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DMST 254 ABD 1 > Biliary Tree > Flashcards

Biliary Tree Flashcards

1
Q

Biliary tree begins where?

A

Liver Lobules Bile Canaliculi

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2
Q

What is the biliary tree?

A

Intercommunicating network located between hepatocytes

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3
Q

The Rt and Lt Hepatic ducts are formed by the union of what?

A

Lobular ducts

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4
Q

Intrahepatic ducts should measure no longer than what? And exhibit what?

A

2mm in diameter and exhibit a branching pattern that parallels the portal veins

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5
Q

The sonographic appearance of dilated intrahepatic duct is often referred to as what?

A

Too many tubes

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6
Q

At the Porta hepatis the RT and LT duct join to form what?

A

Common hepatic duct

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7
Q

Where is the Common hepatic duct located anatomically in relation to the PV and the right hepatic artery?

A
  1. Anterior to PV
  2. Anterior and lateral to right hepatic artery
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8
Q

How is the common bile duct formed?

A

When the Common hepatic duct joins the cystic duct

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9
Q

CBD length is determined by what?

A

Insertion point

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10
Q

The CBD travels how in relation to the MPV?

A

Anterior and lateral

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11
Q

What is the normal diameter of the CBD?

A

4mm

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12
Q

What would change or vary the CBD diameter?

A
  1. Age
  2. Surgery
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13
Q

What would be the diameter of a post cholecystectomy patient?

A

Up to 10mm

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14
Q

What ligament does the CBD travel through?

A

Hepatoduodenal ligament

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15
Q

Where is the HA located in relation to the MPV?

A

Anterior and left micky mouse

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16
Q

How is the CBD located in relation to the MPV?

A

Anterior and right micky mouse

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17
Q

CBD is divided into how many parts?

A

4 parts relating to its position to the duodenum

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18
Q

Label the structures

A
  1. GB
  2. BD
  3. MPV
  4. IVC
    **the arrow points towards the HA
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19
Q

Label the structures

A
  1. GB
  2. BD
  3. HA
  4. MPV
  5. IVC
  6. AO
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20
Q

The 4th part of the CBD is called what?

A

Intraduodenal

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21
Q

The 4th part of the CBD enters what part of the Duodenum and inserts into what?

A

Enters the 2nd part and inserts into the ampulla of vater

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22
Q

The 4th part of the CBD has the sphincter of oddi, what does it do?

A

Regulates bile flow

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23
Q

What is the narrowest part of the extrahepatic biliary tract?

A

4th part of the CBD

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24
Q

What does the CHD join above the duodenum?

A

The cystic duct 1-2 cm above the duodenum

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25
Q

The cystic duct arises from what?

A

The superior aspect of the neck of the GB

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26
Q

What is the shape of the cystic duct?

A

S shaped

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27
Q

What is the dimensions of the cystic ducts?

A

3mm diameter/ 4 cm in length

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28
Q

What valves does the Cystic duct contain?

A

The valves of heister

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29
Q

What are the valves of heister?

A

Mucosal folds that prevents the duct from over distending or collapsing

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30
Q

Where is the gallbladder located?

A

Posterior inferior surface of right liver in the GB fossa

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31
Q

In relation to the MLF where is the GB located?

A

Posterior and caudal

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32
Q

The position of the GB body and fundus varies with what?

A

Patient position

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33
Q

Which cavity is the gallbladder located?

A

Intraperitoneal

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34
Q

What are some landmarks for the GB? 4

A
  1. MLF
  2. RPV
  3. Duodenum
  4. Rt kidney
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35
Q

What is the shape of the gallbladder?

A

Pear or tear drop shape

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36
Q

What is the dimensions of the gallbladder? (Length and Diameter)

A

Length: 8-9 cm
Diameter: 3-5 cm

37
Q

What is the gallbladder sections? 3

A
  1. Fundus
  2. Body
  3. Neck
38
Q

what is the widest part of the gallbladder?

39
Q

Which section of the GB is the most dependent and fixed?

40
Q

The GB wall should measure how much in a fasting state?

A

less than 3mm in a fasting state

41
Q

What are the 4 layers of the GB wall?

A
  1. Mucosal layer
  2. Muscular layer
  3. Subserous Layer
  4. Serosa
42
Q

What is the mucosal layer of the GB wall?

A

Inner epithelial Lining, concentrates bile

43
Q

What is the muscular layer of the GB wall?

44
Q

What is the Subserous layer?

A

Connective tissue

45
Q

What is the Serosa layer of the GB wall?

A

Outer layer in contact with the peritoneum

46
Q

What are the Rokitansky- Aschoff (RA) sinuses?

A

Multiple folds along the inner border of the GB

47
Q

Is the Rokitansky- Aschoff (RA) sinuses normally seen?

A

Not normally seen on U/S unless there is pathology

48
Q

What is the function of the Bile ducts?

A

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

49
Q

What does the GB do? 2

A
  1. Reservior for bile (where bile is stored until required for digestion
  2. Concentrates bile by secreting mucous and absorbing water
50
Q

How much bile does the GB hold?

A

~ 40-70 ml

51
Q

Bile secretion is controlled by what?

52
Q

When would the duodenum release Cholecystokinin (CCK)?

A

With the ingestion of fats and amino acids

53
Q

Cholecystokinin (CCK) stimulates the GB and the sphincter of Oddi to do what?

A

The GB to contract and the sphincter of Oddi to relax

54
Q

GB contraction occurs when?

A

Within 30 minutes following a meal

55
Q

What happens when the GB has been removed? 3

A
  1. Initially the sphincter of Oddi loses its tone
  2. Bile flows in the duodenum during fasting and non fasting states
  3. Some bile also remains in the ducts
56
Q

After ~ 6 months after the GB has been removed, what happens to the sphincter?

A

It regains tone

57
Q

After the GB has been removed the CBD may appear how?

A

Dilated (up to 10mm)

58
Q

What is the bile?

A

Yellow- green liquid produced by hepatocytes

59
Q

What does bile do?

A

Emulsifies fats and helps absorb fatty acids

60
Q

How much bile salts are produced by the liver in a day?

A

1 gram/day

61
Q

What is a precursor of bile salts?

A

Cholesterol

62
Q

How do we get cholesterol in the body? 2

A
  1. Supplied by diet
  2. Synthesized by the liver
63
Q

What is bilirubin?

A

Bile pigment which is the end product of hemoglobin decomposition

64
Q

Where is bilirubin conjugated?

65
Q

What is jaundice?

A

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

66
Q

What is the arterial supply to the GB?

A

Cystic artery

67
Q

What is the venous drainage of the GB?

A

Cystic vein (which drains into the portal venous system)

68
Q

What are some variants of GB? 4

A
  1. Junctional fold
  2. Hartman’s pouch
  3. Phrygian pouch
  4. Septations
69
Q

What is this variant of the GB?

A

Junctional Fold

70
Q

What is this variant of the GB?

A

Hartman’s Pouch

71
Q

What is this GB variant?

A

Phrygian cap

72
Q

What is this GB variation?

73
Q

What is this GB variation?

74
Q

Label the structures

A
  1. RPV
  2. MLF
  3. GB
75
Q

What is the sonographic appearance of the GB?

A
  1. Anechoic/ nearly anechoic structure
  2. Well defined, thin, echogenic walls
76
Q

What is the sagittal shape of the GB?

A

Pear Shaped

77
Q

What is the Transverse appearance of the GB?

A

Anechoic circle

78
Q

What is the Patient prep for GB exams?

A

NPO for 6-8 hours

79
Q

What probe do we use for GB exams?

A

2-6 MHz probe

80
Q

What positions should the patient be in for GB exams?

A
  1. Supine
  2. LLD
81
Q

Erect and prone positions can be used to rule out what?

A

Stones lodge in the neck and cystic duct

82
Q

What do we Look for in GB exams? 5

A
  1. Size
  2. Shape
  3. Content
  4. Wall thickness
  5. Area surrounding GB
83
Q

What are some techniques used to scan GB?

A
  1. Use harmonics to optimize
  2. Windows are important to minimize reverberation artifacts
84
Q

How should we position Patients for Bile ducts?

A

LPO or decubitus

85
Q

What do we measure in bile ducts?

A
  1. Porta hepatis area
  2. The duct inner wall to inner wall
    ** do not measure at the point where the duct crosses the HA**
86
Q

Label the structure

87
Q

Label the structures

A
  1. CBD
  2. CHD
  3. HA
  4. PV
88
Q

What are some lab test/ Other imaging we use for GB?

A
  1. Bilirubin (indirect/ direct)
  2. ALP
  3. Leukocytes (WBC) infection
  4. HIDA - Nuclear medicine
  5. ERCP - Fluoroscopy

DMST 254 ABD 1 (26 decks)

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