Biliary tree Flashcards
Shape and size of the gall bladder
7-10cm long
Pear shaped
Can hold 30-50ml bile
Which abdominal region does the gall bladder lie in
Right hypochondrium
Where does the gall bladder lie
In a fossa between the right and quadrate lobes (visceral surface) on the inferior aspect of the liver
Peritoneal covering of the gall bladder
Peritoneum completely surrounds the fundus and also binds the body and neck to the liver
3 parts of the gall bladder
Fundus
Body
Neck
What is the gall bladder fundus
Rounded end portion that projects into the inferior surface of the liver
What’s the largest part of the gall bladder
Body
What might the gall bladder’s body be in contact with
Transverse colon
Proximal duodenum
What is the mucosal fold in the gall bladder neck
Hartmann’s pouch
What’s the most common site for gallstones to become lodged
Hartmanns pouch
How is the gall bladder attached to the liver
CT of the livers fibrous capsule
What does the neck of the gall bladder join to
Cystic duct
Where do the biliary ducts conduct bile from and to
From the liver to the duodenum
What do hepatocytes secrete bile into
Canaliculi
What do the canaliculi drain into
Interlobular biliary ducts -> collecting bile ducts -> right and left hepatic ducts
What do the left and right hepatic ducts merge to form
The common hepatic duct
What does the common hepatic duct join with and what does this form
Joins with the cystic duct to form the common bile duct
Where does the common bile duct pass relative to the duodenum
Posterior to the proximal duodenum
What does the common bile duct join with before it empties into the duodenum
What does this for
Joins with the pancreatic duct, forming the hepatopancreatic ampulla of Vater
What is the opening for bile into the duodenum called
How is it regulated
Major duodenal papilla
Regulated by a muscular valve called the sphincter of Oddi
Where do gall stones form and what’s the consequence at each location
Gall bladder - asymptomatic
Cystic duct - acute cholecystitis
Common bile duct - biliary obstruction
Terminal duct - pancreatitis
What is anterior and superior to the gall bladder
Inferior border of the liver
Anterior abdominal wall
What is posterior to the gall bladder
Transverse colon
Proximal duodenum
What is inferior to the gall bladder
Biliary tree
Duodenum
What are some types of gall stones
Cholesterol (more common)
Pigment
What increases the risk of gallstones
Increasing age
Pregnancy
Obesity
Female gender
How is a cholecystectomy performed
Key hole surgery
Treatment for gallstones (if symptomatic)
Cholecystectomy
Painkillers and antibiotics given before surgery to reduce pain and limit infection
Arterial supply of the gall bladder and cystic duct
Coeliac trunk -> common hepatic artery -> right hepatic artery -> cystic artery
Where does the cystic artery arise
In the cystohepatic triangle of Calot (between the common hepatic duct, cystic duct and visceral surface of the liver)
Venous drainage of the neck of gall bladder and cystic duct
Cystic veins
What do cystic veins drain into
Enter the over directly or drain through the hepatic portal vein
Venous drainage of the fundus and body of gall bladder
Pass into visceral surface of the liver and drain into the hepatic sinusoids
Sympathetic and sensory Innervation of the gall bladder
Coeliac plexus
Parasympathetic Innervation of the gall bladder
Vagus nerve
Result of parasympathetic stimulation of the gall bladder
Contraction of gall bladder and secretion of bile into the cystic duct
What is the main stimulator of bile secretion
Where is it secreted from
Cholecystokinin
Secreted from the duodenum and travels in the bloodstream
What does lymph from the gall bladder drain into
Cystic node
Where is the cystic node
Gall bladder neck
What does the cystic node drain into
Hepatic lymph node -> coeliac node
