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abdomin and superficial structures > Biliary System > Flashcards

Biliary System Flashcards

1
Q

At what level does the biliary tree begin?

A

Level of the lobules at the bile canailculi

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2
Q

Where are the bile canailculi located?

A

B/w hepatocytes within the interconnecting network

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3
Q

How does the microscopic canailculi form the lobular bile ducts?

A

Anastomose

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4
Q

How are the right and left bile ducts formed?

A

By the union of multiple lobular bile ducts

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5
Q

At what level do the right and left hepatic ducts join to form the CHDs?

A

Porta hepatis

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6
Q

Describe the position of the CHD

A

Anterior to the portal vein

Anterior and lateral to the RHA

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7
Q

Where does the CBD travel?

A

Along the free edge of the lesser omentum

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8
Q

What is the size of the CHD?

A

4mm in diameter

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9
Q

What is the length of the CHD determined by?

A

The insertion point

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10
Q

The CHD joins the cystic duct forming what?

A

CBD

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11
Q

Describe the position of the CBD

A

Anterior and lateral to the MPV

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12
Q

What are the normal diameter ranges for the CBD?

A

Up to 4mm - but varies with age and surgery

Add 1mm for every decade of life after 50years of age

Up to 10mm in post cholecystectomy pt

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13
Q

What ligament does the CBD travel through?

A

Hepatoduodenal ligament

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14
Q

What is the Mickey Mouse appearance?

A

Cross sections through the CBD, HA and MPV

Refer to page 3

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15
Q

How many segments is the CBD divides into?

A

4

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16
Q

What structure are the segments of the CBD relating its position to?

A

Duodenum

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17
Q

What are the 4 segments of the CBD?

A 
1st part (supraduodenal)
2nd part (retroduodenal)
3rd part (infraduodenal)
4th part (intraduodenal)
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18
Q

What does the CBD insert into?

A

Ampulla of vater

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19
Q

What regulates the flow of bile?

A

Sphincter of Oddi

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20
Q

What segment is the narrowest part of the extra-hepatic biliary system?

A

4th part

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21
Q

About how many cm does the cystic duct join the hepatic duct above the duodenum?

A

1-2cm

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22
Q

What part of the GB does the cystic duct arise from?

A

Neck

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23
Q

What is the shape and size of the GB?

A

3mm diameter

4cm length

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24
Q

What are the spiral valves of heister? What are there purpose?

A

Mucosal folds- not true valves
Tortuous areas in the cystic duct
Prevents ducts from over distending or collapsing

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25
Q

Where is the GB located?

A

Posterior inferior surface of the right lobe of the liver in the GB fossa

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26
Q

How does the GB lay in relation to the main lobar fissure?

A

Posterior and caudal to the distal end

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27
Q

What parts of the GB are mobile?

A

Fundus and body

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28
Q

How are the fundus and body positioned with the abdomen?

A

Varies with pt position

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29
Q

Is the GB a retroperitoneal or intraperitoneal organ?

A

Intraperitoneal organ

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30
Q

What is the most reliable landmark in identifying the GB?

A

Main lobar fissure

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31
Q

What are some landmarks for identifying the GB?

A

RPV
Duodenum
Right kidney

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32
Q

What is the size and shape of the GB?

A

Varies widely with pt position
Pear or teardrop shape
8-9cm in length
3-5cm in diameter

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33
Q

What are the 3 divisions of the GB? Describe them

A

Fundus- widest portion, projects below inferior liver margin
Body- lies in contact with the visceral surface of the liver
Neck- tapered to spiral valves, fixed

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34
Q

What is the most dependent portion of the GB in the LLD position?

A

Fundus

35
Q

What is another name for the body of the GB?

A

Corpus

36
Q

What is the most dependent portion of the GB in supine?

A

Neck

37
Q

What should the GB measure less then in a fasting state?

A

3mm

38
Q

What are the 4 layers that make up the GB?

A
  1. Mucosa- inner epithelium
  2. Muscular
  3. Subserous- connective tissue
  4. Serous- outer layer in contact with the peritoneum
39
Q

What layer of the GB concentrates bile?

A

Mucosa

40
Q

What are Rokitansky-Aschoff sinuses? (RA sinuses)

A

Multiple folds along the inner border of the GB coated with epithelial cells (not normally seen without pathology)

41
Q

What is the function of the bile ducts?

A

Drain the liver of bile and carry it into the GI system

42
Q

What is the function of the GB?

A

A resivour for bile - stored until required to aid in digestion

43
Q

How much bile can the GB hold?

A

40-70ml

44
Q

How does the GB concentrate the bile?

A

Secrets mucous and absorbs water

45
Q

Where would a stone most likely get stuck within the biliary tree?

A

4th part of the CBD

46
Q

What sort of pattern should the intrahepatic ducts demonstrate?

A

Demonstrate a branching pattern

47
Q

What should the hepatic ducts measure?

A

No more then 2cm in diameter

48
Q

Do we normally see the intrahepatic ducts?

A

Normally no because they are so small but a landmark used is the portal veins

49
Q

How does knowing the position of the GB aid in the diagnosis of gall stones or sludge?

A

Moving the patient into different positions should move the stones with them- if not other pathologies present

50
Q

What controls bile secretion?

A

Hormones

51
Q

With the ingestion of fats and amino acids what does the duodenum release into the blood stream?

A

Cholecystokinin (CCK)

52
Q

What does the release of CCK stimulate?

A

GB contraction and the sphincter of Oddi to relax

53
Q

What does the sphincter of Oddi control?

A

Passage of bile into the duodenum

Prevents reflux of gastrointestinal fluids into the biliary system

54
Q

When does the GB contract following a meal?

A

30min later

55
Q

What happens to the sphincter of Oddi when the GB is removed?

A

Looses it tone and the pressure in the CBD lowers to equal intra-abdominal pressure

56
Q

What happens to the flow of bile if the GB is removed?

A

Bile flows into duodenum during fasting and non-fasting states

Some bile also remains in the ducts

57
Q

How long after the GB has been removed does the sphincter regain tone?

A

6 months

58
Q

What produces bile?

A

Hepatocytes

59
Q

What is the function of bile?

A

Break down fats, helps absorb fatty acids, cholesterol and other lipids from the intestinal tract

60
Q

How much bile salts are produced per day?

A

1 gram

61
Q

What is a precursor to the formation of bile salts?

A

Cholesterol

62
Q

What is jaundice?

A

Yellowish tint due to large quantities of bilirubin

63
Q

What causes jaundice?

A

Hemolytic anemia, acute and chronic hepatic disease, obstructive jaundice, inability of bilirubin in conjugate

64
Q

Where is the arterial blood supply for the GB from?

A

Cystic artery

65
Q

How does the venous drainage of the GB work?

A

Via cystic vein and drains into the portal vein

66
Q

What is a junctional fold?

A

A fold that occurs at the junction of the body and infundibulum (neck)

May look similar to a separation

67
Q

What is a Hartman’s pouch?

A

Outpouching in the area of the GB neck

68
Q

What is a Phrygian cap?

A

When the GB is partially folded on itself in the region of the fundus

69
Q

What are some other variants related to the GB?

A

Septations- thin walls, partial or complete, dividing the GB lumen
Excessively mobile
Ectopic
Low lying the the RLQ
Totally or partially embedded in the liver

70
Q

What is the sonographic appearance of the GB?

A

Anechoic or nearly anechoic

Well defined walls

71
Q

What is the pt prep for the GB?

A

NPO 6-8hours because we want the GB extended to be able to measure the full size and not miss any pathology

72
Q

What is the scanning technique for the GB?

A

2.5-5 MHz probe

Supine, decubitus

73
Q

Why may erect and prone positions be used to examine the GB?

A

Used to rule out stones lodged in the neck and cystic duct

74
Q

What do we examine when imaging the GB?

A

size, shape, content, wall thickeners and area around GB for fluid

75
Q

Why are windows important in examining the GB?

A

To minimize reverberation artifact

76
Q

What are the 3 lab tests used to see if function of GB is distrubted?

A
  1. Bilirubin
  2. Alkaline Phosphatase
  3. Leukocytes
77
Q

What does increased levels of bilirubin INDIRECTLY suggest in the GB?

A

Hemolysis
RBC degradation
Abnormal hepatocellular uptake

78
Q

What does increased levels of bilirubin DIRECTLY suggest in the GB?

A

Extrahepatic obstruction
Bile duct disease
Intrahepatic disruption

79
Q

What does increased levels of alkaline phosphatase in the GB suggest?

A

Extrahepatic biliary obstruction

80
Q

What do leukocytes measure?

A

The reaction of body to infection

81
Q

What do increased levels of leukocytes suggest?

A

Acute and chronic cholecystitis

Injury to bile ducts

82
Q

What are other tests to image and evaluate the GB?

A
  1. HIDA scan

2. ERCP

83
Q

What is a HIDA scan?

A

Nuclear medicine test
Evaluates function of the GB
Radio pharmaceutical injected into patient
Passes through the blood into the liver and then the biliary system

abdomin and superficial structures (12 decks)

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