Biliary Tree Flashcards by Kate Grimeau

biliary tree begins at the liver _____

lobules

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intercommunicating network located between hepatocytes called _____. Anastomose to form _____

bile canaliculi
lobular bile ducts

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RT and LT hepatic ducts formed by the union of _____ ducts

lobular

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intrahepatic ducts should measure no more than ____ in diameter

2mm

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at the porta hepatis the right and left duct join to form the ___

CHD

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CHD is ____ to PV and ______ to rt hepatic artery

anterior
anterior and lateral

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CHD joins the cystic duct and forms the ____

CBD

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CBD length is determined by

insertion point

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CBD travels ______ to MPV

anterior and lateral

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normal diameter if CBD

up to 4mm up to 40 and then add 1mm for every decade of life (ex. 50=5mm)

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CBD diameter in a post-cholecystectomy patient

up to 10mm

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CBD travels through _________ ligament

hepatoduodenal

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the hepatoduodenal and hepatogastric ligament make up the

lesser omentum

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mickey mouse made of

HA MPV and CBD

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the HA is anterior and ___ of the PV and the CBD is anterior and ____ of thr PV

left
right

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CBD is divided into ___ parts relating to its position to the ____

4
duodenum

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what is the 4th part of the CBD called

intraduodenal

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4th part of the CBD enters the ____, inserts into the _____. The _____ regulates bile flow.

2nd part duodenum
ampulla of Vater
Sphincter od Oddi

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whats the narrowest part of the extrahepatic biliary tract

4th part CBD (double-check notes)

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if you see the cystic duct on US it means it is

dilated

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cystic duct joins the CHD ____ above the duodenum

1-2cm

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cystic duct arises from the _____ aspect of the ___of the gallbladder

superior
neck

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cystic duct is ____ shaped, ____ diameter, ___ in length

s
3mm
4cm

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cystic ducts contains and function

valves of Heister
mucosal folds that prevent the duct from over-distending or collapsing

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GB is on the _____ _____ surface of the right liver

posterior inferior

GB is located in the GB _____

fossa

GB is _____ and ____ to MLF

posterior caudal

GB is intra/retroperitoneal

intra

what portion of GB varies with patient position

body fundus

4 landmarks for identifying the GB

MLF (most reliable) RPV duodenum Rt kidney (only in trans)

GB shape

pear or teardrop

GB length and diameter

8-9cm 3-5cm

divisions of GB

fundus body (corpus) neck (fixed)

what is the most dependent portion of the GB in LLD

fundus

what is the most dependent portion of the GB in supine

neck

GB wall should measure less than____ in a fasting state

3mm

4 layers of GB

mucosal: inner/concentrates bile muscular subserous: CT serosa: outer layer

Rokitansky-Aschoff (RA) sinuses

multiple folds along the inner border of the GB not seen on US unless pathology

how much bile does the GB store

40-70ml

what does the GB do to bile

concentrates bile by secreting mucous and absorbing water

bile secretion is controlled by _____

hormones

with ingestion of fats and amino acids, the duodenum releases _____ which stimulates the GB to ____ and the sphincter of Oddi to _______

cholecystokinin (CK) contract relax

GB contraction occurs within _____ following a meal

30 minutes

what happens when GB removed

initially sphincter of oddi loses tone=bile flows into duodenum during fasting and non fasting states after about 6m, sphincter regains tone CBD may be dilated up to 10mm

what colour is bile

yellow-green

what is bile produced by

hepatocytes

what is bile composed of (5)

water cholesterol bilirubin inorganic and bile salts

bile ____ fats and helps absorb _______

emulsifies fatty acids

how much bile salts are formed a day by the liver

1 gram/day

______ is a precursor of bile salts - supplied by diet or synthesized by the _____

cholesterol liver

bilirubin is an end product of _______ decomposition

hemoglobin

bilirubin is a bile ____ conjugated by the _____

pigment liver

jaundice AKA

icterus

what is jaundice

yellowish tint seen in body tissue due to large quantities of bilrubin

blood supply to GB (arterial supply/venous drainage)

A: cystic artey V: cystic vein (drains to portal venous system)

junctional fold

fold between GB neck/body

hartman's pouch

Outpouching in GB neck

Phrygian cap

when GB partially folded onto itself in the region of the fundus

can septations occur in GB

yes

sagittal shape of GB vs transverse

pear vs circle

GB study patient prep

NPO at least 6-8 hours

scan GB with what probe

2-6 MHz probe

asses GB in what positions

supine and LLD erect and prone can be used also torule out stoned in neck/cystic duct

to measure bile ducts patients is in what postion

LPO or LLD

measure bile duct at _____ area and measure from ____ wall to ____ wall. Do not measure at point where bile duct crosses the ___

porta hepatis inner inner HA