Biliary System Flashcards by Chelsea Norden

At what point is the CBD formed?

when CHD & cystic duct anastomose, near hepatic artery

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At what point is the CHD formed?

when R & L hepatic ducts anastomose, @ level of porta hepatis

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normal diameter of CHD

4 mm

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normal diameter of CBD

4 mm

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structure that releases CCK

duodenum

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hormone responsible for GB contraction

CCK

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rule of thumb for CBD/CHD diameter

4 mm up to age 40, plus 1 mm for each decade afterward

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relationship of CHD to right portal vein

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relationship of CHD to right hepatic artery

anterolateral

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relationship of CBD to main portal vein

anterior & right

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connective tissue through which the CBD passes

through the hepatoduodenal ligament

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normal CBD diameter, post-cholecystectomy

up to 10 mm

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connective tissue through which the CHD passes

along free edge of lesser omentum

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relationship of HA to MPV

anterior & left

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relationship of CBD to HA

right

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relationship of HA to CBD

left

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relationship of MPV to HA

posterior & right

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relationship of MPV to CBD

posterior & left

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narrowest part of the extrahepatic biliary tract

intraduodenal/4th segment of CBD

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intraduodenal CBD segment

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infraduodenal CBD segment

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retroduodenal CBD segment

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supraduodenal CBD segment

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CBD segment that enters 2nd part of duodenum

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4th CBD segment

intraduodenal

3rd CBD segment

infraduodenal

2nd CBD segment

retroduodenal

1st CBD segment

supraduodenal

structure where the CBD enters the duodenum

sphincter of Oddi

function of the sphincter of Oddi

regulates bile flow

From where does the cystic duct arise?

GB neck

shape of cystic duct

S-shaped

normal diameter of cystic duct

3-4 mm

mucosal folds of the GB

spiral valves of Heister

function of the spiral valves of Heister

structural

normal diameter of intrahepatic ducts

2 mm

path of intrahepatic ducts

with portal veins

structural support feature of the GB

spiral valves of Heister

relationship of GB to main lobar fissure

posterior & inferior to distal portion

typical GB length

8-9 cm

typical GB diameter

3-5 cm

most dependent portion of GB in LLD

fundus

most dependent portion of GB in supine

neck

normal GB wall thickness

< 3 mm

microscopic folds of epithelial cells along the inner border of the GB

RA sinuses

normal volume of bile in the GB

40-70 mL

How does the GB concentrate bile?

secretes mucous and absorbs water

hormone released by duodenum to stimulate bile secretion

cholecystokinin

CCK

cholecystokinin

What does CCK stimulate?

stimulates GB contraction and relaxation of the sphincter of Oddi

How long after a meal before the GB is contracted?

30 minutes

effects of a cholecystectomy on the CBD & sphincter of Oddi

dilation of CBD up to 10 mm, initial loss of tone for sphincter of Oddi, sphincter of Oddi regains tone after 6 months

main contents of bile

water, cholesterol, bilirubin, inorganic salts, bile acid salts

amount of bile salts formed by the liver each day

1 gram

common causes of jaundice

hemolytic anemia, hepatic disease, obstructive jaundice, inability of bilirubin to conjugate

junctional fold

fold at GB body and neck

GB infundibulum, aka

GB neck

GB neck, aka

GB infundibulum

Hartman's pouch

outpouching of GB neck

Phrygian cap

partial fold of GB fundus

anatomical variant of GB exhibiting a fold btwn the GB body and neck

junctional fold

anatomical variant of GB exhibiting a partial fold of the GB fundus

Phrygian cap

anatomical variant of GB exhibiting an outpouching of the GB neck

Hartman's pouch

ideal location of CBD measurement

region of the porta hepatis, btwn HA and pancreatic head, not AT the hepatic artery

where to place calipers on the CBD

inner wall to inner wall

biliary indications of increased ALP in the blood

indicative of extrahepatic biliary obstruction

biliary indications of increased conjugated bilirubin in the blood

indicative of bile duct disease, intra- or extrahepatic obstruction

biliary indications of increased unconjugated bilirubin in the blood

indicative of hemolysis, abnormal hepatocellular uptake

biliary indications of increased leukocytes in the blood

infection of GB or bile ducts, injury to bile ducts

Which liver enzyme is found in the blood associated with extrahepatic biliary obstruction?

ALP

Which test evaluates GB function?

HIDA (nuclear medicine)

ERCP

endoscopic retrograde cholangiopancreatography

Which test involves the injection of contrast material into the bile ducts and pancreatic ducts?

ERCP