Biliary System - Part 1 Flashcards
Biloma
An extrahepatic collection of extravasated bile from
trauma, surgery, or gallbladder disease
Caroli disease
A segmental, saccular, or beaded appearance to the intrahepatic biliary ducts
Cholecystokinin
Hormone secreted in the small intestine that stimulates GB contraction and secretion of pancreatic enzymes
- stimulation occurs after food reaches the duodenum
Cholesterosis
Type of cholesterolosis associated with a strawberry appearance to the GB
Courvoisier sign
Painless jaundice associated with an enlarged GB caused by the obstruction of the distal common bile duct by an external mass
- typically adenocarcinoma of the pancreatic head
Emphysematous cholecystitis
Gas in the GB wall or lumen
Hartmann pouch
Small posterior pouch near the GB neck
Klatskin tumour
Carcinoma located at the junction of the right and left hepatic ducts
Mirizzi syndrome
Impacted stone in the cystic duct causing compression on the common hepatic duct resulting in jaundice
Porcelain GB
Calcification of the GB wall
What are the functions of the biliary system? (3)
- Transport bile to the GB through the bile ducts
- Store and concentrate bile in the GB
- Transport bile through the bile ducts to the duodenum
What does the extrahepatic ducts include? (2)
- Cystic duct
2. Common duct
When does bile flow?
When the intraductal pressure is lower than the hepatic secretory pressure
What does the cystic duct drain?
GB
What is the mean length of a cystic duct?
4cm
What does the cystic duct contain?
Spiral valves of Heister
Where does the cystic duct course?
Posteriorly and inferiorly merging with the CHD to form the CBD
Is the cystic duct routinely imaged on US?
No
What forms the CBD? (2)
- CHD
2. Cystic duct
Where does the CBD course?
Inferiorly
- joining the main pancreatic duct at the ampulla of Vater to enter the descending portion of the duodenum
Where does the CBD lie compared to the main portal vein and the proper hepatic artery?
- MPV = anterior
2. PHA = lateral
What is the average intraluminal diameter of the CBD?
4mm
- should not exceed 6mm in adults
At what age does the CBD begin to increase? And by how much per decade?
- Age 60
2. 1mm per decade
What happens to the CBD after a fatty meal?
It will either decrease in size or remain the same
What is the US appearance of intrahepatic bile ducts? (4)
- Anechoic non-vascular tubular structures coursing with in the hepatic parenchyma
- Smooth hyper echoic walls
- Normal intraluminal diameter of the CHD
- The right and left hepatic bile ducts generally lie anterior to the corresponding
portal vein
What is the US appearance of extrahepatic bile ducts? (3)
- Anechoic non-vascular tubular structure anterior to the main portal vein
- Smooth hyper echoic walls
- Normal intraluminal diameter of the CBD
What are the functions of the GB? (3)
- Concentrates bile through the GB epithelium
- Stores concentrated bile
- Contracts to release bile when the hormone cholecystokinin is released into the
bloodstream
What are the 3 parts that make up the GB?
- Fundus
- Body
- Neck
Fundus of the GB
Most inferior and anterior portion of the GB
- has a blind end
Body of the GB
Midportion between then neck and fundus
Neck of the GB
Narrow, tapering tubelike structure - most superior portion - smallest transverse diameter - fixed anatomic relationship to the main lobar fissure and right portal vein
What are the 4 layers of the GB wall?
- Outer serosal
- visceral - Subserous
- connective tissue - Muscular
- contracts - Inner epithelial
- mucosal
What is the location of the GB? (4)
- GB fossa on the posterior surface of the liver
- Lies lateral to the IVC and anterior and medial to the right kidney
- Lies posterior and inferior to the main lobar fissure
- GB neck lies most superior
