Flashcards in Gallbladder and biliary test 3 Deck (56):
What is the biliary system?
consists of right and left hepatic duct
common hepatic duct
What plays a role in the digestive process to store and transport bile?
What ducts emerge from the right lobe of the liver in the porta hepatis?
right and left hepatic ducts
What size is the common hepatic duct?
approx 4 mm
What joins with the cystic duct to form the CBD?
common hepatic duct
What is the measurement of the CBD?
Where is the common bile duct in the first part of its course?
it lies in the right free edge of the lesser omentum
Where is the CBD in the second part of its course?
situated posterior to the first part of the duodenum
The CBD is joined by the main pancreatic duct and together they open though the ____________into the duodenal wall
ampulla of Vater
What circular muscle fibers surround the CBD, main pancreatic duct, and the ampulla?
Sphincter of Oddi
What is the cystic duct?
connects neck of GB with common hepatic duct for form the CBD
What helps prevent kinking of the cystic duct?
Heister valve aka spiral valve
Where is the GB found?
RUQ - anterior aspect
related to the visceral surface of the liver fossa
Where is the GB found?
posterior to the rt lobe of the liver
Is the GB in the intraperitoneal or the retroperitoneal?
what are the three segments of the GB?
sonographically what is the superior part of the GB?
Where is the fundus?
projects below the inferior margin of the liver and comes into contact with the anterior abd wall
Where is the body of GB?
lies in contact with the visceral surface of the liver
Where is the neck of the GB?
continuous with the cystic duct
(which turns to join the right side of the common hepatic duct to form the common bile duct)
What are the cellular layers of the GB?
What is found in the outer serosal layer of the GB?
Rokitanksy - Aschoff sinus
little sections in the GB wall
what does the muscular layer of the GB contract to?
Cholecystokinin (hormone that secrets bile) CCK
What is the arterial supply of the GB?
(branch of the rt hepatic artery)
What is Hartmann's pouch?
when the gallbladder folds back on itself at the neck
gallstones tend to collect here
What is the most common variant of the folds in the gallbladder?
appears between the body and neck
What is phrygian cap??
folding of the fundus of the gallbladder
Partial septations and folds in the gallbladder are normal variants....true or false?
What is the primary function of the extrahepatic biliary tract?
transportation of bile from liver to the intestine
regulation of flow
When does concentration of bile in the GB occur?
during a state of fasting
How does the wall of the gallbladder look when it's contracted?
What happens to the extrahepatic bile ducts after a cholcystectomy?
they dilate...usually less than 10mm
patients older than 60 - duct can be up to 10mm and be normal
What is the criteria for a sonographic eval of the GB?
NPO 8-12 hrs
begin patient supine
second roll patient LLD or upright position
transverse, sag, and oblique scans are made over the upper abd
identify: GB, biliary system, liver rt kidney and head of pancreas
What are the indications that a GB scan is needed?
positive Murphy's sign
pain radiating to shoulder
nausea and vomiting
loss of appetite
What is the typical wall thickness of the GB wall?
What is hydrops?
dilation of the gallbladder (>5 trv, >10 sag)
not related only to gb
when the right and left hepatic ducts merge what does it create?
the common hepatic duct
the hepatic duct runs ___________ to the portal vein
In the third part of its course, the CBD lies where?
in a groove on the posterior surface of the head of the pancreas
where does the common bile duct end?
by piercing the medial wall of the second part of the duodenum
The cystic vein drains directly into what?
the portal vein
What is another name for the normal variant "complete septation" as it refers to the GB?
What stimulates the GB to contract and what is the result?
the influence of food
resulting: outpouring of bile into the duodenum
why would you roll a patient into a steep decubitus or upright position when you suspect stones?
to separate small stones from gallbladder wall or cystic duct
what is the main lobar fissure?
a bright linear reflector within the liver connecting the gallbladder and the right or main portal vein is a reliable indicator of the location of the gallbladder
What makes the "Mickey Mouse" sign?
common duct, hepatic artery, and portal vein
the hepatic artery lies __________ and __________ to the portal vein
the CBD lies _________ and ___________ to portal vein
What is bile made of?
and other organic substances
What is the bile's two major functions in the body?
breaks down the fats that you can eat so that your body can utilize them
bile is a very powerful antioxidant
When you have increased WBC what do you most likely have?
When evaluating the lab values for serum bilirubin, unconjugated/indirect what would you be looking for?
pre-hepatic or hepatic abnormality
elevates for hematologic disease
when considering the lab values for serum bilirubin, conjugated/direct, what clues will it give you?
post hepatic abnormality
elevates in hepatocellular disease
elevates for biliary obstruction
When you have a biliary obstruction what lab value is elevated?
alk phos (ALP)
What do AST and ALT lab values indicate?