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Flashcards in Biliary Tract and Upper GI Deck (111):
1

Radiographic examination of the biliary system involves studying the

manufacture, transport, and storage of bile.

2

Liver:

Large wedge-shaped organ
Located inferior to the diaphragm.
Largest solid organ
3-4 lbs
Occupies most of RUQ and extends to LUQ
Well protected by rib cage.

3

Describe the upper border of the liver:

Widest part 8 to 9”
Convex to conform to diaphragm

4

Describe the right border of the liver:

Largest vertical dimension 6-7”
10th rib to just above R. Kidney

5

Distal end of gall bladder extends:

below anterior, inferior margin of liver

6

Remainder of GB (when discussing the distal end) lies

inferior and posterior surface of liver

7

The right lobe and left lobe of the liver are divided by:

the falciform ligament.

8

The quadrate lobe and caudate lobe are located:

on medial aspect of R. Lobe of the liver.

9

The quadrate lobe is located:

Between GB and falciform ligament

10

The caudate lobe is located:

Posterior to quadrate lobe

11

Hilum of liver (porta hepatitis) is located:

between the 2 minor lobes

12

The function of the liver that is most applicable to radiographic study is:

the production of bile

13

The liver secretes _________of bile per day

800 to 1000 ml (≈ 1 quart)

14

The major function of bile is:

to aid in the digestion of fats by emulsifying fat globules and the absorption of fat following its digestion.

15

Bile is a liquid substance composed mainly of

bile salts, bile pigments, cholesterol and water.

16

Bile pigments are responsible for

the yellow color of bile.

17

Bile salts facilitate

the absorption of fats.

18

If bile contains either insufficient bile salts or excessive cholesterol,

the cholesterol may crystallize to form gallstones.

19

As gallstones grow in size and number, may cause

minimal, intermittent, or complete obstruction of the flow of bile from the gallbladder into the duodenum.

20

Bile formed in liver and travels to

R&L hepatic ducts

21

Hepatic ducts join to form

common hepatic duct

22

Bile is carried to gallbladder by _____ for temporary storage in gallbladder or may be secreted directly into duodenum by way of ______ which is joined by _________.

cystic duct, common bile duct, pancreatic duct

23

How big is the gall bladder and how much does it hold?

7 to 10 cm (3-4”) long
Holds about 30 to 40 mL bile

24

What are the three parts of the gall bladder?

Fundus:
Broad distal end
Body:
Main section
Neck:
Narrow proximal end
Continues as cystic duct

25

How long is the cystic duct?

3 to 4 cm long

26

What is the function of the spiral valve?

to prevent distention or collapse of cystic duct.

27

What and where is the spiral valve?

The spiral valve is folds within the cystic duct.

28

The three primary functions of the gallbladder are

(1)store and (2)concentrate bile, and to (3)contract when stimulated.

29

If bile is not needed for digestive purposes, it is:

stored for future use in the gallbladder.

30

Bile is concentrated within the gallbladder as a result of a process called

hydrolysis (removal of water).

31

If too much water is absorbed during hydrolysis or if the cholesterol becomes too concentrated _________ may form in the gallbladder.

gallstones (choleliths)

32

How are the most common type of gallstones formed?

Cholesterol coming out of solution

33

The gallbladder normally contracts when

foods such as fats or fatty acids are in the duodenum. These foods stimulate the mucosa of the duodenum to secrete a hormone called cholecystokinin (CCK)

34

Increased levels of CCK in the blood cause the GB to _______ and terminal opening of the CBD to ______.

Contract, relax

35

CCK also causes

increased exocrine activity by the pancreas

36

When the gall bladder stimulates the pancreas, what happens?

It causes the hepatopancreatic spincter to relax, permitting the flow of both bile and pancreatic juice into the duodenum.

37

The bile and pancreatic juice mix with

food substances.

38

What is the length of the common bile duct?

About 7.5 cm long
Internal diameter about the size of drinking straw

39

What is the location of the common bile duct?

Descends behind superior portion of duodenum and head of pancreas to enter descending portion of duodenum

40

The common bile duct joins the ________ and they enter together or side by side into an enlarged chamber known as the ____________.

pancreatic duct (duct of Wirsung), hepatopancreatic ampulla (ampulla of Vater)

41

Pancreatic duct and CBD remain separated in about __% of people

40

42

Hepatopancreatic ampulla is controlled by circular muscle called

hepatopancreatic sphincter (sphincter of Oddi)

43

Hepatopancreatic ampulla is a common site for

gallstones.

44

The presence of the hepatopancreatic sphincter causes a protrusion into the lumen of the duodenum known as the

duodenal papilla (papilla of Vater)

45

Lateral View demonstrates gallbladder anterior to the ____.
Ductal system is located about ____________________.

MCP, midway between the front and back

46

Prone position:
Places gallbladder:

closer to the IR.

47

Supine position for gall bladder is used if primary purpose is to:

drain the gallbladder into the duct system

48

Contrast medium was ingested orally for a cholecystogram and was called

an oral cholecystogram (OCG). These have been replaced by sonography.

49

Production of contrast media for OCG has been discontinued, however, imaging of biliary system is still performed:

during and after gallbladder surgery and by direct injection procedures.

50

4 advantages of ultrasound of the GB over OCG:

No ionizing radiation
Able to detect small calculi
No contrast medium
Less patient preparation

51

choledocho-

common bile duct

52

choleangio-

bile ducts

53

Choledocholithiasis

is the presence of stones in the biliary ducts.

54

Symptoms of Choledocholithiasis include:

pain
tenderness in the RUQ, jaundice
sometimes pancreatitis

55

Who are at high risk of developing gallstones?

Females and obese patients are at a high risk of developing gallstones
Four F's (Fat, Female, near Forty and Fertile)

56

Increased levels of _______ ,_______, or _______ may lead to formation of gallstones

bilirubin, calcium or cholesterol

57

About ______% of gallstones are radiolucent

85% to 90

58

radiolucent gallstones are made up of:

cholesterol and or crystalline salts

59

About ____% to ___% gallstones are radiopaque

10 - 15

60

Radiopaque gallstones are made up of:

crystalline calcium salts

61

Milk calcium bile

Emulsion of biliary stones in gallbladder. Demonstrates as diffuse collection of sand-like calcifications


62

With sonography, stones within gallbladder produce :

“shadowing” effect
Created by partial blockage of sound wave as it passes by

63

Cholecystitis

Inflammation of the gallbladder
Acute or chronic

64

The length of the GI tract from the esophagus to end of large intestine is about

30 feet long.

65

The small intestine averages ___ ft in length.

23

66

Tremendous individual variation of the small intestine exists. In one series of 100 autopies, the small bowel varied in length from

15 to 31 feet

67

Three primary functions of the digestive system:

Intake and digestion, absorption, elimination.

68

Two common radiographic procedures involving the digestive system:

1. Esophagram
(or barium swallow)
2. Upper GI series (UGI)

69

Purpose of Esophagram:

Study the form and function of the pharynx and the esophagus

70

Acute Cholecystitis

Blockage of cystic duct frequently due to stone in neck of GB. Bile irritates lining of GB
Can also be caused by bacterial infection and ischemia

71

Chronic Cholecystitis

Due to gallstones, pancreatitis or cancer of GB, thickening or calcification of wall of GB
May produce repetitive attacks following meals and typically subsides in 1-4 hrs.

72

Neoplasms of the gall bladder or biliary ducts:

Growths that can be benign or malignant

73

Biliary Stenosis

Narrowing of one of biliary ducts
May restrict flow of bile leading to obstruction
Cholecystitis and jaundice may result

74

Purpose of Upper GI:

Study the form and function of the distal esophagus, stomach, and duodenum
Also called UGI, upper, GI or upper GI

75

Mouth (oral cavity)(buccal cavity):

Beginning of GI tract where mastication of food occurs

76

The roof of the oral cavity is formed by the

hard and soft palates

77

Uvula hangs from mid posterior soft palate. What does it do?

Helps to prevent food from entering the pharynx prematurely.

78

Soft palate begins at the

last molar and is suspended from the posterior border of the hard palate

79

Hard palate:

formed by the palatine process of the maxillary bone and the 2 (horizontal portions of) palatine bones

80

Oral cavity connects posteriorly with

the pharynx

81

Three pairs of salivary glands secrete into the oral cavity:
They are called:

Parotid salivary glands, Submandibular (submaxillary) salivary glands, and Sublingual salivary glands.

82

Saliva is composed of:

99.5% water and 0.5% salts and certain digestive enzymes.

83

Between _______________ ml of saliva are excreted daily.

1000 - 1500 ml

84

Mumps:

Inflammation and enlargement of the parotid glands
Caused by mumps virus

85

Pharynx

Part of the alimentary canal that is posterior to nasal cavity, mouth and larynx

86

The pharynx is about ___ inches long:

5

87

The pharynx Serves as a common passageway for

foods, liquids, and air.

88

They pharynx Divided into three parts:

nasopharynx
oropharynx
laryngopharynx

89

Nasopharynx:

Posterior to bony nasal septum, nasal septum and soft palate
Not part of digestive system

90

Oropharynx:

Posterior to oral cavity
Extends from soft palate to epiglottis

91

Epiglottis:

Cartilage that covers opening of larynx during swallowing

92

Laryngopharynx

Extends from level of epiglottis to level of lower border of larynx
Then continues as esophagus

93

______ is located anterior to esophagus

The trachea

94

7 cavities communicate with the three portions of pharynx are:

2 Tympanic cavities, 2 Nasal cavities, 1 Oral cavity (mouth), 1 Larynx, & 1 Esophagus.

95

During swallowing (or Deglutition):

Soft palate closes off nasopharynx
Tongue prevents material from reentering mouth
Epiglottis is depressed to cover laryngeal opening
vocal cords come together to close of epiglottis
Respiration is inhibited

96

Function of the esophagus:

transport food and fluids from pharynx to stomach

97

Dimensions of the esophagus:

About 10” (25 cm) long and ¾ in (2 cm) in diameter

98

The esophagus Extends from _________ to ___________.

lower border of cricoid cartilage (C5,C6), to stomach (T11)

99

Wall of esophagus is composed of 4 layers:

Fibrous
Muscular
Submucosal
Mucosal

100

______ Is the narrowest part of the alimentary canal

Esophagus

101

There are TWO INDENTATIONS present in the esophagus:

aortic arch
left primary bronchus

102

Distal esophagus passes through an opening in diaphragm called the __________ at the level of ____.

esophageal hiatus, T-10

103


The junction of the stomach and the esophagus is attached to the diaphragm, so upper stomach tends to follow

respiratory movement of diaphragm

104

A condition where the upper portion of the stomach protrudes through the esophageal hiatus is called a

hiatal hernia

105

Cardiac Antrum:

Abdominal segment of the esophagus
Very short area of esophagus just below diaphragm
Less than 1” in length

106

Esophagogastric junction (cardiac orifice)

Opening between esophagus and stomach

107

The esophagus is a collapsible tube that only opens when

swallowing occurs

108

Deglutition originates in _____ and continues in _____

Mouth & pharynx, the esophagus.

109

Fluids tend to pass from the mouth and pharynx to the stomach primarily by

gravity

110

A bolus of solid food tends to pass both by

gravity and peristalsis

111

Peristalsis –

wavelike series of involuntary muscular contractions that propels solid and semisolid materials through the entire alimentary canal.