UNIT 2: GI Accessory Organs and Biliary

Question 1

Liver and Biliary System are located in the

Answer 1

RUQ/R Hypochondrium and Epigastric regions

Question 2

Lobes of the liver

Answer 2

-Four (4) Lobes
Left Lobe
Right Lobe
Caudate lobe
Quadrate lobe

Question 3

Liver Hilum (porta hepatis) is an entry/exit point for

Answer 3

-Portal vein
-Hepatic artery
-Biliary Tree

Question 4

Functions of the Portal System

Answer 4

-Drains blood from digestive tract
-Metabolizes nutrients and medications in the liver
-Hepatic veins convey blood from the liver to the IVC

Question 5

Functions of the Liver

Answer 5

-Clears blood of drugs and harmful substances
-Produces Bile
-Aids in the digestion and break down of fatty foods
-Stores and releases glucose
-Both an excretion AND a secretion
-Secretion: aids in the emulsification of fats
-Excretion: aids in the removal of waste products from red blood cell production (Bilirubin)

Question 6

A function of bile is to

Answer 6

Emulsify fats

Question 7

Secretion vs Excretion

Answer 7

-Secretion: aids in the emulsification of fats
-Excretion: aids in the removal of waste products from red blood cell production (Bilirubin)

Question 8

The Biliary System

Answer 8

-Bile ducts and gallbladder
-Hepatic Ducts (right and left)
-Common Hepatic Duct
-Cystic Duct
-Common Bile Duct
-Pancreatic Duct
-Hepatopancreatic ampulla/Ampulla of Vater

Question 9

The Gallbladder

Answer 9

-Narrow neck, body, fundus
-Concentrates bile through absorption of water
-Stores bile for digestion
-Contraction activated by hormone
-Cholecystokinin (CCK) that is secreted by the duodenum in response to ingestion of fats

Question 10

Where is bile stored for digestion?

Answer 10

Gallbladder

Question 11

Contraction activated by which hormone

Answer 11

cholecystokinin (CCK)

Question 12

cholecystokinin (CCK) is

Answer 12

a hormone secreted by the duodenum in response to ingestion of fats

Question 13

Body Habitus

Answer 13

-Asthenic: very slender
-Hyposthenic: intermediate between asthenic and sthenic
-Sthenic: moderate heavy build
-Hypersthenic: large build

Question 14

The Pancreas

Answer 14

-Head, neck, body, and tail
-Head is enclosed in the curvature of the duodenum
-Exocrine and endocrine gland
-Exocrine: produces digestive enzymes
-Endocrine: produces insulin and glucagon

Question 15

Exocrine vs Endocrine Glands in the Pancreas

Answer 15

Exocrine: produces digestive enzymes
Endocrine: produces insulin and glucagon

Question 16

The Spleen

Answer 16

-Lymphatic organ
-Stores lymphocytes and stores/removes dead red blood cells
-Located in the left upper quadrant below the diaphragm and retrogastric

Question 17

____________ has become the modality of choice for the gallbladder

Answer 17

Sonography

Question 18

Cholegraphy is the

Answer 18

radiographic study of the biliary system

Question 19

Cholecystography is the

Answer 19

radiographic study of the gallbladder

Question 20

Cholangiography is the

Answer 20

radiographic study of the biliary ducts

Question 21

Common procedures for Diagnostic Radiology

Answer 21

-Percutaneous Transhepatic Cholangiography (PTC)
-Postoperative (T-tube) Cholangiography
-Endoscopic Retrograde Cholangiopancreatography (ERCP)
-Intraoperative Cholangiogram (IOC)

Question 22

Percutaneous Transhepatic Cholangiography (PTC)

Answer 22

-Patient admits to hospital with acute symptoms
Jaundice
Pain in upper right quadrant
Nausea/vomiting
-Imaging reveals blockage of the biliary ducts
-Patient placed supine on table and right abdomen surgically prepped
-Local anesthetic (Lidocaine)
-Chiba needle is inserted through the right lateral intercostal space and advanced to the hilum of the liver
-Water-soluble iodinated contrast is injected under fluoro or CT guidance
-Often a drain can be placed in the biliary tree in order for excess bile and fluid build-up to drain
-Drain will be left in place until patient goes to operating room to have gallbladder removed

Question 23

Post-operative Cholangiography (T-tube)

Answer 23

-Patient who has had gallbladder removed has a drain left in place from surgery
-Severe infection of the biliary system
-Drain left in place until infection clears
-Drain is clamped prior to procedure (24 hours)
-Patient is NPO before the exam
-Cleansing enema may be administered the day of the exam
-25-30% concentrated Water-soluble iodinated contrast is injected into T-tube drain
-Images taken in AP, RPO, and Lateral positions to evaluate
-Caliber and patency of ducts
-Status of the sphincter of the hepatopancreatic ampulla
-Presence of residual stones or sludge

Question 24

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Answer 24

-Patient is most likely under general anesthesia either in Radiology suite or an Endoscopy suite
-Fiberoptic endoscope passed through the mouth into the duodenum under fluoro guidance
-Ampulla of Vater located and physician inserts a catheter
-Contrast is injected retrograde to fill the biliary system
-Stones may be removed via a balloon or basket
-Stents may be placed in the biliary ducts to ensure patency of ducts if infection or a mass is present
-Can be done even if there is a contrast allergy because it is not going into the bloodstream

Question 25

Intraoperative Cholangiogram (IOC)

Answer 25

-Patient has been diagnosed with gallstones or infection of the biliary system -Images taken with the C-arm during Laparoscopic or Open Cholecystectomy **-Catheter inserted into the cystic duct and clamped into place** **-Contrast is injected to visualize ductal system** -Ensure ducts are clear of stones and sludge **-Evaluate patency of Ampulla of Vater** -Stones may be removed and cholangiogram repeated until clear

Question 26

Abdominal Fistulae and Sinuses

Answer 26

**-A fistula is an abnormal connection between 2 body parts or to the outside of the body** **-A sinus is an abnormal channel leading to an abscess** -Can occur after abscess or surgery on any area of the body -For fistulas involving the **colon, a water-soluble iodinated contrast enema** can be done -For fistulas involving the **small bowel, the patient may ingest either thin barium or water-soluble contrast** -For the **bladder, a cystogram may be performed using iodinated contrast media**

Question 27

What divides the right and left lobe of the liver?

Answer 27

Falciform ligament

Question 28

What are the two minor lobes located on the medial side of the right lobe of the liver?

Answer 28

-caudate lobe on the posterior surface -quadrate lobe on the inferior surface

Question 29

The hilum of the liver is also called the

Answer 29

Porta hepatis

Question 30

The common bile duct and the pancreatic duct join together and enter into the

Answer 30

Ampulla of vater (hepatopancreatic ampulla)

Question 31

The spleen is part of of what system in the body?

Answer 31

Lymphatic

Question 32

What veins convey the blood from the liver sinusoids to the inferior vena cava?

Answer 32

Hepatic

Question 33

The two main hepatic ducts join to form the

Answer 33

Common hepatic duct

Question 34

The structures that join together to form the common bile duct are the

Answer 34

Cystic duct and common hepatic duct

Question 35

the ____________________ joins the ___________________ and they enter together into the ampulla of vater (hepatopancreatic ampulla)

Answer 35

common bile duct, pancreatic duct

Question 36

The distal end of the common bile duct is controlled by the

Answer 36

Choledochal sphincter

Question 37

The Ampulla of vater (hepatopancreatic ampulla)is controlled by the

Answer 37

Sphincter of the hepatopancreatic ampulla aka sphincter of oddi

Question 38

The hepatopancreatic ampulla is also known as the

Answer 38

ampulla of vater