Abdo- GB Flashcards
what is the biliary system comprised of? (3)
- intrahepatic bile ducts
- GB
- common bile duct
what are hepatocytes?
- produce bile
- transported though the rt and lt intrahepatic bile ducts to the porta hepatis where they converge to form the common hepatic duct
function of the common hepatic duct?
- transports the bile into the GB through the cystic duct
function of the valves of heister?
- in the cystic duct
- control the flow of bile
location of the extrahepatic CBD?
- distal to the cystic duct and CHD
function of GB?
- stores and concentrates bile in the GB
- transports bile through the CBD to the duodenum
what hormone is released into the bloodstream and stimulates the release of bile into the CBD and duodenum?
cholecystokinen
when is the hormone cholecystokinen released?
when fat enters the digestive system
GB blood supply?
- the GB and cystic duct are supplied by the cystic artery
- it is a branch of the right hepatic artery
when the GB is not working what other 2 organs are probably affected as well?
- liver and pancreas
normal total bilirubin?
0.3 to 1.1 /dL
normal direct bilirubin?
0.1 - 0.4/dL
what is bilirubin?
- a product from the breakdown of hemoglobin in old RBC’s
what is jaundice?
- Leakage of bilirubin into tissues that gives the skin a yellow appearance
- jaunice itself is not a disease but a sign
jaunice is AKA?
icterus
causes of Hyperbilirubinemia?
- increased levels of bilirubin in the blood
- bilirubin is usually excreated in bile and urine
what is jaundice often seen in? (4)
- liver disease
- hepatitis and cirrhosis
- liver or pancreatic cancer
- may indicate an obstruction of the biliary tract (stones in CBD)
symptoms of jaundice? (5)
- pruritis- itchiness
- fatigue
- abdominal pain
- weight loss
- vomiting
signs of jaundice (3)?
- yellow discoloration of skin and eyes
- fever
- pale stools and dark urine
Elevation of direct or conjugated bilirubin is associated with? (4)
- obstruction
- hepatitis
- cirrhosis
- liver mets
Elevation of indirect or unconjugated bilirubin is associated with?
- nonobstructive conditions
- steatosis
Alkaline Phosphatase (ALP)?
- Enzyme produced primarily by liver, bone, and placenta
- excreated through bile ducts
ALP elevation is associated with?
- obstrictive jaundice
what is Alanine Aminotransferase(ALT)?
- enzyme found in high concentration in the liver and lower concentrations in the heart, muscle, and kidneys
- remains elevated longer than AST
what is used to assess jaundice?
Alanine Aminotransferase(ALT)
elevation of Alanine Aminotransferase(ALT) is associated with? (3)
- cirrhosis
- hepatitis
- biliary obstruction
mild elevation of Alanine Aminotransferase(ALT) is associated with?
liver metastases
what is Aspartate Aminotransferase(AST)?
- enzyme present in many kinds of tissue that is released when cells are injured or damaged
levels will be proportional to the amount of damage and the time between cell injury and testing
- used to diagnose liver disease before jaundice occurs
elevation of Aspartate Aminotransferase(AST) is associated with?
- cirrhosis
- hepatitis
- mononucleosis
normal GB measurment?
TRV: <4cm
SAG: <8-12 cm
wall thickness: <3mm
dialation of GB is known as?
hydrops
what is milk of calcium bile?
- rare condition
- GB filled with semisolid calcium carbonate
what is milk of calcium bile caused by?
- stasis
- rarely causes acute cholecystitis
biliary sludge on u/s?
- appears as amorphous low-level echoes
- no acoustic shadowing
- lacks vascularity
- may move or chance position
- normal GB wall
- Tumefactive sludge (sludge balls) mimics polyps
biliary sludge predisposing factors? (6)
Pregnancy Rapid weight loss Prolonged fasting Critical illness Long term parental nutrition Bone marrow transplant
Clinical Symptoms and Signs of Gallbladder Disease?
- RUQ abdominal pain develops after the ingestion of greasy foods
- Nausea and vomiting sometimes occur and may indicate the presence of a stone in the common bile duct
- A gallbladder attack may cause pain in the right shoulder.
- Jaundice is a clinical sign of gallbladder disease
what is cholecystitis?
- inflammation of the GB that may take one of several forms
Cholecystitis is an inflammation of the gallbladder that may take one of several forms- including? (4)
Acute or chronic
Acalculous
Emphysematous
Gangrenous
Most common cause of acute cholecystitis is?
gallstones
what is Acute Cholecystitis?
caused by stones being impacted in the cystic duct or in the neck of the gallbladder (Hartmann’s pouch)
clinical presentation of acute cholecystitis?
- RUQ pain
- positive murphy’s sign
- inspiratory arrest upon palpitation of GB area
- fever
- leukocytosis
- increased bilirubin and alkaline phosphatase levels
acute cholecystitis complications?
May be serious and include:
- empyema
- emphysematous
- gangrenous cholecystitis
- perforation
Acute Cholecystitis sono findings?
Gallbladder wall >3 mm Distended gallbladder lumen >4 cm Gallstones Impacted stone in Hartmann’s pouch or cystic duct Positive Murphy’s sign Increased color Doppler flow Pericholecystic fluid collection