Biliary Tract and Upper GI Flashcards
Radiographic examination of the biliary system involves studying the
manufacture, transport, and storage of bile.
Liver:
Large wedge-shaped organ Located inferior to the diaphragm. Largest solid organ 3-4 lbs Occupies most of RUQ and extends to LUQ Well protected by rib cage.
Describe the upper border of the liver:
Widest part 8 to 9”
Convex to conform to diaphragm
Describe the right border of the liver:
Largest vertical dimension 6-7”
10th rib to just above R. Kidney
Distal end of gall bladder extends:
below anterior, inferior margin of liver
Remainder of GB (when discussing the distal end) lies
inferior and posterior surface of liver
The right lobe and left lobe of the liver are divided by:
the falciform ligament.
The quadrate lobe and caudate lobe are located:
on medial aspect of R. Lobe of the liver.
The quadrate lobe is located:
Between GB and falciform ligament
The caudate lobe is located:
Posterior to quadrate lobe
Hilum of liver (porta hepatitis) is located:
between the 2 minor lobes
The function of the liver that is most applicable to radiographic study is:
the production of bile
The liver secretes _________of bile per day
800 to 1000 ml (≈ 1 quart)
The major function of bile is:
to aid in the digestion of fats by emulsifying fat globules and the absorption of fat following its digestion.
Bile is a liquid substance composed mainly of
bile salts, bile pigments, cholesterol and water.
Bile pigments are responsible for
the yellow color of bile.
Bile salts facilitate
the absorption of fats.
If bile contains either insufficient bile salts or excessive cholesterol,
the cholesterol may crystallize to form gallstones.
As gallstones grow in size and number, may cause
minimal, intermittent, or complete obstruction of the flow of bile from the gallbladder into the duodenum.
Bile formed in liver and travels to
R&L hepatic ducts
Hepatic ducts join to form
common hepatic duct
Bile is carried to gallbladder by _____ for temporary storage in gallbladder or may be secreted directly into duodenum by way of ______ which is joined by _________.
cystic duct, common bile duct, pancreatic duct
How big is the gall bladder and how much does it hold?
7 to 10 cm (3-4”) long
Holds about 30 to 40 mL bile
What are the three parts of the gall bladder?
Fundus: Broad distal end Body: Main section Neck: Narrow proximal end Continues as cystic duct
How long is the cystic duct?
3 to 4 cm long
What is the function of the spiral valve?
to prevent distention or collapse of cystic duct.
What and where is the spiral valve?
The spiral valve is folds within the cystic duct.
The three primary functions of the gallbladder are
(1)store and (2)concentrate bile, and to (3)contract when stimulated.
If bile is not needed for digestive purposes, it is:
stored for future use in the gallbladder.
Bile is concentrated within the gallbladder as a result of a process called
hydrolysis (removal of water).
If too much water is absorbed during hydrolysis or if the cholesterol becomes too concentrated _________ may form in the gallbladder.
gallstones (choleliths)
How are the most common type of gallstones formed?
Cholesterol coming out of solution
The gallbladder normally contracts when
foods such as fats or fatty acids are in the duodenum. These foods stimulate the mucosa of the duodenum to secrete a hormone called cholecystokinin (CCK)
Increased levels of CCK in the blood cause the GB to _______ and terminal opening of the CBD to ______.
Contract, relax
CCK also causes
increased exocrine activity by the pancreas
When the gall bladder stimulates the pancreas, what happens?
It causes the hepatopancreatic spincter to relax, permitting the flow of both bile and pancreatic juice into the duodenum.
The bile and pancreatic juice mix with
food substances.
What is the length of the common bile duct?
About 7.5 cm long
Internal diameter about the size of drinking straw
What is the location of the common bile duct?
Descends behind superior portion of duodenum and head of pancreas to enter descending portion of duodenum
The common bile duct joins the ________ and they enter together or side by side into an enlarged chamber known as the ____________.
pancreatic duct (duct of Wirsung), hepatopancreatic ampulla (ampulla of Vater)
Pancreatic duct and CBD remain separated in about __% of people
40
Hepatopancreatic ampulla is controlled by circular muscle called
hepatopancreatic sphincter (sphincter of Oddi)
Hepatopancreatic ampulla is a common site for
gallstones.
The presence of the hepatopancreatic sphincter causes a protrusion into the lumen of the duodenum known as the
duodenal papilla (papilla of Vater)
Lateral View demonstrates gallbladder anterior to the ____.
Ductal system is located about ____________________.
MCP, midway between the front and back
Prone position:
Places gallbladder:
closer to the IR.
Supine position for gall bladder is used if primary purpose is to:
drain the gallbladder into the duct system
Contrast medium was ingested orally for a cholecystogram and was called
an oral cholecystogram (OCG). These have been replaced by sonography.
Production of contrast media for OCG has been discontinued, however, imaging of biliary system is still performed:
during and after gallbladder surgery and by direct injection procedures.
4 advantages of ultrasound of the GB over OCG:
No ionizing radiation
Able to detect small calculi
No contrast medium
Less patient preparation
choledocho-
common bile duct
choleangio-
bile ducts
Choledocholithiasis
is the presence of stones in the biliary ducts.
Symptoms of Choledocholithiasis include:
pain
tenderness in the RUQ, jaundice
sometimes pancreatitis
Who are at high risk of developing gallstones?
Females and obese patients are at a high risk of developing gallstones
Four F’s (Fat, Female, near Forty and Fertile)
Increased levels of _______ ,_______, or _______ may lead to formation of gallstones
bilirubin, calcium or cholesterol
About ______% of gallstones are radiolucent
85% to 90
radiolucent gallstones are made up of:
cholesterol and or crystalline salts
About ____% to ___% gallstones are radiopaque
10 - 15
Radiopaque gallstones are made up of:
crystalline calcium salts
Milk calcium bile
Emulsion of biliary stones in gallbladder. Demonstrates as diffuse collection of sand-like calcifications
With sonography, stones within gallbladder produce :
“shadowing” effect
Created by partial blockage of sound wave as it passes by
Cholecystitis
Inflammation of the gallbladder
Acute or chronic
The length of the GI tract from the esophagus to end of large intestine is about
30 feet long.
The small intestine averages ___ ft in length.
23
Tremendous individual variation of the small intestine exists. In one series of 100 autopies, the small bowel varied in length from
15 to 31 feet
Three primary functions of the digestive system:
Intake and digestion, absorption, elimination.
Two common radiographic procedures involving the digestive system:
- Esophagram
(or barium swallow) - Upper GI series (UGI)
Purpose of Esophagram:
Study the form and function of the pharynx and the esophagus
Acute Cholecystitis
Blockage of cystic duct frequently due to stone in neck of GB. Bile irritates lining of GB
Can also be caused by bacterial infection and ischemia
Chronic Cholecystitis
Due to gallstones, pancreatitis or cancer of GB, thickening or calcification of wall of GB
May produce repetitive attacks following meals and typically subsides in 1-4 hrs.
Neoplasms of the gall bladder or biliary ducts:
Growths that can be benign or malignant
Biliary Stenosis
Narrowing of one of biliary ducts
May restrict flow of bile leading to obstruction
Cholecystitis and jaundice may result
Purpose of Upper GI:
Study the form and function of the distal esophagus, stomach, and duodenum
Also called UGI, upper, GI or upper GI
Mouth (oral cavity)(buccal cavity):
Beginning of GI tract where mastication of food occurs
The roof of the oral cavity is formed by the
hard and soft palates
Uvula hangs from mid posterior soft palate. What does it do?
Helps to prevent food from entering the pharynx prematurely.
Soft palate begins at the
last molar and is suspended from the posterior border of the hard palate
Hard palate:
formed by the palatine process of the maxillary bone and the 2 (horizontal portions of) palatine bones
Oral cavity connects posteriorly with
the pharynx
Three pairs of salivary glands secrete into the oral cavity:
They are called:
Parotid salivary glands, Submandibular (submaxillary) salivary glands, and Sublingual salivary glands.
Saliva is composed of:
99.5% water and 0.5% salts and certain digestive enzymes.
Between _______________ ml of saliva are excreted daily.
1000 - 1500 ml
Mumps:
Inflammation and enlargement of the parotid glands
Caused by mumps virus
Pharynx
Part of the alimentary canal that is posterior to nasal cavity, mouth and larynx
The pharynx is about ___ inches long:
5
The pharynx Serves as a common passageway for
foods, liquids, and air.
They pharynx Divided into three parts:
nasopharynx
oropharynx
laryngopharynx
Nasopharynx:
Posterior to bony nasal septum, nasal septum and soft palate
Not part of digestive system
Oropharynx:
Posterior to oral cavity
Extends from soft palate to epiglottis
Epiglottis:
Cartilage that covers opening of larynx during swallowing
Laryngopharynx
Extends from level of epiglottis to level of lower border of larynx
Then continues as esophagus
______ is located anterior to esophagus
The trachea
7 cavities communicate with the three portions of pharynx are:
2 Tympanic cavities, 2 Nasal cavities, 1 Oral cavity (mouth), 1 Larynx, & 1 Esophagus.
During swallowing (or Deglutition):
Soft palate closes off nasopharynx
Tongue prevents material from reentering mouth
Epiglottis is depressed to cover laryngeal opening
vocal cords come together to close of epiglottis
Respiration is inhibited
Function of the esophagus:
transport food and fluids from pharynx to stomach
Dimensions of the esophagus:
About 10” (25 cm) long and ¾ in (2 cm) in diameter
The esophagus Extends from _________ to ___________.
lower border of cricoid cartilage (C5,C6), to stomach (T11)
Wall of esophagus is composed of 4 layers:
Fibrous
Muscular
Submucosal
Mucosal
______ Is the narrowest part of the alimentary canal
Esophagus
There are TWO INDENTATIONS present in the esophagus:
aortic arch
left primary bronchus
Distal esophagus passes through an opening in diaphragm called the __________ at the level of ____.
esophageal hiatus, T-10
The junction of the stomach and the esophagus is attached to the diaphragm, so upper stomach tends to follow
respiratory movement of diaphragm
A condition where the upper portion of the stomach protrudes through the esophageal hiatus is called a
hiatal hernia
Cardiac Antrum:
Abdominal segment of the esophagus
Very short area of esophagus just below diaphragm
Less than 1” in length
Esophagogastric junction (cardiac orifice)
Opening between esophagus and stomach
The esophagus is a collapsible tube that only opens when
swallowing occurs
Deglutition originates in _____ and continues in _____
Mouth & pharynx, the esophagus.
Fluids tend to pass from the mouth and pharynx to the stomach primarily by
gravity
A bolus of solid food tends to pass both by
gravity and peristalsis
Peristalsis –
wavelike series of involuntary muscular contractions that propels solid and semisolid materials through the entire alimentary canal.
