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AB&SS 1 > C4: Biliary System > Flashcards

C4: Biliary System Flashcards

1
Q

The biliary tree beings at what level

A

Level of the lobule at the bile canaliculi

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2
Q

Microscopic canaliculi anastomoses to form what

A

Lobular bile ducts

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3
Q

Where do the R and L. Hepatic ducts join to form the CHD

A

Porta hepatis

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4
Q

List the relationship of the CHD to the PV and HA

A

PV: anterior
HA: anterior and lateral

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5
Q

Where does the CHD travel

A

In the free edge of the lesser omentum

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6
Q

What determines the length of the CBD

A

The insertion point of the CBD

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7
Q

What s the relationship of the CBD to the MPV

A

Anterior and lateral

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8
Q

Norm value for the CBD

A

Up to 4 mm…. varies w/ age and surgery

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9
Q

How does the diameter of the CBD change w/ age

A

Add 1mm for every decade of life after 50 yrs

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10
Q

Norm value for CBD post cholecystectomy

A

Up to 10 mm

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11
Q

The CBD travels through which ligament

A

Hepatoduodenal ligament (part of lesser omentum)

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12
Q

What’s the relationship of the HA and the CBD to the PV

A

HA: anterior and left
CBD: anterior and right

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13
Q

What are the 4 segments of the CBD related to the duodenum

A 
1st part (supraduodenal)
2nd part (retroduodenal)
3rd part (infraduodenal)
4th part (intraduodenal)
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14
Q

Describe the 4th part (intraduodenal) of the CBD

A
  • enters 2nd part of duodenum and inserts into ampulla of vater
  • narrowest part of extrahepatic biliary tract (most likely place for stone to lodge)
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15
Q

What regulates the flow of bile

A

Sphincter of Oddi

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16
Q

Where does the cystic duct join the CHD

A

Just above the duodenum

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17
Q

Where does the cystic duct arise

A

Superior aspect of the neck of the GB

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18
Q

Norm value of cystic duct diameter and length

A

3mm diameter

4cm length

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19
Q

Where are the spiral valves of heisted located

A

The cystic duct

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20
Q

Are the spinal valves of Heister real valves? What is there function

A
  • no, they’re mucosal folds
  • prevent duct from over distending or collapsing…. doesn’t control flow.
  • for structural support
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21
Q

Where is the GB located

A

-posterior inferior surface of the R lobe of liver in the GB fossa

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22
Q

Where is the Gb located compared to the MLF

A

Posterior and inferior

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23
Q

Which part of the GB is fixed? Which is mobile

A

Neck is fixed

Body is mobile

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24
Q

What is the most reliable landmarks for the GB

25
Q

what is a norm value of the intrahepatic ducts

A

< or = 2 mm in diameter

26
Q

What does in indicate when yo see too many tubes

A

Intrahepatic duct dilation

27
Q

What is the norm size of the GB

A

8-9 cm in length

3-5 cm in diameter

28
Q

What is the most dependent part of the GB in supine and LLD

A

Supine: neck
LLD: fundus

29
Q

What’s another term for the body of the GB

30
Q

Which are of the GB contain the spiral folds

31
Q

Norm value for GB wall measurement in fasting state

A

<3 mm in thickness

32
Q

What are the 4 layers of the GB wall. Describe each

A

Mucosa:
Inner epithelial lining
* FUNCTION to concentrate bile

Muscularis:
Muscle layer

Subserous layer:
C-tissue

Serous:
Outer layer in contact w/ peritoneum

33
Q

What are the Rokitansky-Aschoff sinuses

A

Multiple folds along the inner lining of the GB

34
Q

Do we usually see the RA sinuses

A

No, only w/ pathology

35
Q

How much bile does the GB hold

36
Q

How is bile concentrated?

A

By secreting mucous and absorption get water

37
Q

What controls bile secretion

A

The release of CCK (cholystokinin) which is produced by the duodenum

38
Q

What does CCK stimulate

A

The Gb to contract and the sphincter of Oddi to relax

39
Q

What does the sphincter of Oddi control and what does it prevent

A

-controls flow of bile into the duodenum and prevents reflux of GI fluids in to the biliary system

40
Q

What happens to the Gb and the sphincter of Oddi when the sm intestine is empty

A

Sphincter closes and bile backs up into the GB

41
Q

What amount of bile salts are produced daily

42
Q

What is a precursor to bile salt

A

Cholesterol

43
Q

What is jaundice. What is another term for it

A

Yellowish tint in body tissue due to large quantities of bilirubin (will cause ascites)

44
Q

Where does the GB get its blood supply (arterial and venous)

A

Arterial: cystic artery
Venous: cystic vein which drains into the portal veins

45
Q

What is a junctional fold

A

Fold that occurs @ the junction of the body and infundibulum (neck) of the GB

46
Q

What is Hartman’s pouch

A

An outpouching in the area of the GB neck

47
Q

What is a Phrygian cap

A

When the GB is partially folded onto itself in the area of the fundus ad body

48
Q

What are some other GB variants

A
  • too mobile
  • ectopic
  • low lying
  • embedded in liver
49
Q

How does the GB appear on US

A

Anechoic
Well defined thank, echogenic walls

SAG: pear shape
TRX: anechoic circle

50
Q

In what position should you scan the GB in

A

Supine, decubitus to assess for mobility

51
Q

What should you assess when scanning the GB

A

Size, shape, wall thickness, content, area around the GB

52
Q

How can you minimize artifacts in the GB

A

Come to the R and angle back towards the GB

53
Q

How should you measure the CBD

A

In the region of the porta hepatis, measure inner to inner @ the widest portion

54
Q

Do you measure the CBD where it crosses the HA

A

No b/c the HA will compress the CBD

55
Q

What does the WBC lab test check for

What could an increased WBC lab value indicate in terms of the GB

A
  • measures rxn of body to infection

- acute and/or chronic cholecystitis or injury to bile duct (depending on the cause)

56
Q

What is a HIDA scan

A
  • nuch med test

- evaluations function of the GB

57
Q

What is a ERCP test

A

-ampulla of vater is cannulized and contrast material is injectors to assess biliary system

58
Q

Norm value for CHD

AB&SS 1 (13 decks)

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