Pathogenesis and dissolution of gallstones. Zakim D, Boyer TD, eds. A Textbook of Liver Disease. Diseases of the gallbladder and biliary tree.
The gallbladder is generally imaged with patients in both supine and posterior oblique LPO positions. Upright and, on occasion, prone scans may be helpful to visualize very small gallstones.
When stones are not immediately apparent, the region of the cystic duct and neck of the gallbladder should carefully be scrutinized for stones in both transverse and sagittal views. When a gallstone is identified in the neck of the gallbladder, it is important to scan the patient in multiple positions to determine if the stone is impacted.
All patients with acute right upper quadrant pain should be evaluated for sonographic signs of acute cholecystitis.
Sonography of the gallbladder is best performed with a 5-MHz curved array transducer. A 5-MHz linear array transducer may be helpful in patients with very superficial gallbladders.
In obese patients or in patients with difficult sonographic access, a 3,5-MHz sector or curved linear transducer is necessary. It is preferred as a initial imaging study due to several clear advantages in the evaluation of patients with possible acute cholecystitis: It is less expensive than other techniques.
It often can be performed and interpreted more quickly. It provides considerably more anatomic information. It can definitely diagnose gallstones as well as other important secondary findings se below.
It is independent of hepatic function and biliary obstruction unlike scintigraphy. It may be performed at the bedside in critically ill patients. In patients with gangrenous cholecystitis, sonography may guide percutaneous cholecystostomy when clinically appropriate.
Sonography can survey the entire abdomen if the gallbladder is normal an important capability as only a minority of patients referred for imaging with right upper quadrant pain prove to have cholecystitis.
Despite these advantages, sonography has a number of significant limitations in the diagnosis of acute cholecystitis: While cystic duct obstruction can generally be inferred when a stone is identified impacted in the neck of the gallbladder, sonography cannot directly diagnose cystic duct obstruction.
Sonographic Diagnosis of Acute Calculous Cholecystitis: Gallstones are the single most important finding. It differs significantly from the clinical sign and refers to focal tenderness directly over the gallbladder when pressure is applied by the ultrasound transducer.
However, there are generally other significant sonographic abnormalities such as gallstones, wall thickening, or pericholecystic fluid to suggest the diagnosis of cholecystitis. Thickening of the gallbladder wall is an important sonographic observation in acute cholecystitis.
The normal gallbladder wall measures 3mm or less. Measurements are most accurate when obtained from the anterior subhepatic gallbladder wall using a long axis image.
This avoids side-lobe artifacts from adjacent bowel gas and difficulties encountered by dependent intraluminal sludge. In the absence of gallstones, this finding must be interpreted with caution in patients with possible cholecystitis.
Generalized gallbladder wall thickening may occur in a broad spectrum of other disorders including hepatitis, acquired immunodeficiency syndrome AIDScongestive heart failure, hypoalbuminemia, ascites, hyperplastic cholecystosis, and chronic cholecystitis.
Asymmetric thickening of the gallbladder wall may be due to carcinoma, metastases, adenomyomatosis, or gangrenous cholecystitis.Psoriasis (Ps) Stelara ® is indicated for the treatment of patients 12 years or older with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.
Psoriatic Arthritis (PsA) Stelara ® is indicated for the treatment of adult patients with active psoriatic arthritis. Stelara ® can be used alone or in combination with methotrexate (MTX). Mar 30, · Cholelithiasis is the medical term for gallstone disease. Gallstones are concretions that form in the biliary tract, usually in the gallbladder (see the image below).
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Gallbladder and Biliary Tract Disease Online Medical Reference - from definition and diagnosis through risk factors and treatments. Authored by David S.
Barnes, MD of the Cleveland Clinic. Gallbladder diseases considered here include gallstones, tumors, and acute acalculous cholecystitis. Labs Values by Disease Process. Please keep in mind that all of the following lab values are for the adult patient, unless otherwise stated.
We also do our very best to provide you with consistent normal ranges, however please keep in mind that these may vary depending upon your reference source.