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Extra hepatic biliary apparatus Flashcards

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1
Q

What are the components of the extrahepatic biliary apparatus?

A

Right and left hepatic ducts, common hepatic duct, gall bladder, cystic duct, bile duct

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2
Q

What is the function of the extrahepatic biliary apparatus?

A

Receives, stores, concentrates bile

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3
Q

Why is knowledge of the extrahepatic biliary apparatus clinically important?

A

Frequently affected by diseases like cholecystitis, cholelithiasis, CBD obstruction

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4
Q

Where do the hepatic ducts emerge from?

A

From right and left liver lobes through porta hepatis

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5
Q

What do the right and left hepatic ducts unite to form?

A

Common hepatic duct

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6
Q

How long is the common hepatic duct?

A

About 2.5 cm (1 inch)

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7
Q

Which duct joins the common hepatic duct to form the CBD?

A

Cystic duct

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8
Q

What is the angle called between the cystic and common hepatic ducts?

A

Cystohepatic angle

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9
Q

Where does the common hepatic duct lie in the lesser omentum?

A

In the right free margin, Right of hepatic artery proper, anterior to portal vein

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10
Q

How often are accessory hepatic ducts present?

A

About 15% of cases

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11
Q

Where can accessory hepatic ducts open?

A

Common hepatic duct, cystic duct, bile duct, gall bladder

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12
Q

What is the capacity of the gallbladder?

A

30�50 ml

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13
Q

What is the shape of the gallbladder?

A

Elongated pear-shaped sac

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14
Q

How does the gallbladder discharge bile?

A

By muscular contraction

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15
Q

Why are radiopaque substances used in cholecystography?

A

They concentrate in gallbladder to visualize cavity and function

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16
Q

Which hormone causes gallbladder contraction?

A

Cholecystokinin (CCK)

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17
Q

Where is cholecystokinin produced?

A

Duodenal cells

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18
Q

What reflex occurs during gallbladder contraction?

A

Sphincter of Oddi relaxes

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19
Q

Where is the gallbladder located?

A

In fossa on inferior surface of right liver lobe

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20
Q

What lobe is the gallbladder along?

A

Right edge of quadrate lobe

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21
Q

What are the gallbladder dimensions?

A

10 cm long, 3cm wide

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22
Q

What are the parts of the gallbladder?

A

Fundus, body, neck

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23
Q

Where does the fundus project?

A

From inferior liver border at tip of right 9th costal cartilage

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24
Q

What is anterior to the fundus?

A

Anterior abdominal wall

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25
What is posterior to the fundus?
Transverse colon
26
What is the body of the gallbladder related to superiorly?
Liver
27
What is the body of the gallbladder related to inferiorly?
Second part of duodenum
28
Where is the neck of the gallbladder?
Near right end of porta hepatis
29
What marks the junction of neck and cystic duct?
Constriction
30
What is embedded in areolar tissue at the neck?
Cystic artery
31
What lies inferior to the neck of gallbladder?
First part of duodenum
32
What is Hartmann�s pouch?
Posteromedial dilatation of gallbladder neck
33
What complication can occur with gallstones in Hartmann�s pouch?
Adhesion/perforation of first part of duodenum
34
What layers form the gallbladder wall?
Serous, subserous, fibromuscular, mucous membrane
35
What is the mucosal appearance of the gallbladder?
Honeycomb due to rugae
36
What epithelium lines the gallbladder?
Single layer of tall columnar cells
37
What artery supplies the gallbladder?
Cystic artery
38
Where can the cystic artery originate from?
Right hepatic
39
What veins drain the gallbladder?
Cystic vein which drains into portal vein
40
Where does most lymph from the gallbladder drain?
Cystic node of Lund and node alongside upper part of bile duct
41
Where do a few lymphatics from gallbladder go?
Directly to subscapular lymph vessels of liver
42
Which node is enlarged in cholecystitis?
Cystic node of Lund
43
What is the nerve supply of the gallbladder?
Cystic plexus formed by the sympathetic fibers (T7�T9)
44
Where is gallbladder pain referred by sympathetic fibers?
Inferior angle of right scapula
45
Where is gallbladder pain referred by phrenic nerve?
Tip of right shoulder
46
Where is gallbladder pain referred by vagus?
Stomach
47
How long is the cystic duct?
3�5 cm
48
Where does the cystic duct run?
Backward and downward to join common hepatic duct
49
What is the valve in the cystic duct called?
Spiral valve (of Heister)
50
What is the function of Heister�s valve?
Keeps cystic duct open for bile flow
51
How long is the common bile duct (CBD)?
About 7.5 cm
52
What are the four parts of the CBD?
Supraduodenal, retroduodenal, infraduodenal, intraduodenal
53
Where is the supraduodenal part located?
Right free margin of lesser omentum, anterior to portal vein and right of hepatic artey proper
54
What lies behind the retroduodenal part of CBD?
IVC and portal vein
55
Where does the infraduodenal part of CBD run?
Behind pancreas
56
What crosses the bile duct in the infraduodenal part?
Superior pancreaticoduodenal artery
57
Where does the intraduodenal part of CBD enter?
Posteromedial surface of 2nd part of duodenum
58
What does the bile duct form with the pancreatic duct?
Hepatopancreatic ampulla (of Vater)
59
What forms the major duodenal papilla?
Ampulla of Vater bulging inward
60
What is the sphincter around the bile duct called?
Sphincter choledochus (of Boyden)
61
What is the sphincter around the ampulla called?
Sphincter of Oddi (ampulla)
62
What triggers sphincter relaxation and bile flow?
Cholecystokinin
63
What supplies the upper CBD with blood?
Descending Branch of cystic artery
64
What supplies the lower CBD?
Ascending Branch of gastroduodenal and superior pancreaticoduodenal artery
65
What defines the cystohepatic triangle?
Cystic duct (right), hepatic duct(left), inferior surface of liver
66
What are the contents of Calot�s triangle?
Right hepatic artery, cystic artery, cystic node of lund
67
What is Moynihan�s hump?
Loop in right hepatic artery in Calot�s triangle
68
What is acute cholecystitis?
In adult women, sudden pain in hypochondrium, vomitting, positive murphys sign
69
What triggers pain in Murphy�s sign?
Palpation under right costal margin during inspiration
70
What aggravates cholecystitis symptoms?
Fatty meals
71
What hormone stimulates gallbladder after fat intake?
Cholecystokinin�pancreozymin (CCK-PZ)
72
What is chronic cholecystitis usually associated with?
Gallstones (cholelithiasis)
73
What is the 5F rule for cholelithiasis risk?
Fat fertile flatulous female of forty
74
What causes referred pain in cholecystitis?
Irritation of subdiaphragmatic parietal peritoneum supplied by phrenic nerve (c3, c4,c5)
75
What is biliary colic?
Intermittent pain from gallbladder muscle spasm to expel stone
76
Where is pain from biliary colic referred?
Right upper quadrant or epigastrium (T7�T9 dermatomes)
77
What causes CBD obstruction?
Gallstones, pancreatic carcinoma, enlarged neoplastic hepatic lymph nodes
78
What does CBD obstruction lead to?
Jaundice
79
What is Courvoisier�s law?
Distended, Palpable gallbladder with obstructive jaundice = extrinsic CBD obstruction

Anatomy (14 decks)

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