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Abdominal II > Biliary System > Flashcards

Biliary System Flashcards

1
Q

Biliary system components

A
  • cystic duct
  • GB
  • Common bile duct (CBD)
  • Common hepatic duct (CHD) (right & left)
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2
Q

Cystic duct

A
  • branches to GB & drains it
  • 2-6 mm in length
  • connects neck of GB to CHD to form CBD
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3
Q

Spiral Valves of Heister

A
  • folds that prevent cystic duct from collapsing & distending
  • 2 way street for bile flow
  • found in cystic duct
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4
Q

Gallbladder appearance

A
  • shaped like a pear
  • has a neck, body, fundus (all equally important)
  • if removed, bile duct can be a little bigger
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5
Q

Gallbladder function

A
  • used for storage, we can live without it
  • behaves like a water balloon
  • if scarred too much, won’t work properly
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6
Q

Is the GB part of the biliary tree?

A

No but it is part of the biliary tract

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7
Q

Common bile duct (CBD)

A
  • outside of liver tissue
  • should not be under a lot of pressure or dilated
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8
Q

Common hepatic duct (CHD)

A
  • closest to the liver, within liver tissue
  • measure & compare to CBD
  • intra hepatic vs. extra hepatic
  • right & left hepatic ducts
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9
Q

intra hepatic vs. extra hepatic

A
  • dilating intra (inside) takes more pressure than extra (outside)
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10
Q

right & left hepatic ducts

A
  • merge at porta hepatis & becomes CHD
  • completes portal triad
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11
Q

Pancreatic duct

A

produces digestive enzymes & joins w/ biliary duct

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12
Q

Ampulla of Vater

A
  • where CBD & main pancreatic duct combine
  • opening of duodenum
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13
Q

Sphincter of Oddi

A
  • muscle that controls the emptying of bile & pancreatic juices through CBD into duodenum
  • after the ampulla of vater
  • controls pressure differences
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14
Q

Infundibulum

A
  • part of GB neck nearest to the cystic duct
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15
Q

Hartmann’s Pouch

A
  • dilation of GB neck b/c it is folded back on itself
  • anatomic variation
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16
Q

Retrograde

A

backwards

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17
Q

Biliary system functions

A
  • concentrate & store bile
  • transport bile to duodenum
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18
Q

Cholecystokinin (CCK)

A
  • hormone released by duodenum
  • tells biliary system what to do
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19
Q

Cholecystokinin (CCK) function

A
  • causes GB to contract, then contents are emptied & wall layers thicken
  • stimulated once food reaches duodenum
  • aids in digestion by breaking down fatty foods & dairy
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20
Q

Can you see wall abnormalities when GB is contracted?

A

no, nearly impossible

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21
Q

How does cholecystokinin move contents?

A

stimulates GB to contract, sphincter of Oddi opens allowing bile to flow to small intestine

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22
Q

Portal triad

A

proper hepatic artery, main portal vein, common hepatic duct (leading to CBD)

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23
Q

Porta hepatis

A
  • where everything enters the liver
  • contains portal triad
24
Q

GB fossa location/size/shape

A
  • inf/post to liver border
  • pear shaped: neck, body, fundus
  • 10 cm in length, 3 cm wall thickness
25
Q

CBD location

A
  • post to duodenum at pancreas posterior
  • joins pancreatic duct at ampulla of vater
  • sphincter of Oddi = muscle control (Cholecystokinin)
26
Q

How do you find the CBD?

A
  • use main lobar fissure
  • follow GB neck from porta hepatis
27
Q

Fundus of GB

A
  • most inferior portion of GB
  • usually projects below inferior margin of liver
28
Q

Cystic artery

A
  • supplies GB & biliary tree
  • branch of R hepatic artery vessels & ducts course together generally
29
Q

Neck of GB

A

fixed relationship to main lobar fissure & RPV

30
Q

Fundus of GB

A
  • most inferior portion of the GB
  • typically the largest part of GB upon distention
31
Q

What is placed in the body to prevent an obstruction?

A

ERPC tube

32
Q

What can develop around the gallbladder from pressure?

A

vericose veins

33
Q

Congenital variants

A
  • variants of anatomy or position
  • septate, junction fold, phrygian, duplication
34
Q

Septate GB

A
  • may be partial or complete (double GB)
  • splits lumen into several parts, increased chance of obstruction (look for opening in each pocket)
35
Q

Junctional fold

A
  • M/C GB variant (variant of position)
  • thick & incomplete
  • momentary obstruction
36
Q

2 types of junctional folds

A
  • Hartman’s pouch: GB folds back on itself at neck
  • Phrygian cap: fold at GB fundus
37
Q

F cap

A

bubble of gallbladder that can cause obstruction

38
Q

Phrygian

A
  • at fundus
  • one variant is position & one is anatomy
39
Q

Duplication of GB

A
  • presence of accessory GB
  • Boyden’s classification
  • 3 different types
40
Q

Boyden’s classification

A
  • bilobed, 1 cystic duct, incomplete division
  • complete duplication w/ 2 cystic ducts connecting to a single CHD
  • complete duplication connecting to a single cystic duct that enters the CHD
41
Q

Types of duplication of GB

A
  • type I (split primordial gallbladders): septated, V-type, Y-type
  • type II (accessory gallbladders): H-type (ductular), trabecular
  • type III: triple gallbladder
42
Q

Gallbladder imaging

A
  • ideally fasting for at least 6 hours
  • anechoic contents w/ echogenic thin wall (<3mm)
  • not fasting = won’t know if contraction is from eating or a condition
  • pear shape in long axis, round in short axis
43
Q

Scanning GB neck

A
  • anchored along portal triad in long axis
  • located at porta hepatis w/ main lobar fissure
  • elongation of cystic duct should be attempted
  • cystic duct isn’t always visible
44
Q

What positions may help visualize the cystic duct?

A

Trendelenburg or right posterior oblique positions

45
Q

Scanning GB fundus

A
  • make sure you have seen the end of it
  • moves w/ patient position & gravity
  • typically most inferior
46
Q

GB Evaluation

A
  • note pt position & difference of content location
  • always look at gallbladder from multiple angles/viewpoints
47
Q

GB wall measurements

A
  • be perpendicular to the wall
  • beam needs to hit where you will measure
  • try to be adjacent to the liver
  • short axis to measure walls (round)
48
Q

Bile duct vessel intersections

A
  • CBD & CHD course along w/ portal veins & hepatic arteries, often anteriorly
  • MPV comes from pancreas to liver
49
Q

Bile ducts

A
  • small linear anechoic structures along the portal veins (portal triad)
  • CBD courses to the posterior pancreatic head
  • enlarged bile ducts generally occur after cholecystectomy & increase in size as the patient ages
50
Q

Why would it be beneficial to have the patient drink water & elevate their head when scanning?

A

can help visualize the distal CBD & pancreatic head (check that it’s the right call first)

51
Q

Scanning bile ducts

A

-elongating, following to panc. head, note where it ends the liver
- look for portal vein entering the liver, stay on it, should be right near it
- small movements
- don’t just slap color on

52
Q

Bile duct wall measurements

A
  • wall shouldn’t be more than 4 mm
  • once out of liver it shouldn’t be more than 6 mm
53
Q

When would it make sense for the bile duct walls to measure longer?

A
  • age allows room for an extra mm per decade once 60 y/o (6mm for 60, 7 mm for 70, etc.)
  • removing GB can increase measurement
54
Q

Ideal position for scanning bile duct

A
  • decube position
  • start at midline & take a deep breath
  • then come up under ribcage & look up to liver
55
Q

Why should you follow the CBD all the way to the end?

A

to make sure there isn’t a stone

Abdominal II (4 decks)

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