1
Q
What is the primary composition of most gallstones?
A
80% cholesterol, 20% pigmented
2
Q
What are the “4 Fs” associated with gallstone formation?
A
Fat (obesity), Female, Forty (age >40), Fertile (multiparity)
3
Q
How do gallstones typically appear on ultrasound in B-mode?
A
Echogenic (bright)
4
Q
What is the significance of posterior shadowing in relation to gallstones?
A
It is pathognomonic, meaning it is a characteristic sign.
5
Q
What is the “WES sign” and what does it indicate?
A
WES sign stands for Wall Echo Shadow and is pathognomonic for a gallstone.
6
Q
Are gallstones typically mobile or fixed?
A
Gallstones are typically mobile with changes in position or gravity.
7
Q
How does the compressibility of a gallstone differ from a fixed lesion?
A
Gallstones are non-compressible and rigid.
8
Q
What is the first-line imaging modality for suspected cholelithiasis?
A
Ultrasound (USG) is the first-line imaging modality, with a sensitivity of 90-95%.
9
Q
What is sonographic Murphy’s sign and what is its specificity?
A
Sonographic Murphy’s sign is tenderness over the gallbladder when the ultrasound probe is applied, with a specificity of 95% or higher.
10
Q
What gallbladder wall thickness is indicative of inflammation in acute cholecystitis?
A
A gallbladder wall thickness greater than 3 mm suggests inflammation.
11
Q
What does the presence of pericholecystic fluid suggest in acute cholecystitis?
A
Fluid around the gallbladder suggests severe inflammation.
12
Q
What does an impacted stone in the neck or cystic duct indicate?
A
It has high specificity for acute cholecystitis.
13
Q
What temperature is considered a clinical finding for acute cholecystitis?
A
A temperature greater than 38°C (100.4°F).
14
Q
What is the clinical finding of RUQ tenderness in acute cholecystitis?
A
Localized pain over the gallbladder area.
15
Q
What is the diagnostic criterion for acute cholecystitis using ultrasound?
A
At least 2 ultrasound findings, preferably with clinical correlation.
16
Q
What is a HIDA scan and when is it used in the diagnosis of cholecystitis?
A
A HIDA scan (Hepatic Iminodiacetic Acid) is used when ultrasound findings are equivocal.
17
Q
What is the most specific finding on a HIDA scan for cystic duct obstruction?
A
Non-visualization of the gallbladder.
18
Q
What does it mean if the gallbladder fills on a HIDA scan?
A
It rules out cholecystitis.
19
Q
What does dilation of the biliary tree on a HIDA scan suggest?
A
It suggests obstruction.
20
Q
What is the recommended management for uncomplicated acute cholecystitis?
A
Cholecystectomy within 72 hours, as early surgery leads to better outcomes.
21
Q
What is the management for complicated acute cholecystitis (e.g., gangrenous, perforated)?
A
Immediate surgery.
22
Q
What does the MACE scoring system for acute cholecystitis include?
A
Murphy’s sign, Anterior wall thickness, Collection (fluid), and Echo stone.
23
Q
What is a key finding in the GB wall in emphysematous cholecystitis?
A
Echogenic foci in the GB wall.
24
Q
What does the presence of gas in the GB wall indicate in emphysematous cholecystitis?
A
Risk of gangrene.
25
What are common causative organisms for emphysematous cholecystitis?
E. coli, Clostridium, Staphylococcus.
26
Which bacteria are typically associated with gas formation in emphysematous cholecystitis?
Gas-forming bacteria.
27
What are significant risk factors for emphysematous cholecystitis?
Diabetes and immunocompromised status.
28
What is the implication of diabetes and immunocompromised status in relation to emphysematous cholecystitis?
Increased mortality.
29
What imaging modalities are useful for diagnosing emphysematous cholecystitis?
CT or X-ray.
30
What specific finding on CT or X-ray suggests emphysematous cholecystitis?
Air in the GB wall.
31
What is the typical mortality rate for emphysematous cholecystitis?
High mortality (30-50%).
32
What is the recommended management for emphysematous cholecystitis?
Requires urgent surgery.
33
What is the preferred imaging modality for showing gas in emphysematous cholecystitis?
CT abdomen.
34
What is the characteristic finding of the GB wall in chronic cholecystitis?
Thickened and fibrotic (>3 mm).
35
What is the typical size of the GB in chronic cholecystitis?
Shrunken and non-functional.
36
What are common associated findings with chronic cholecystitis on imaging?
Stones and calcification.
37
What is porcelain GB?
A completely calcified GB wall.
38
What is the characteristic appearance of porcelain GB?
Eggshell appearance.
39
What is the risk associated with porcelain GB?
High risk of cancer (10-15%).
40
What is the recommended treatment if porcelain GB is identified?
Cholecystectomy.
41
What is the management for a gallbladder polyp less than 10 mm?
USG surveillance every 6-12 months.
42
What is the management for a gallbladder polyp between 10-20 mm?
USG follow-up and consideration of surgery.
43
What is the management for a gallbladder polyp greater than 20 mm?
Cholecystectomy is indicated, as it is likely malignant.
44
What does a 'comet tail artifact' indicate in a gallbladder ultrasound?
It indicates a gas bubble, which is benign and requires no follow-up.
45
What is a 'Phrygian cap' in the context of gallbladder anatomy?
It is a normal anatomical variant and requires no follow-up.
46
Which type of gallbladder polyp carries a higher risk of malignancy?
A sessile polyp greater than 10 mm.
47
What are associated conditions or factors that increase the risk of malignancy with gallbladder polyps?
Primary sclerosing cholangitis (PSC), a solitary large polyp (>20 mm), and age >60 years.
48
What are the common causes for non-visualization of the gallbladder?
Cystic duct obstruction, post-cholecystectomy, or a normal variant.
49
What does cystic duct obstruction mean?
A stone or inflammation is blocking the cystic duct.
50
What is the management if the gallbladder has already been removed?
Clinical history is sufficient.
51
What is the management if the gallbladder may not always be visible due to a normal variant?
Repeat the exam.
52
What is considered the gold standard for diagnosing gallbladder issues related to visualization?
HIDA scan.
53
What type of radiopharmaceutical is used in a HIDA scan?
A Tc-99m IDA derivative.
54
What does it mean if the gallbladder visualizes on a HIDA scan?
It rules out cystic duct obstruction.
55
What does it mean if the gallbladder does not visualize on a HIDA scan?
Cystic duct obstruction is confirmed.
56
What is a key feature of adenomyomatosis regarding the gallbladder wall?
The gallbladder wall is thickened, measuring greater than 3-4 mm, and contains cystic spaces.
57
What is the characteristic appearance of cystic dilatations in the wall of adenomyomatosis?
The cystic dilatations in the wall are often described as a 'rosary bead' appearance.
58
Is adenomyomatosis associated with an increased risk of malignancy?
No, adenomyomatosis is a benign condition and does not carry an increased risk of malignancy.
59
What is the typical frequency of adenomyomatosis found in cholecystectomy specimens?
It is found in 5-10% of cholecystectomy specimens and is often an incidental finding.
60
What is the definition of hyperbilirubinemia in the context of obstructive jaundice?
Hyperbilirubinemia is defined as a total bilirubin level greater than 2 mg/dL.
61
What are the clinical signs of icterus?
Icterus is characterized by yellowing of the sclera (whites of the eyes) and skin.
62
What does the presence of pale stools indicate in obstructive jaundice?
Pale stools suggest that there is decreased bile reaching the colon.
63
What does dark urine signify in obstructive jaundice?
Dark urine indicates an increase in conjugated bilirubin in the urine.
64
What causes pruritus in obstructive jaundice?
Pruritus (itching) is caused by bile salt deposition in the skin.
65
What is steatorrhea and what does it indicate in obstructive jaundice?
Steatorrhea refers to fatty stools and indicates fat malabsorption due to the lack of bile.
66
What is the primary indicator of jaundice?
Increased bilirubin levels.
67
In Step 1 of evaluating jaundice, what does a higher direct bilirubin level compared to indirect bilirubin suggest?
Obstructive jaundice (cholestasis).
68
In Step 1 of evaluating jaundice, what does a higher indirect bilirubin level compared to direct bilirubin suggest?
Hepatocellular jaundice.
69
What is the first imaging modality recommended in Step 2 for evaluating jaundice?
Ultrasound (USG) of the abdomen.
70
What is the 'Double Barrel Sign' on an abdominal USG, and what does it indicate?
The 'Double Barrel Sign' refers to a dilated portal vein and common bile duct (CBD). It confirms obstruction.
71
What does the presence of dilated intrahepatic ducts on USG suggest?
It suggests upstream obstruction.
72
What is considered an abnormal diameter for the common bile duct (CBD) on USG?
Greater than 6 mm is considered abnormal.
73
If a stone is visible in the CBD on USG, what is the likely cause of jaundice?
A CBD stone causing obstruction.
74
What finding on USG, in the context of jaundice and dilated ducts, might suggest pancreatic cancer?
A pancreatic head mass.
75
If the intrahepatic ducts are normal but there is jaundice, what is the likely cause?
Hepatocellular dysfunction.
76
What imaging modality is recommended in Step 3 if ERCP is not immediately available?
Magnetic Resonance Cholangiopancreatography (MRCP).
77
What type of MRI images are used in MRCP to visualize the biliary tree non-invasively?
T2-weighted MRI images.
78
What is the purpose of ERCP (Endoscopic Retrograde Cholangiopancreatography) as described in Step 4?
ERCP is used when the diagnosis is clear and an intervention is needed, such as for stones or placing stents.
79
What is considered the gold standard for diagnosing and treating CBD stones and performing procedures like papillotomy?
ERCP.
80
What is the normal measurement for the CBD diameter?
Less than 6 mm.
81
What CBD diameter is considered abnormal and likely indicates obstruction?
Greater than 6-8 mm.
82
What is the significance of a CBD diameter between 7-8 mm after a cholecystectomy?
The CBD can dilate to 7-8 mm after cholecystectomy, so this range may still be considered normal in that context.
83
What CBD diameter is still considered abnormal even after a cholecystectomy?
Greater than 8 mm.
84
How does a CBD stone appear on ultrasound?
As an echogenic focus with shadowing.
85
What does the presence of prominent or dilated intrahepatic ducts on ultrasound signify?
It signifies upstream obstruction.
86
What is the critical measurement for the CBD diameter in relation to obstruction?
6 mm.
87
What does the finding of dilated intrahepatic ducts indicate?
Proximal obstruction.
88
What is a key advantage of using Ultrasound (USG) for imaging obstructive jaundice?
USG is non-invasive, cheap, has no radiation, and is fast.
89
What is a significant disadvantage of USG in diagnosing obstructive jaundice?
It is operator-dependent and may miss stones smaller than 5mm.
90
What advantage does CT offer in the investigation of obstructive jaundice?
CT provides detailed imaging and is good for evaluating pancreatic pathology.
91
What are the disadvantages of CT for obstructive jaundice?
CT involves radiation and is less sensitive for detecting small stones.
92
What is the primary advantage of MRCP in obstructive jaundice?
MRCP offers non-invasive T2-weighted visualization of the biliary tree.
93
What are the disadvantages of MRCP?
MRCP is slower and more expensive than other modalities.
94
What is the role of MRCP in obstructive jaundice?
MRCP is used for diagnosis only and does not involve treatment.
95
What is considered the gold standard for both diagnosis and treatment of obstructive jaundice?
ERCP (Endoscopic Retrograde Cholangiopancreatography).
96
What is the main disadvantage of ERCP?
It is invasive and carries a risk of pancreatitis (1-5%).
97
What is a unique advantage of Percutaneous Transhepatic Cholangiography (PTC)?
PTC bypasses the duodenum.
98
What are the disadvantages of PTC?
PTC is invasive and associated with more complications.
99
When is PTC typically used in the management of obstructive jaundice?
PTC serves as a backup option if ERCP fails.
100
What is the mnemonic for remembering the diagnostic and therapeutic roles of ERCP and MRCP?
ERCP = Only for Dx + Rx; MRCP = Diagnosis only.
101
What is the imaging finding for a dilated CBD (Common Bile Duct) in obstructive jaundice?
A CBD greater than 6 mm with an echogenic focus and shadowing.
102
What is the management for a dilated CBD with a stone?
ERCP for stone extraction.
103
What is the WES sign in the CBD?
It indicates a stone visualized with shadowing within the CBD.
104
What is the gold standard treatment for a WES sign in the CBD?
ERCP.
105
What are the signs of ascending cholangitis?
Fever and Charcot's triad (fever, jaundice, right upper quadrant pain).
106
What is the management for ascending cholangitis?
ERCP combined with antibiotics.
107
What is a common imaging finding in pancreatic head cancer?
Dilated common bile duct (CBD) and intrahepatic ducts.
108
What type of pancreatic mass is often seen with dilated CBD and intrahepatic ducts in pancreatic head cancer?
A hypoechoic pancreatic mass.
109
What is the 'double duct sign' in the context of pancreatic cancer?
It refers to a dilated CBD and a dilated pancreatic duct, indicating pancreatic obstruction.
110
What does Courvoisier's law suggest?
A palpable gallbladder in a jaundiced patient suggests malignancy, not a gallstone.
111
What is the typical prognosis for pancreatic head cancer?
Poor, with a 5-year survival rate of approximately 5%.
112
What is the recommended imaging for tumor staging in pancreatic cancer?
CT/MRI.
113
What is the mechanism of Mirizzi syndrome?
A stone in the cystic duct causes external compression of the common bile duct (CBD).
114
What imaging finding is characteristic of Mirizzi syndrome?
A stone visible at the gallbladder neck with CBD obstruction due to external compression.
115
How does Mirizzi syndrome cause CBD obstruction?
From an adjacent stone (not inside the CBD) that narrows the CBD externally.
116
How common is Mirizzi syndrome as a cause of gallstone disease?
It is a rare cause, accounting for less than 1% of gallstone disease.
117
What is the management for Mirizzi syndrome?
Cholecystectomy, which includes the surgical removal of the obstructing stone.
Radio diagnosis
flashcards
Decks in class (21)
# Cards
-
basics and usg abdo184
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usg abdo 2123
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usg abdo 3156
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machines161
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MRI150
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mri and c270
-
usg145
-
contrast media78
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GI131
-
Intestine156
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gallbladder117
-
gallbladder 232
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Kidneysss158
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Uretheral trauma ovaries and pregnancy130
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thoracic radio210
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thoracic park 2108
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neuroradio139
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neuroradio 296
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MSK145
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nuclear radio155
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nuclear radio 2119
