Biliary tree

Question 1

Shape and size of the gall bladder

Answer 1

7-10cm long
Pear shaped
Can hold 30-50ml bile

Question 2

Which abdominal region does the gall bladder lie in

Answer 2

Right hypochondrium

Question 3

Where does the gall bladder lie

Answer 3

In a fossa between the right and quadrate lobes (visceral surface) on the inferior aspect of the liver

Question 4

Peritoneal covering of the gall bladder

Answer 4

Peritoneum completely surrounds the fundus and also binds the body and neck to the liver

Question 5

3 parts of the gall bladder

Answer 5

Fundus
Body
Neck

Question 6

What is the gall bladder fundus

Answer 6

Rounded end portion that projects into the inferior surface of the liver

Question 7

What’s the largest part of the gall bladder

Answer 7

Body

Question 8

What might the gall bladder’s body be in contact with

Answer 8

Transverse colon

Proximal duodenum

Question 9

What is the mucosal fold in the gall bladder neck

Answer 9

Hartmann’s pouch

Question 10

What’s the most common site for gallstones to become lodged

Answer 10

Hartmanns pouch

Question 11

How is the gall bladder attached to the liver

Answer 11

CT of the livers fibrous capsule

Question 12

What does the neck of the gall bladder join to

Answer 12

Cystic duct

Question 13

Where do the biliary ducts conduct bile from and to

Answer 13

From the liver to the duodenum

Question 14

What do hepatocytes secrete bile into

Answer 14

Canaliculi

Question 15

What do the canaliculi drain into

Answer 15

Interlobular biliary ducts -> collecting bile ducts -> right and left hepatic ducts

Question 16

What do the left and right hepatic ducts merge to form

Answer 16

The common hepatic duct

Question 17

What does the common hepatic duct join with and what does this form

Answer 17

Joins with the cystic duct to form the common bile duct

Question 18

Where does the common bile duct pass relative to the duodenum

Answer 18

Posterior to the proximal duodenum

Question 19

What does the common bile duct join with before it empties into the duodenum
What does this for

Answer 19

Joins with the pancreatic duct, forming the hepatopancreatic ampulla of Vater

Question 20

What is the opening for bile into the duodenum called

How is it regulated

Answer 20

Major duodenal papilla

Regulated by a muscular valve called the sphincter of Oddi

Question 21

Where do gall stones form and what’s the consequence at each location

Answer 21

Gall bladder - asymptomatic
Cystic duct - acute cholecystitis
Common bile duct - biliary obstruction
Terminal duct - pancreatitis

Question 22

What is anterior and superior to the gall bladder

Answer 22

Inferior border of the liver

Anterior abdominal wall

Question 23

What is posterior to the gall bladder

Answer 23

Transverse colon

Proximal duodenum

Question 24

What is inferior to the gall bladder

Answer 24

Biliary tree

Duodenum

Question 25

What are some types of gall stones

Answer 25

Cholesterol (more common)

Pigment

Question 26

What increases the risk of gallstones

Answer 26

Increasing age
Pregnancy
Obesity
Female gender

Question 27

How is a cholecystectomy performed

Answer 27

Key hole surgery

Question 28

Treatment for gallstones (if symptomatic)

Answer 28

Cholecystectomy

Painkillers and antibiotics given before surgery to reduce pain and limit infection

Question 29

Arterial supply of the gall bladder and cystic duct

Answer 29

Coeliac trunk -> common hepatic artery -> right hepatic artery -> cystic artery

Question 30

Where does the cystic artery arise

Answer 30

In the cystohepatic triangle of Calot (between the common hepatic duct, cystic duct and visceral surface of the liver)

Question 31

Venous drainage of the neck of gall bladder and cystic duct

Answer 31

Cystic veins

Question 32

What do cystic veins drain into

Answer 32

Enter the over directly or drain through the hepatic portal vein

Question 33

Venous drainage of the fundus and body of gall bladder

Answer 33

Pass into visceral surface of the liver and drain into the hepatic sinusoids

Question 34

Sympathetic and sensory Innervation of the gall bladder

Answer 34

Coeliac plexus

Question 35

Parasympathetic Innervation of the gall bladder

Answer 35

Vagus nerve

Question 36

Result of parasympathetic stimulation of the gall bladder

Answer 36

Contraction of gall bladder and secretion of bile into the cystic duct

Question 37

What is the main stimulator of bile secretion

Where is it secreted from

Answer 37

Cholecystokinin

Secreted from the duodenum and travels in the bloodstream

Question 38

What does lymph from the gall bladder drain into

Answer 38

Cystic node

Question 39

Where is the cystic node

Answer 39

Gall bladder neck

Question 40

What does the cystic node drain into

Answer 40

Hepatic lymph node -> coeliac node