Module 11 - Biliary System

Question 1

Where is the liver primarily located in the abdomen?

Answer 1

In the right upper quadrant (RUQ), with some extension into the left upper quadrant (LUQ).

Question 2

What vertebral level does the inferior angle of the liver typically reach?

Answer 2

Level of L3, just below the right lower costal margin.

Question 3

What causes the right lung to appear higher than the left on imaging?

Answer 3

The convex superior surface of the liver pushing up the right diaphragm.

Question 4

What is the general shape of the liver?

Answer 4

Wedge-shaped.

Question 5

What are the approximate dimensions of the liver (horizontal × vertical × AP)?

Answer 5

20 cm × 16 cm × 13 cm.

Question 6

What are the two major lobes of the liver?

Answer 6

Right lobe and left lobe.

Question 7

What are the two minor lobes of the liver?

Answer 7

Caudate lobe and quadrate lobe.

Question 8

Which liver lobe is the largest and where is it located?

Answer 8

The right lobe, located in the lateral RUQ.

Question 9

Where is the left lobe of the liver located?

Answer 9

Medially, crossing the midline into the LUQ.

Question 10

What separates the right and left lobes of the liver?

Answer 10

The falciform ligament.

Question 11

What does the falciform ligament attach to?

Answer 11

The anterior abdominal wall and diaphragm.

Question 12

What separates the quadrate lobe from the left lobe?

Answer 12

The fissure of ligamentum teres.

Question 13

What separates the caudate lobe from the left lobe?

Answer 13

The fissure of ligamentum venosum.

Question 14

What are the two main blood vessels supplying the liver?

Answer 14

The hepatic artery and the hepatic portal vein.

Question 15

What type of blood does the hepatic artery carry to the liver?

Answer 15

Oxygenated blood.

Question 16

Where does the hepatic artery originate from?

Answer 16

The aorta.

Question 17

What type of blood does the hepatic portal vein carry to the liver?

Answer 17

Deoxygenated, nutrient-rich blood.

Question 18

What organs drain into the hepatic portal vein?

Answer 18

The digestive tract, pancreas, spleen, and gallbladder.

Question 19

What two veins join to form the hepatic portal vein?

Answer 19

The splenic vein and the superior mesenteric vein.

Question 20

What is the starting point of bile drainage in the liver?

Answer 20

The intrahepatic (secondary) ducts.

Question 21

What ducts drain the left and right lobes of the liver?

Answer 21

The left and right hepatic ducts.

Question 22

What structure is formed by the union of the left and right hepatic ducts?

Answer 22

The common hepatic duct.

Question 23

What duct joins the common hepatic duct from the gallbladder?

Answer 23

The cystic duct.

Question 24

What is the name of the duct formed by the union of the common hepatic duct and the cystic duct?

Answer 24

The bile duct (common bile duct).

Question 25

Where does the bile duct drain bile into?

Answer 25

The duodenum.

Question 26

What is the widened area of the bile duct before it enters the duodenum called?

Answer 26

The hepatopancreatic ampulla (ampulla of Vater).

Question 27

What duct joins the bile duct at the hepatopancreatic ampulla?

Answer 27

The pancreatic duct.

Question 28

What structure controls bile and pancreatic juice flow into the duodenum?

Answer 28

The sphincter of ampulla (Sphincter of Oddi).

Question 29

What is the name of the imaging procedure used to visualize the bile ducts with contrast?

Answer 29

A cholangiogram.

Question 30

What digestive substance is produced by the liver?

Answer 30

Bile.

Question 31

What is the function of bile?

Answer 31

To aid in metabolizing fats in the small intestine.

Question 32

What anticoagulant substance is naturally produced by the liver?

Answer 32

Heparin.

Question 33

How does the liver contribute to detoxification?

Answer 33

It cleanses hormones, drugs, and chemicals like alcohol.

Question 34

Which vein delivers digestion products to the liver for metabolism?

Answer 34

The hepatic portal vein.

Question 35

What protein, important for maintaining blood volume and pressure, is produced by the liver?

Answer 35

Blood plasma albumin.

Question 36

What does the liver do to worn-out red blood cells?

Answer 36

It breaks them down.

Question 37

What does the liver do to metabolic by-products?

Answer 37

Converts them into a safe form for elimination.

Question 38

What structure is the superior surface of the liver related to?

Answer 38

The undersurface of the diaphragm.

Question 39

What is the right surface of the liver related to?

Answer 39

The diaphragm and costal cartilages.

Question 40

What does the anterior surface of the liver contact?

Answer 40

The diaphragm and the anterior abdominal wall.

Question 41

What structures are related to the posterior surface of the liver?

Answer 41

The diaphragm, inferior vena cava, and abdominal aorta.

Question 42

What organs lie near the inferior surface of the liver?

Answer 42

The right kidney, duodenum, hepatic flexure, gallbladder, and stomach.

Question 43

Which imaging modality best demonstrates the liver’s density?

Answer 43

Computed Tomography (CT).

Question 44

What conditions can liver imaging detect?

Answer 44

Size/contour variations, calcifications, abscesses, cysts, tumors, and vascular lesions.

Question 45

What does ERCP stand for?

Answer 45

Endoscopic Retrograde Cholangiopancreatography.

Question 46

What is the purpose of an ERCP?

Answer 46

To assess the pancreatic head, pancreatic ducts, bile duct, and common hepatic duct for blockages, stones, or lesions.

Question 47

Through which anatomical route is the ERCP scope advanced?

Answer 47

From the mouth through the Upper GI tract to the duodenum.

Question 48

What is injected into the ducts during ERCP to assess patency?

Answer 48

Contrast media.

Question 49

What tool can be used during ERCP to remove stones from ducts?

Answer 49

A basket-like retrieval device.

Question 50

What can be inserted into ducts during ERCP to maintain openness?

Answer 50

Stents (permanent or semi-permanent).

Question 51

What is the name of the procedure to enlarge the Sphincter of Oddi?

Answer 51

Sphincterotomy.

Question 52

What does PTC stand for?

Answer 52

Percutaneous Transhepatic Cholangiogram.

Question 53

What is the purpose of a PTC?

Answer 53

To assess obstructive disease in the hepatic ducts.

Question 54

How is contrast introduced during a PTC?

Answer 54

Via a needle inserted through the abdominal wall into the liver.

Question 55

Where is the gallbladder located in relation to the liver?

Answer 55

On the inferior surface of the liver.

Question 56

In relation to the abdomen, where does the gallbladder mostly lie?

Answer 56

Anterior to the mid-coronal plane.

Question 57

Which duct drains bile from the gallbladder?

Answer 57

The cystic duct.

Question 58

What is the typical length and width of the gallbladder?

Answer 58

7–10 cm long and about 3 cm wide.

Question 59

What is the bile storage capacity of the gallbladder?

Answer 59

30–40 mL.

Question 60

What is the shape of a bile-filled gallbladder?

Answer 60

Pear-shaped.

Question 61

What are the three main parts of the gallbladder?

Answer 61

Fundus (rounded end), body (middle), and neck (narrow S-shaped end).

Question 62

Where is the gallbladder located in sthenic and hyposthenic body types?

Answer 62

Between the xiphoid tip and lower costal margin, around T11–L2.

Question 63

How does gallbladder location differ in a hypersthenic body type?

Answer 63

It is positioned higher, more rightward, and lies more horizontally.

Question 64

Where is the gallbladder located in an asthenic body type?

Answer 64

Lower, closer to the midline, and lies more vertically.

Question 65

What is the primary function of the gallbladder?

Answer 65

To store and concentrate bile produced by the liver.

Question 66

When does the gallbladder release bile?

Answer 66

When fat enters the small intestine for digestion.

Question 67

What keeps the cystic duct open and helps regulate bile flow?

Answer 67

Spiral valves formed by folds in the cystic duct wall.

Question 68

What is the path of bile from the liver to the duodenum?

Answer 68

Liver → hepatic ducts → common hepatic duct → cystic duct → gallbladder → cystic duct → bile duct → duodenum.

Question 69

Where is the gallbladder located relative to the mid-coronal plane?

Answer 69

Anterior to the mid-coronal plane.

Question 70

Where is the cystic duct located in relation to the mid-coronal plane?

Answer 70

Posterior to the mid-coronal plane.

Question 71

What duct is formed by the union of the cystic duct and common hepatic duct?

Answer 71

The common bile duct.

Question 72

What structure does the bile duct join before entering the duodenum?

Answer 72

The pancreatic duct at the hepatopancreatic ampulla (ampulla of Vater).

Question 73

What controls bile flow into the duodenum?

Answer 73

The sphincter of ampulla (Sphincter of Oddi).

Question 74

Where is the spleen located in the body?

Answer 74

In the left upper quadrant, just below the diaphragm.

Question 75

What ribs is the spleen located near?

Answer 75

Ribs 9 to 11.

Question 76

What organ lies anterior to the spleen?

Answer 76

The stomach.

Question 77

What is the primary function of the spleen?

Answer 77

To filter blood, removing old red blood cells and pathogens.

Question 78

What does the spleen store and release during bleeding?

Answer 78

Platelets.

Question 79

What is the general shape of the spleen?

Answer 79

Bean-shaped.

Question 80

What are the approximate dimensions of the spleen?

Answer 80

12.5 cm long, 7.5 cm wide, 3.5 cm thick.

Question 81

What structure lies lateral to the spleen?

Answer 81

The abdominal wall.

Question 82

What structures lie medial to the spleen?

Answer 82

The left adrenal gland and left kidney.

Question 83

What structure lies inferior to the spleen?

Answer 83

The splenic flexure of the colon.

Question 84

What structure lies anterior to the spleen?

Answer 84

The stomach.

Question 85

What structure lies superior and posterior to the spleen?

Answer 85

The diaphragm.

Question 86

Where is the lower pole of the spleen seen on a radiograph?

Answer 86

Just superior to the lower costal margin (LCM).

Question 87

What imaging technique can visualize spleen vasculature using contrast?

Answer 87

Angiography or contrast-enhanced CT.

Question 88

Through which vessel does contrast exit the spleen and travel to the liver?

Answer 88

The portal vein.

Question 89

What serious complication can result from abdominal trauma involving the spleen?

Answer 89

Splenic rupture.

Question 90

What surgical procedure may be required after spleen rupture?

Answer 90

Splenectomy (removal of the spleen).

Question 91

Is the pancreas retroperitoneal or intraperitoneal?

Answer 91

Retroperitoneal.

Question 92

What vertebral levels does the pancreas span?

Answer 92

L1–L2.

Question 93

In which anatomical plane does the pancreas lie horizontally?

Answer 93

The mid-coronal plane.

Question 94

Where is the head of the pancreas located?

Answer 94

Within the curve of the duodenum.

Question 95

Where does the tail of the pancreas extend?

Answer 95

Toward the spleen on the left side of the abdomen.

Question 96

What is the approximate length of the pancreas?

Answer 96

About 13 cm (5.5 inches).

Question 97

What duct drains the pancreas?

Answer 97

The pancreatic duct.

Question 98

Where does the pancreatic duct join the common bile duct?

Answer 98

At the hepatopancreatic ampulla (ampulla of Vater).

Question 99

Where do the pancreatic and bile ducts empty their contents?

Answer 99

Into the duodenum at the sphincter of ampulla (Sphincter of Oddi).

Question 100

What digestive role does the pancreas play?

Answer 100

It produces digestive enzymes.

Question 101

What hormones does the pancreas produce to regulate blood sugar?

Answer 101

Insulin and glucagon.

Question 102

A: The common bile duct

Answer 102

inferior vena cava

Question 103

What part of the GI tract lies medial to the pancreatic head?

Answer 103

The duodenum.

Question 104

Which major vessels lie posterior to the pancreatic head?

Answer 104

The common bile duct, inferior vena cava, and abdominal aorta.

Question 105

Which vessels run anterior to the aorta and posterior to the pancreas?

Answer 105

The superior mesenteric vessels.

Question 106

What organ lies posterior to the tail of the pancreas?

Answer 106

The left kidney.

Question 107

What part of the stomach lies anterior and superior to the pancreas?

Answer 107

The pylorus.

Question 108

What organ lies lateral to the tail of the pancreas?

Answer 108

The spleen.

Question 109

What imaging procedure is used to assess both pancreatic and biliary duct systems?

Answer 109

ERCP (Endoscopic Retrograde Cholangiopancreatography).

Question 110

What does ERCP visualize using contrast?

Answer 110

The bile ducts and pancreatic ducts.

Question 111

What are two non-invasive imaging modalities commonly used to assess pancreatic tissue?

Answer 111

CT scan and ultrasound.

Question 112

On ERCP imaging, what does the pancreatic duct typically appear as?

Answer 112

A thin black line veering to the patient’s left.