AB-Gallbladder and Biliary System Flashcards
The biliary ducts
Right and left hepatic ducts
Common hepatic duct
Common bile duct
Cystic duct
Hepatic Ducts
Right and left hepatic ducts emerge from the right lobe of liver in the porta hepatis and unite to form the common hepatic duct, which passes caudally and medially.
Run parallel with the portal vein
Each duct is formed by the union of bile canaliculi from the liver lobules
Common Hepatic Duct
Approximately 4mm in diameter
Descends within the edge of the lesser omentum
Joined by the cystic duct to form the common bile duct
Common Bile Duct
Normal measurement is <6mm for people 60 years or younger. 1mm per decade after age 60
Proximal portion lies lateral to the hepatic artery and anterior to the portal vein (left ear of Mickey Mouse)
Ends by piercing into the wall of the duodenum where is joins the main pancreatic duct and together, they open into the duodenum through a small opening called the ampulla of Vater
Cystic Duct
Approx. 4 cm long
Connects the neck of the gallbladder to the CHD to form the CBD
Normally not seen by ultrasound
Function of the Gallbladder
Stores bile produced by the liver; can hold approx 50 ml
Concentrates bile when the body is in a fasting state
Anatomic variations of the gallbladder
Bilobed gallbladder-Hourglass appearance
Septated gallbladder-Appear as thin separations within the gallbladder
Phrygian cap-Gallbladder fundus is folded onto itself
Hartmann pouch-Outpouching of gallbladder neck
Junctional fold-Prominent fold located at the junction of the gallbladder neck
Courvoisier’s sign
Indicates an extrahepatic mass compressing the common bile duct, which can produce an enlarged gallbladder
Common causes of thickening of the gallbladder wall ( >3 mm)
Intrinsic Cholecystitis Gallbladder perforation Sepsis Hyperplastic cholecystosis Gallbladder carcinoma AIDS cholangiography Sclerosing cholangitis Extrinsic Hepatitis/cirrhosis Hypoalbuminemia Ascites Right heart failure Renal failure Multiple myeloma Portal node lymphatic obstruction
Sonographic findings for gallbladder carcinoma
Nonmobile mass within the gallbladder lumen that measures >2cm
Gallstones seen in approx 90%
Diffuse or focal gallbladder wall thickening Irregular mass that may completely fill the
gallbladder fossa
Invasion of the mass into surrounding liver
tissue
Gallbladder carcinoma
Rare, although most common cancer of the
biliary tract
Caused by chronic irritation of the gallbladder wall by gallstones
Size > 2cm , suspicous for carcinoma vs polyps
Color doppler can reveal vessels within the
malignancy
Porcelain gallbladder
Results from the calcification of the gallbladder wall
Occurs mainly in older female patients
May appear sonographically similar to WES
sign
Has been associated with the potential
development of gallbladder carcinoma (25%)
Gallbladder perforation is seen in which disease?
Acute cholecystitis
Malignant melanoma
Most common metastatic disease of the
gallbladder
Cholangiocarcinoma
Dilated intrahepatic ducts that abruptly terminate at the level of the tumor
A solid mass may be noted within the liver or ducts
