C4: Biliary System Flashcards by M B

The biliary tree beings at what level

Level of the lobule at the bile canaliculi

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Microscopic canaliculi anastomoses to form what

Lobular bile ducts

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Where do the R and L. Hepatic ducts join to form the CHD

Porta hepatis

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List the relationship of the CHD to the PV and HA

PV: anterior
HA: anterior and lateral

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Where does the CHD travel

In the free edge of the lesser omentum

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What determines the length of the CBD

The insertion point of the CBD

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What s the relationship of the CBD to the MPV

Anterior and lateral

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Norm value for the CBD

Up to 4 mm…. varies w/ age and surgery

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How does the diameter of the CBD change w/ age

Add 1mm for every decade of life after 50 yrs

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Norm value for CBD post cholecystectomy

Up to 10 mm

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The CBD travels through which ligament

Hepatoduodenal ligament (part of lesser omentum)

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What’s the relationship of the HA and the CBD to the PV

HA: anterior and left
CBD: anterior and right

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What are the 4 segments of the CBD related to the duodenum

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

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Describe the 4th part (intraduodenal) of the CBD

enters 2nd part of duodenum and inserts into ampulla of vater
narrowest part of extrahepatic biliary tract (most likely place for stone to lodge)

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What regulates the flow of bile

Sphincter of Oddi

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Where does the cystic duct join the CHD

Just above the duodenum

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Where does the cystic duct arise

Superior aspect of the neck of the GB

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Norm value of cystic duct diameter and length

3mm diameter

4cm length

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Where are the spiral valves of heisted located

The cystic duct

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Are the spinal valves of Heister real valves? What is there function

no, they’re mucosal folds
prevent duct from over distending or collapsing…. doesn’t control flow.
for structural support

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Where is the GB located

-posterior inferior surface of the R lobe of liver in the GB fossa

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Where is the Gb located compared to the MLF

Posterior and inferior

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Which part of the GB is fixed? Which is mobile

Neck is fixed

Body is mobile

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What is the most reliable landmarks for the GB

MLF

what is a norm value of the intrahepatic ducts

< or = 2 mm in diameter

What does in indicate when yo see too many tubes

Intrahepatic duct dilation

What is the norm size of the GB

8-9 cm in length | 3-5 cm in diameter

What is the most dependent part of the GB in supine and LLD

Supine: neck LLD: fundus

What’s another term for the body of the GB

Corpus

Which are of the GB contain the spiral folds

Neck

Norm value for GB wall measurement in fasting state

<3 mm in thickness

What are the 4 layers of the GB wall. Describe each

Mucosa: Inner epithelial lining * FUNCTION to concentrate bile Muscularis: Muscle layer Subserous layer: C-tissue Serous: Outer layer in contact w/ peritoneum

What are the Rokitansky-Aschoff sinuses

Multiple folds along the inner lining of the GB

Do we usually see the RA sinuses

No, only w/ pathology

How much bile does the GB hold

40-70 ml

How is bile concentrated?

By secreting mucous and absorption get water

What controls bile secretion

The release of CCK (cholystokinin) which is produced by the duodenum

What does CCK stimulate

The Gb to contract and the sphincter of Oddi to relax

What does the sphincter of Oddi control and what does it prevent

-controls flow of bile into the duodenum and prevents reflux of GI fluids in to the biliary system

What happens to the Gb and the sphincter of Oddi when the sm intestine is empty

Sphincter closes and bile backs up into the GB

What amount of bile salts are produced daily

1 gram

What is a precursor to bile salt

Cholesterol

What is jaundice. What is another term for it

Yellowish tint in body tissue due to large quantities of bilirubin (will cause ascites)

Where does the GB get its blood supply (arterial and venous)

Arterial: cystic artery Venous: cystic vein which drains into the portal veins

What is a junctional fold

Fold that occurs @ the junction of the body and infundibulum (neck) of the GB

What is Hartman’s pouch

An outpouching in the area of the GB neck

What is a Phrygian cap

When the GB is partially folded onto itself in the area of the fundus ad body

What are some other GB variants

- too mobile - ectopic - low lying - embedded in liver

How does the GB appear on US

Anechoic Well defined thank, echogenic walls SAG: pear shape TRX: anechoic circle

In what position should you scan the GB in

Supine, decubitus to assess for mobility

What should you assess when scanning the GB

Size, shape, wall thickness, content, area around the GB

How can you minimize artifacts in the GB

Come to the R and angle back towards the GB

How should you measure the CBD

In the region of the porta hepatis, measure inner to inner @ the widest portion

Do you measure the CBD where it crosses the HA

No b/c the HA will compress the CBD

What does the WBC lab test check for | What could an increased WBC lab value indicate in terms of the GB

- measures rxn of body to infection | - acute and/or chronic cholecystitis or injury to bile duct (depending on the cause)

What is a HIDA scan

- nuch med test | - evaluations function of the GB

What is a ERCP test

-ampulla of vater is cannulized and contrast material is injectors to assess biliary system

Norm value for CHD

4mm