Biliary System

Question 1

Extra hepatic biliary tract consist of

Answer 1

• The bifurcation of the left and right hepatic ducts
• Common hepatic duct
• Common bile duct
• Cystic duct and the gallbladder

Question 2

The left hepatic duct is formed by the ducts draining segment ?

Answer 2

II, III, and IV of the liver, courses horizontally along the base of segment IV.

Question 3

The right hepatic duct is formed by ?

Answer 3

The right posterior ( segment IV and VII ) and right anterior ( segments V and VIII) hepatic ducts.

Question 4

The portal triad consist of

Answer 4

Bile duct
Portal vein
Hepatic Artery

Question 5

The blood supply to the extra hepatic biliary tree ?

Answer 5

Distally from the gastroduodenal, retroduodenal, and postrosuperior pancreatoduodenal arteries.

Proximally, from the right hepatic and cystic arteries, these arteries supply the common bile and common hepatic duct thorough branches running parallel to the duct in the 3 and 9 o’clock position.

Question 6

Calot triangle content and boundaries

Answer 6

Question 7

Nerve supply of the gallbladder

Answer 7

Parasympathetic; hepatic branch of Vagus
Symptomatic: greater splanchnic nerve from T5-9
Sensory to the peritoneum: Right phrenic nerve ( C3,4,5).

Question 8

Surface anatomy of the gallbladder

Answer 8

The fundus of the G.B. Correspondence to the tip of the right 9th costal cartilage where the transpyloric plane or right lateral vertical plane crosses the right costal margin.

Question 9

Biliary infections are usually due to three factors

Answer 9

• Susceptible host
• Sufficient inculum
• Stasis

Question 10

The most common symptoms related to the biliary tract

Answer 10

Abdominal pain in the right upper quadrant, jaundice, fever.

Question 11

Jaundice when the serum concentration of bilirubin exceeds about

Answer 11

2.5 mg/dL , ( scleral icterus )

Question 12

Charcot triad

Answer 12

• right upper Quadrant pain
• jaundice
• Fever

Question 13

Pentad of Reynolds

Answer 13

• Charcots triad ( jaundice, fever, abdominal pain ) + altered mental status + hypotension.

Question 14

Diagnosis of biliary tract disease

Answer 14

• Hx and physical examination.
• Labs :
• Biliary colic without gallbladder pathology or
  obstruction normal LFT .
• Obstructive choledocholithiasis is commonly
  associated with elevation in LFT .
• Hepatocellular injury results in increased levels of
  unconjugated or indirect bilirubin .
• Bile duct obstruction lead to an
  increased alkaline phosphatase level and
  bilirubin
• Leukocytosis, composed primarily of
  neutrophils, is often present with acute
  cholecystitis or cholangitis, but is a
  nonspecifc fnding .
• Radiology gold standard ( US)

Question 15

Modalities of cholangiography

Answer 15

1- MRCP
2- ERCP
3- PTC
4- Intra hepatic cholangioram