign Signup and view all the answers

What is the primary reason for a gallbladder to be enlarged?

The patient has a mass or lymph node pressing externally on the duct Signup and view all the answers

What is the diameter of the common hepatic duct that indicates dilation?

More than 5 mm Signup and view all the answers

Why should no clinical judgment be made if the gallbladder is not visualized, even after scanning in different positions?

Because there are very few pathological conditions that result in persistent non-visualization Signup and view all the answers

What is the primary indication of a gallbladder contraction?

The patient has been given a fatty meal Signup and view all the answers

What characteristic of the gallbladder wall is commonly found in acute cholecystitis?

Thickened and oedematous Signup and view all the answers

What is the distinguishing feature of a mucocele in the gallbladder?

Thin walls with fluid Signup and view all the answers

Which of these should be considered if gallstones are not causing symptoms?

Considering other diseases Signup and view all the answers

Which imaging position might help in better visualization of gallstones when they are not clearly seen on routine scans?

Oblique or erect position Signup and view all the answers

What feature characterizes gallstones in an ultrasound?

Bright intraluminal echogenic structures with an acoustic shadow Signup and view all the answers

Which symptom is usually associated with acute cholecystitis?

Pain in the right upper abdomen Signup and view all the answers

What is a common feature of gallbladder perforation in acute cholecystitis?

Presence of adjacent fluid Signup and view all the answers

What is a recommended action when rescan is required for suspected but unclear gallstones?

Rescan with the patient in an oblique or erect position Signup and view all the answers

Study Notes

Gallbladder Conditions

Distended gallbladder with thickened walls (>5 mm) and fluid indicates potential empyema, likely presenting with local tenderness upon examination.
Distended gallbladder with thin walls and fluid suggests a mucocele, typically without local tenderness.
Transverse and longitudinal scans reveal thick-walled, distended gallbladder.

Acute Cholecystitis

Characterized by right upper abdomen pain and local tenderness when the transducer is applied near the gallbladder.
Often associated with one or more gallstones, particularly in the gallbladder neck or cystic duct.
Gallbladder walls appear thickened and edematous; it may not always be distended.
Perforation of the gallbladder usually results in fluid accumulation nearby.
Not all gallstones cause symptoms; differential diagnosis is necessary.

Gallstone Identification

Mobile internal echoes with shadowing signify gallstones, appearing as bright echogenic structures with acoustic shadowing.
Patient repositioning (oblique or erect) can help visualize gallstones if not seen initially due to their movement within the gallbladder.
Continuous non-visualization of the gallbladder may indicate lack of experience from the examiner; consult a colleague for further evaluation.

Enlarged Gallbladder

Gallbladder is considered enlarged if transverse diameter exceeds 4 cm.
Distension can occur due to dehydration, low-fat diet, intravenous nutrition, or immobilization.
If cholecystitis is not indicated and gallbladder walls are normal, administration of a fatty meal followed by a repeat ultrasound can help assess wall contraction.
Absence of contraction may warrant investigation for obstruction due to gallstones or mass pressing on the cystic duct.

Ultrasound Findings

Normal gallbladder is expected to contract after ingestion of a fatty meal; if not, complications such as obstruction may be present.
Scans need to investigate potential cystic duct or common bile duct obstructions, indicated by dilatation of the common hepatic duct (>5 mm).
Using hands/knees position during scans can enhance visualization by moving gallstones anteriorly.

Reliability of Ultrasound

Ultrasound is effective for diagnosing gallstones in the gallbladder but less reliable for those in the bile ducts.
Differential causes of internal echoes without shadowing include gallstones (small stones may not cast shadows), sludge (thickened bile), pyogenic debris, blood clots, and parasites like Ascaris.

Nonmobile Internal Echoes

Nonmobile internal echoes with shadowing suggest impacted gallstones; other calculi should be sought within the gallbladder.
Chronic inflammation may lead to thickened walls alongside gallstone presence, raising suspicion for acute or chronic cholecystitis.
Difficulty in excluding carcinoma associated with gallbladder wall calcification if thickened.

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Description

Identify the symptoms and diagnosis of gallbladder conditions, including empyema and mucocele, based on clinical observations and ultrasound scans.