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Abd & Superficial Structures 1 > Biliary System > Flashcards

Biliary System Flashcards

1
Q

Biliary tree begins at the level of

A

The bile canaliculi

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2
Q

Intercommunicating network

A

Hepatocytes, where bile canaliculi are located between

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3
Q

Microscopic canaliculi anastomose to form

A

Lobular bile ducts

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4
Q

Travel with a

A

Hepatic artery and portal vein

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5
Q

What’s formed by the union of multiple lobular bile ducts

A

Right and left hepatic ducts

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6
Q

What forms the common hepatic duct

A

Right and left hepatic ducts

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7
Q

What is the level that the common hepatic duct is formed

A

Portal hepatis

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8
Q

Common hepatic duct

A 
CHD
Anterior to portal vein 
Antrolateral to right hepatic artery
Travels in free edge of lesser omentum
~4mm in diameter
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9
Q

What forms the common bile duct

A

CHD and the cystic duct

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10
Q

How is the length of the CBD determined

A

By the insertion point

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11
Q

Where is the cystic ducts from

A

The gullbladder

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12
Q

CBD

A

Antrolateral to MPV
Diameter ranges up to 4mm
Travel through heaptoduodenal ligament

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13
Q

Hepatoduodenal ligament is part of what

A

Lesser omentum

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14
Q

What is referred to as the Mickey Mouse appearance at the porta hepatis

A

A cross section of the CBD, HA and MPV

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15
Q

HA lies what to the PV

A

Anterior and to the left

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16
Q

CBD lies what to the PV

A

Anterior and to the right

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17
Q

What are the 4 segments of the CBD

A

Supraduodenal
Retroduodenal
Infraduodenal
Intraduodenal

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18
Q

Segments of the CBD are named in relation to its position compared to what organ

A

Duodenum

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19
Q

What CBD segment enters the 2nd part of the duodenum and where does it insert

A

Intraduodenal and it inserts into ampulla of Vater

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20
Q

What does the splinter of Oddi do

A

Regulates bile flow

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21
Q

What is the narrowest part of the extrahepatic biliary tract

A

Intraduodenal segment

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22
Q

What joins the CHD about 1-2 cm above the duodenum to form CBD

A

Cystic duct

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23
Q

Aries from superior aspect of the neck of the gullbladder

A

Cystic duct

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24
Q

Cystic duct

A

S-shaped
~3mm in diameter and 4cm in length
Contains the spiral valves of heister

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25
Q

Spiral valves of heister

A

Tortuous area of the cystic duct
Not true valves
Prevents duct from over extending or collapsing
Does not control bile flow

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26
Q

If the spiral valves of heister are not true valves what are they

A

Mucosal folds

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27
Q

Landmarks for identifying the gullbladder

A

Main lobar fissure
RPV
duodenum
Right kidney

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28
Q

Size and shape of gullbladder

A

Varies widely from patient to patient
Usually pear or teardrop shaped
Generally 8-9cm in length and 3-5 cm in diameter

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29
Q

What are the three parts of the gullbladder

A

Fundus
Body
neck

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30
Q

What is the most dependent portion of the gullbladder and in what body position

A

Fundus in LLD

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31
Q

Widest portion of gullbladder

A

Fundus

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32
Q

What part of the gullbladder projects below inferior liver margin

A

Fundus

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33
Q

What is another name for gullbladder body

A

Corpus

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34
Q

What is portion of the gullbladder is the body

A

Middle

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35
Q

What surface of the liver is the body of the gullbladder in contact with

A

Visceral

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36
Q

Tapered portion of the gullbladder with spiral folds is the

A

Neck

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37
Q

Most dependant portion of the gullbladder in supine

A

Neck

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38
Q

Where is the neck of the gullbladder in a fixed portion

A

Main lobar fissure

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39
Q

The gullbladder should measure what in a fasting state

A

Less than 3mm

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40
Q

How many layers does the gullbladder wall have and what are the names

A 
4 layers:
Mucosa 
Muscular layer
Subserous layer
Serous
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41
Q

What is the mucosa layer of the gullbladder wall

A

Inner epithelial lining

Concentrates bile

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42
Q

What is the muscular layer of the gullbladder wall

A

Muscle

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43
Q

What is the subserous layer of the gullbladder wall

A

Connective tissue

44
Q

What is the serous layer of the gullbladder wall

A

Outer layer

45
Q

What is the serous layer of the gullbladder wall in contact with

A

Peritoneum

46
Q

What is the Rokitansky-Aschoff sinuses

A

Abbreviated to RA sinuses

Multiple folds along the inner boarder of the gullbladder, coated with epithelial cells

47
Q

Are the RA sinuses normally visualized on ultrasound

A

No, unless there is pathology

48
Q

What is bile

A

Yellowish green liquid produced and secreted by hepatocytes

49
Q

What does bile consist of

A 
Water 
Cholesterol
Pigments 
Inorganic salts 
Salts of bile acids
50
Q

What does bile do

A

Breaks down fat

Helps absorb fatty acid, cholesterol and other lipids from the intestinal tract

51
Q

How much bile salt is formed by the liver each day

A

1 gram

52
Q

What is a precursor for bile salt

A

Cholesterol

53
Q

What is the end product of hemoglobin decomposition

A

Bilirubin

54
Q

What is bilirubin

A

Bile pigment

55
Q

Where does bilirubin conjugate

A

In the liver

56
Q

Another term for jaundice is

A

Icterus

57
Q

What is jaundice

A

Yellowish tint in the body tissue due to large quantities of bilirubin

58
Q

What causes jaundice

A

Hemolytic anemia
Acute and chronic hepatic disease
Obstructive jaundice
Inability of bilirubin to conjugate

59
Q

What is the arterial blood supply for the gullbladder

A

Cystic artery

60
Q

Venous drainage occurs via what in the gallbladder

A

Cystic vein

61
Q

Where does the cystic vein drain directly into

A

Portal vein

62
Q

What is the function of the biliary ducts

A

Drain the liver of bile and carry it to the GI system

63
Q

The function of the gallbladder

A

A reservoir for bile

64
Q

When is bile stored till

A

Until it’s required to aid in digestion

65
Q

How much bile does the GB hold

A

40-70ml

66
Q

What does the full bladder do to bile and how does it do it

A

Concentrates bile by decreasing mucus and absorbing water

67
Q

How is bile secretion controlled

A

By hormones

68
Q

with the ingestion of fats and amino acids what does the duodenum release via the bloodstream

A

cholecystokinin (CCK)

69
Q

what does CCK stimulate

A

the gallbladder to contract

the sphincter of Oddi to relax

70
Q

what does the sphincter of Oddi do

A

regulates the passage of bile into the duodenum and prevents the reflux f GI fluids into the biliary system

71
Q

where is the sphincter of Oddi located

A

duodenum

72
Q

how long does it take the gallbladder to contract after a meal

A

30 mins

73
Q

what happens when the small intestine is empty

A

sphincter closes and bile does back into the gallbladder

74
Q

what happens to the sphincter of Oddi when the GB is removed

A

loses its tone

75
Q

does the pressure in the CBD raise or lower when the GB is removed

A

lowers

76
Q

why does the pressure change in the CBD when the gullbladder is removed

A

it changes to lower the intra-abdominal pressure

77
Q

where does bile flow when there is no GB

A

into the duodenum

78
Q

when does the flowing of bile occur in the duodenum when there is no GB

A

in fasting and non-fasting states

79
Q

does some bile also remain in the ducts when there is no GB

A

yes

80
Q

after what time period will the sphincter regain its tone

A

~6months

81
Q

what will also appear diated on patients when the GB is removed

A

CBD

82
Q

how dilated can the CBD get when there is no GB prestnt

A

up to 10mm

83
Q

what is a junctional fold

A

a fold that occurs at the juntion of the body and neck of the GB

84
Q

what does a juntional fold look similar too

A

a septation

85
Q

what is another name for the GB neck

A

infundibulum

86
Q

what is Hartman’s pouch

A

an outpouching in the area of the GB neck

87
Q

what is a Pharygian cap

A

when the GB is partically folded onto itself in the region of the fundus

88
Q

what are GB septation varients

A

thin walls

partical or complete dividing of the GB lumen

89
Q

are GB septations common or rare

A

rare

90
Q

other GB varients are

A

excessively mobile
ectopic
low lying in RLQ
totally or partically embedded in liver

91
Q

sonographic apperance of the GB

A

anechoic or nearly anechoic structure
well defined, thin, echogenic walls
saggital: pear shaped
transverse: anechoic circle

92
Q

why does a patient have to be NPO for at least 6-8 hours before an exam

A

because the GB contacts

93
Q

what postions may be used to rule out stones lodged in the neck and cystic duct

A

supine
decubitus
erect
prone

94
Q

to examine for fluid in and the GB what do you look at

A 
size
shape
content
wall thickness 
area around GB
95
Q

how do you optimize the GB image

A

harmonics

96
Q

what is important to minimize reverberation artifact

A

windows

97
Q

what structure measurements usually involve placing the patient in an LPO or decubitus postion

A

CHD

CBD

98
Q

how do you meausre the cystic duct

A

region of the porta hepatis

inner wall to inner wall

99
Q

where do you not measure the cystic duct

A

at the point where it crosses the hepatic artery

100
Q

indirect increased bilirubin values indicated what

A

hemolysis
RBC degradation
abnormal hepatocellular uptake

101
Q

direct increased bilirubin values indicated what

A

extrahepatic obstruction
bile duct disease
intrahepatic disruption

102
Q

alkaline phosphatase lab test are ordered to asses if there is an increase in what values

A

extrahepatic biliary obstruction

103
Q

Leukocyte lab test asses and indicate what

A

assesses reaction of the body to infection

indicates increased values in acute and chroinic cholecystitis , which can indicate an injury ti bile ducts

104
Q

HIDA scan

A

nuclear medicine test
evaluates function of GB
radio pharmaceutical is injected into patient which then passes through the bloof to the liver and then to the biliary system

105
Q

ERCP

A

endoscopic retrograde cholangiopancreatography
ampulla of vater is cannulized through a tube inserted into the patient’s upper GI tract
contrast material is injected and the bile and pancreatic ducts are delineated

Abd & Superficial Structures 1 (10 decks)

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