Biliary System - Part 1

Question 1

Biloma

Answer 1

An extrahepatic collection of extravasated bile from

trauma, surgery, or gallbladder disease

Question 2

Caroli disease

Answer 2

A segmental, saccular, or beaded appearance to the intrahepatic biliary ducts

Question 3

Cholecystokinin

Answer 3

Hormone secreted in the small intestine that stimulates GB contraction and secretion of pancreatic enzymes
- stimulation occurs after food reaches the duodenum

Question 4

Cholesterosis

Answer 4

Type of cholesterolosis associated with a strawberry appearance to the GB

Question 5

Courvoisier sign

Answer 5

Painless jaundice associated with an enlarged GB caused by the obstruction of the distal common bile duct by an external mass
- typically adenocarcinoma of the pancreatic head

Question 6

Emphysematous cholecystitis

Answer 6

Gas in the GB wall or lumen

Question 7

Hartmann pouch

Answer 7

Small posterior pouch near the GB neck

Question 8

Klatskin tumour

Answer 8

Carcinoma located at the junction of the right and left hepatic ducts

Question 9

Mirizzi syndrome

Answer 9

Impacted stone in the cystic duct causing compression on the common hepatic duct resulting in jaundice

Question 10

Porcelain GB

Answer 10

Calcification of the GB wall

Question 11

What are the functions of the biliary system? (3)

Answer 11

1. Transport bile to the GB through the bile ducts
2. Store and concentrate bile in the GB
3. Transport bile through the bile ducts to the duodenum

Question 12

What does the extrahepatic ducts include? (2)

Answer 12

1. Cystic duct

2. Common duct

Question 13

When does bile flow?

Answer 13

When the intraductal pressure is lower than the hepatic secretory pressure

Question 14

What does the cystic duct drain?

Answer 14

GB

Question 15

What is the mean length of a cystic duct?

Answer 15

4cm

Question 16

What does the cystic duct contain?

Answer 16

Spiral valves of Heister

Question 17

Where does the cystic duct course?

Answer 17

Posteriorly and inferiorly merging with the CHD to form the CBD

Question 18

Is the cystic duct routinely imaged on US?

Answer 18

No

Question 19

What forms the CBD? (2)

Answer 19

1. CHD

2. Cystic duct

Question 20

Where does the CBD course?

Answer 20

Inferiorly

- joining the main pancreatic duct at the ampulla of Vater to enter the descending portion of the duodenum

Question 21

Where does the CBD lie compared to the main portal vein and the proper hepatic artery?

Answer 21

1. MPV = anterior

2. PHA = lateral

Question 22

What is the average intraluminal diameter of the CBD?

Answer 22

4mm

- should not exceed 6mm in adults

Question 23

At what age does the CBD begin to increase? And by how much per decade?

Answer 23

1. Age 60

2. 1mm per decade

Question 24

What happens to the CBD after a fatty meal?

Answer 24

It will either decrease in size or remain the same

Question 25

What is the US appearance of intrahepatic bile ducts? (4)

Answer 25

1. Anechoic non-vascular tubular structures coursing with in the hepatic parenchyma 2. Smooth hyper echoic walls 3. Normal intraluminal diameter of the CHD 4. The right and left hepatic bile ducts generally lie anterior to the corresponding portal vein

Question 26

What is the US appearance of extrahepatic bile ducts? (3)

Answer 26

1. Anechoic non-vascular tubular structure anterior to the main portal vein 2. Smooth hyper echoic walls 3. Normal intraluminal diameter of the CBD

Question 27

What are the functions of the GB? (3)

Answer 27

1. Concentrates bile through the GB epithelium 2. Stores concentrated bile 3. Contracts to release bile when the hormone cholecystokinin is released into the bloodstream

Question 28

What are the 3 parts that make up the GB?

Answer 28

1. Fundus 2. Body 3. Neck

Question 29

Fundus of the GB

Answer 29

Most inferior and anterior portion of the GB | - has a blind end

Question 30

Body of the GB

Answer 30

Midportion between then neck and fundus

Question 31

Neck of the GB

Answer 31

``` Narrow, tapering tubelike structure - most superior portion - smallest transverse diameter - fixed anatomic relationship to the main lobar fissure and right portal vein ```

Question 32

What are the 4 layers of the GB wall?

Answer 32

1. Outer serosal - visceral 2. Subserous - connective tissue 3. Muscular - contracts 4. Inner epithelial - mucosal

Question 33

What is the location of the GB? (4)

Answer 33

1. GB fossa on the posterior surface of the liver 2. Lies lateral to the IVC and anterior and medial to the right kidney 3. Lies posterior and inferior to the main lobar fissure 4. GB neck lies most superior