Module 4 : The Biliary System Flashcards
1
Q
The biliary tree path
A
lobules (bile canaliculi) - lobular bile ducts - right and left hepatic duct - common hepatic duct + cystic duct - common bile duct
2
Q
bile canaliculi
A
- located between the hepatocytes
- intercommunicating network
- anastomose to form lobular bile ducts
- travel with portal vein and hepatic artery (portal triad)
3
Q
right and left hepatic duct
A
- formed by union of multiple lobular bile ducts
- at level of porta hepatis right and left join to form common hepatic duct
4
Q
common hepatic duct
A
- anterior to the portal vein
- anterior and lateral to right hepatic artery
- travels in free edge of lesser omentum
- 4 mm diameter
5
Q
common bile duct
A
- length determined by insertion point
- anterior and lateral to main portal vein’
- 4mm through 40’s then add 1mm/10yrs
- 10mm normal with cholecystectomy
- ## TRAVELS THROUGH HEPATODUODENAL LIGAMENT
6
Q
mickey mouse
A
CBD anterolateral HA anteromedial MPV posterior
7
Q
4 segments of CBD
A
- 1st (supraduodenal)
- 2nd (retroduodenal)
- 3rd (infra duodenal)
- 4th (intraduodenal)
8
Q
intraduodenal segment of CBD
A
- 4th part
- enters 2nd portion of duodenum and inserts into ampulla of Vater
- narrowest portion of extrahepatic biliary tree
+ where stones like to sit
9
Q
sphincter of oddi
A
- regulates bile for into duodenum
10
Q
cystic duct
A
- joins CHD 1-2cm above duodenum to form CBD
- arise from superior aspect of tech of GB
- s shaped
- 3mm diameter 4cm in length
- contain spiral valves of heister
11
Q
spiral valves of heister
A
- not true valves
+ mucosal folds - prevent duct from over distending or collapsing
12
Q
intrahepatic ducts
A
- within the liver
- no more than 2mm in diameter
- branching pattern
- portal veins are landmarks for them
- TOO MANY TUBES = INTRAHEPATIC DUCT DILATION
13
Q
gallbladder location
A
- posterior inferior surface of right lobe of liver
- GALLBLADDER FOSSA
- posterior and caudal to distal end of MLF
- intraperitoneal
14
Q
GB position
A
- variable with patient position
- neck of GB fixed
- body and fundus are mobile
- neck most dependent in supine fundus most dependent in LLD
15
Q
landmarks for GB
A
- MAIN LOBAR FISSURE = most reliable
- rpv
- duodenum
- right kidney
16
Q
size and shape of GB
A
- pear/tear drop shape
- 8-9cm in length and 2-5cm in diameter
17
Q
divisions of GB
A
fundus, body, neck
18
Q
fundus of GB
A
- widest portion
- MOST DEPENDENT IN LLD
19
Q
body of GB
A
- middle portion
- aka corpus
20
Q
neck of GB
A
- tapered portion
- fixed position
- MOST DEPENDENT IN SUPINE
21
Q
gallbladder wall
A
- in FASTING STATE LESS THAN 3mm
- 4 layers
+ mucosa
+ muscular layer
+ subserous layer
+ serous layer
22
Q
mucosa layer
A
- inner epithelial lining
- concentrates bladder
23
Q
muscular layer
A
- muscle
24
Q
sub serous layer
A
- connective tissue
25
serous
- outer layer = in contact with peritoneum
26
Rokitansky - Aschoff sinuses (RA sinuses)
- multiple folds along inner border of GB coated with epithelial cells
- not seen unless pathology
27
function of biliary ducts
- drain liver of bile and carry to GI system
28
function of GB
- reservoir for bile
+ stored until required to aid in digestion
+ holds 40-70ml
+ concentrates bile by secreting mucus and absorbing water
29
hormone control of bile secretion
- ingestion of fats and amino acids duodenum releases CCK (cholecystokinin)
30
Cholecystokinin (CCK)
- released by duodenum with ingestion of fats and amino acids
- stimulates GB to contract and sphincter of oddi to relax
31
GB contraction time
- contracts 30 minutes following a meal
32
bile
- yellowish green liquid produced and secreted by hepatocyte
- consists of water, cholesterol, bilirubin, inorganic salts, bile acid
- breaks down fat and absorb fatty acids
33
bile salts
- 1gram of bile salts/day in liver
- cholesterol is precursor of bile salts
+ supplied by diet or synthesized by liver
34
bilirubin
- end product of hemoglobin decomposition
- bile pigment
- conjugates in liver
35
jaundice/icterus
- yellowish tint seen in body tissue due to large quantities of bilirubin
36
blood supply to GB
- arterial blood supply from cystic artery
| - venous drainage occurs via cystic vein drains directly into portal vein
37
GB variants
- junctional fold
- Hartmans pouch
- phyrgian cap
- septations
- excessively mobile
- ectopic
- low lying
- embedded in liver
38
junctional fold
- occurs at junction of BODY AND NECK
| - similar look as septation
39
Hartmans pouch
- OUTPOUCHING in area of GB neck
40
phyrigian cap
- GB partially folded onto itself in region of FUNDUS
41
sonographic appearance of GB
- anechoic or nearly anechoic
- thin echogenic walls
- sagital pear shaped
- trans is circle
42
GB exam
- px in supine and decubitus to move stones
- size, shoe, wall thickness, and fluid
- liver as wind to minimize reverb
- LPO good for measure CBD
- measure duct INNER TO INNER
+ distal to HA
43
lab tests
- bilirubin
- alkaline phosphatase
- leukocytes
- HIDA scan
- ERCP
44
bilirubin
```
- indirect = increased values
+ hemolysis
+ RBC degradation
+ abnormal hepatocellural uptake
- direct = increased values
+ extra hepatic obstruction
+ bile duct disease
+ intraheptaic disruption
```
45
alkaline phosphatase (alk phos)
- increased value in EXTRAHEPATIC BILIARY OBSTRUCTION
46
leukocytes
- MEASURES REACTION OF BODY TO INFECTION
| -
47
HIDA scan
- nuke med test
| - ASSES GB FUNCTION
48
ERCP
- like fluoroscopy
| - asses for obstruction
