women are affected more often. Since 80% of the patients with gallstones are asymptomatic, detected gallstones are only consequential in context with , their complications (cholecystitis, cholangitis, colics, biliary obstruction). If removal is indicated, this can be achieved by percutaneous or open cholecystectomy or, alternatively, by ESWL (extracorporeal shock wave lithotripsy) or ERCP. Furthermore, the composition of the bile can be altered by medication and some stones regress following nutritional changes.
Note the thin, single-layered, echogenic wall (80) of both gallbladders (14) shown in Figures 35.1 and 35.2. There is no inflammatory thickening of the gallbladder wall. Compare this finding to the one on the images on the next page.
Cholecystitis is invariably caused by stones (49). Early cholecystitis only causes the gallbladder (14) to be tender, but inflammatory edema of the gallbladder wall (80) soon develops and the wall becomes thickened and multilayered
ITie preprandial gallbladder wall normally measures less than 4 mm. Thickening of the gallbladder wall does not have to be a sign of inflammation since it can be found in many conditions, including ascites (68) (Fig. 36.2), hypoalbu-minemia, or right-sided cardiac insuffiency.
An additional finding indicative of an acute inflammation is pericholecystic accumulation of fluid (68), which in some cases can be confined to Morrison's pouch between the inferior hepatic border and right kidney. Finally, the gallbladder can become indistinct in outline where it abuts the hepatic parenchyma (9). An increased diameter of the gallbladder of more than 4 cm is a sign of hydrops, but even more characteristic for hydrops is the associated altered configuration from a pear-shaped to a more biconvex and spherical structure.
Recognizing air within the lumen of the gallbladder or in its wall (mural emphysema) is crucial since an infection with gas-forming organisms implies a poor prognosis and is associated with a high risk of perforation. Chronic cholecystitis can lead to a contracted gallbladder or a porcelain gallbladder with mural calcifications. Both conditions cannot easily be differentiated by sonography and have to be evaluated together with the clinical findings.
Quiz for self-assessment:
01 What is the maximum diameter of the common bile duct? What diameter in mm arouses suspicion of a biliary obstruction?
Hi Write down several diagnoses found in the sonographic image on the left, after careful review. Compare your result with the answer on page 76.
The kidneys are generally best shown in the lateral decubitus position. The longitudinal section of the kidney is visualized by placing the transducer on the extended intercostal line of the flank. With deep inspiration, the kidney moves inferiorly away from the obscuring costal acoustic shadows and appears in its longitudinal dimension (Fig. 37.1a) for evaluation. As is essential for a complete evaluation of any organ, the kidney must also be delineated in a second plane, as demonstrated in Figure 37.1 h for the evaluation of the transverse plane of the left kidney (right lateral decubitus position).
Normal renal parenchyma (29) is slightly decreased or equal in echogenicity relative to the splenic or hepatic parenchyma (9). The width of the parenchyma should measure at least 1.3 cm (the measurements in Fig. 37.2 are 1.5 cm and 2.4 cm, respectively). The ratio between parenchymal width and pelvic width (= PP-index) decreases with age (compare normal values below). In the typical longitudinal section (Fig. 37.2), the hypoechoic medullary pyramids (30) are seen like a string of pearls between the parenchymal cortex and the centrally situated echogenic collecting system(renal pelvis, 31). They should not be mistaken for tumors or cysts. An enlarged adrenal gland should be searched for within the perirenal fat above the upper pole of the kidney (27), where it can appear as a hypoechoic mass within the echogenic perirenal fat. The renal hilum, together with the renal vein (25), is generally well seen on the transverse section (Fig. 37.3). Because of their thin diameter, the ureter and renal artery are often identified only with great difficulty. Why is the position of the transducer depicted in Figure 37.3a not completely compatible with the images shown in Figures 37.3 b and c?
Normal renal values:
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One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.