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Anatomy (TOPNOTCH SUPPLEMENT) > Gallbladder > Flashcards

Flashcards in Gallbladder Deck (30):
0

Relations:
ANTERIOR - anterior abdominal wall, inferior surface of liver

POSTERIOR - transverse colon, 1st-2nd parts of duodenum

Gallbladder

1

Pear-shaped sac lying on the inferior surface of the liver

Receives, stores and concentrates bile by absorbing water and salts

Contracts to expel bile upon release of cholecystokinin from duodenum

Capacity of 30-50ml

Gallbladder

2

Cystohepatic triangle

Triangle of Calot

3

Boundaries of Triangle of Calot

Liver - SUPERIOR

Cystic duct - INFERIOR

Common hepatic duct - MEDIAL

4

Parts of GB

Fundus - rounded blind end

Body - major part

Neck - narrow part directed toward the portahepatis which gives rise to cystic duct

Hartmann's pouch - infundibulum of the GB, junction between neck and cystic duct

5

The cystic artery usually originates from the ____ artery:

Right hepatic

6

Blood supply

CYSTIC ARTERY from R HEPATIC ARTERY

Celiac artery
Left gastric
Splenic
Hepatic - common hepatic - R/L hepatic - gastroduodenal

7

Valve of Houston is associated with what organ?

Rectum

8

Common site of an impacted gallstone; patients exhibit referred pain in the epigastric region

Hepatopancreatic ampulla

9

May cause enlargement of the GB; patients exhibit BILIARY COLIC (severe colicky pain that begins in the epigastric region but moves to a point where the 9th costal cartilage intersects the lateral border of the rectus sheath

A STONE BLOCKING THE CYSTIC DUCT

10

Stimulation of visceral pain fibers that innervated a GIT structure results in a DULL, poorly localized pain that is referred over the T5 through L1 dermatome a

Referred pain

11

Has a fundus (anterior portion), body & neck (posterior portion)

Hartmann pouch may extend from neck
- common site for gallstones to lodge

Gallbladder

12

Occurs when the mucosa of the gallbladder penetrates deep into the muscularis externa

Early indicator of pathologic changes

Rokitansky-Aschoff sinuses

13

Venous drainage

Cystic veins --> portal vein or directly to liver sinusoids

14

Lymphatic drainage

Hepatic & pancreaticoduodenal lymph nodes

15

Sensory fibers

Great thoracic splanchnic nerves to spinal level T7-10

16

Parasympathetic

Action:
- GB contract
- sphincter of Oddi relax (bile release)

Vagus nerve (pre & postganglionic)

17

Sympathetic

Action:
- GB relax
- sphincter of Oddi contract

Greater thoracic splanchnic nerve (Preganglionic)

Celiac plexus (postganglionic)

18

Hormone secreted by I cells of small intestine

Mimics parasympathetic functions of vagus nerve on GB & sphincter of Oddi

Cholecystokinin (CKK)

19

Functions of GB

Bile storage & concentration (10 fold)

Bile calcification, addition of mucus ("white bile")

20

R & L hepatic ducts --> common hepatic duct

Common hepatic duct + cystic duct --> CBD
- mucosa of cystic duct is arranged in a spiral fold with a core of smooth muscle called SPIRAL VALVE OF HELSTER

CBD passes posterior to pancreas --> ends at hepatoduodenal ampulla (ampulla of Vater) where it joins the pancreatic duct

Extrahepatic biliary ducts

21

Surrounds CBD as it transverses the ampulla

Sphincter of Oddi

22

Produced by hepatocytes

Average rate: 600 ml/day

Composition:
- water
- electrolytes
- bilirubin glucoronide (bile pigment)
- Cholic acid
- chenodeoxycholic acid conjugated to glycine or taurine (bile salts)
- cholesterol
- lecithin (lipids) calcium
- secretory IgA

Function: emulsify fats

Lactated Ringer solution: good replacement fluid for bile loss

Bile

23

Large & smooth

Obesity, chronic disease, cystic fibrosis, clofibrate, estrogen, rapid weight loss

Cholesterol stones

24

Smooth, green/black

Hemolysis (sickle cell, spherocytosis)

Cirrhosis, biliary infection

More common in Asia

Pigment (bilirubin) stones

25

Infection or inflammation of biliary

Calcium bilirubinate

26

GALLSTONE OBSTRUCTION

within the cystic duct

Biliary colic, pain shifts to R hypochondriac region

Causes acute cholecystitis

Bile precipitates in the GB --> "milk of calcium" bile

No jaundice because bile flow from liver, remains open

27

Large gallstone impacted in cystic duct extrinsically obstruct the common hepatic duct

Mirizzi syndrome

28

GALLSTONE OBSTRUCTION

within the CBD

Obstructs bile flow GB & the liver

Jaundice (1st observed under the tongue)
- moderate, fluctuates because a stone rarely causes complete obstruction

29

GALLSTONE OBSTRUCTION

at hepatoduodenal ampulla

Obstruct bile flow from both the GB & the liver

Pancreatic duct may be blocked

Jaundice & pancreatitis are common