Biliary System Flashcards
At what point is the CBD formed?
when CHD & cystic duct anastomose, near hepatic artery
At what point is the CHD formed?
when R & L hepatic ducts anastomose, @ level of porta hepatis
normal diameter of CHD
4 mm
normal diameter of CBD
4 mm
structure that releases CCK
duodenum
hormone responsible for GB contraction
CCK
rule of thumb for CBD/CHD diameter
4 mm up to age 40, plus 1 mm for each decade afterward
relationship of CHD to right portal vein
anterior
relationship of CHD to right hepatic artery
anterolateral
relationship of CBD to main portal vein
anterior & right
connective tissue through which the CBD passes
through the hepatoduodenal ligament
normal CBD diameter, post-cholecystectomy
up to 10 mm
connective tissue through which the CHD passes
along free edge of lesser omentum
relationship of HA to MPV
anterior & left
relationship of CBD to HA
right
relationship of HA to CBD
left
relationship of MPV to HA
posterior & right
relationship of MPV to CBD
posterior & left
narrowest part of the extrahepatic biliary tract
intraduodenal/4th segment of CBD
intraduodenal CBD segment
4
infraduodenal CBD segment
3
retroduodenal CBD segment
2
supraduodenal CBD segment
1
CBD segment that enters 2nd part of duodenum
4
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