ch. 6 hepatobillary system Flashcards
What is the hepatobillary system composed of?
- Liver
- Gallbladder
- Biliary tree
Is the pancreas included in the hepatobilary system?
no but it is closely related because it shares a portion of the bilary ductal system
Largest SOLID organ in the body is the _______
liver
The right lobe and left lobe are separated by ____
falciform ligament
Name the functions of the liver
- substance metabolism
2 Synthesis of sunstance - Detox of substance
- Stores vitamen B
The liver has a dual supply of blood that comes from ___ & ____
- hepatic artery ( takes oxygenated blood to the liver)
2. Portal vein ( returns venous blood to the inferior vena cava)
What are the functions of the hepatic artery and the portal vein
Dual supply of blood that comes from
1. hepatic artery ( takes oxygenated blood to the liver)
- Portal vein ( Returns venous blood to the inferior vena cava)
____ drains bile that is produced by the liver and drains it into the duodenum
Biliary tree
What is the purpose of the biliary tree
drains bile produced by the liver into the duodenum
What forms the common bile duct
- Cystic duct
2. common hepatic duct
The short part of the common bile duct after joining the pancreatic duct is known as _____
hepatopancreatic ampulla
aka
ampulla of vater
Ampulla of vater is also known as
hepatopancreatic ampulla
It is the short portion of the commonbile duct and the pancreatic duct m
Rt and Lt hepatic ducts forms the _____
Common hepatic duct
Name the Biliary tree
- RT and LT duct forms the
- Common hepatic duct that meets with the
- Cystic duct , these 2 form
- Common bile duct that meets with the
- Pancreatic duct that forms the
- Hepatopancreatic amulla ( ampulla of vater)
what is another name for the hepatopancreatic sphincter?
Function _____
Spinchter of Oddi
regulate the bile flow into the duodenum
Sphincter of oddi is also known as ____.
Function___
Hepatopancreatic sphincter
regulates bile into the duodenum
_____ regulate the flow of bile into the duodenum
Hepatopancreatic sphincter
aka spinchter of oddi
Hormone that is released in the presence of fatty food in the stomach.
Cholecystokinin
The release of bile into the duodenum is triggered by ____.
Cholecystokinin
What is the purpose of bile
Emulsifies fats for absorption
Pear shaped sac found on the underside of the right liver :_______
Gallbladder
What is the function of the gallbladder
store bile that is produced by the liver
The gallbladder recieves bile from the liver via the _____
hepatic duct
Elongated, flat organ that croses to the left side of the abdomen and behind the stomach
Pancreas
Functions as both exocrine and endocrine glads
Name the 3 digestive enzyme that is produced by the pancreas (Exocrine function)
- Trypsin- Breaks down protien
- Amylase- Breaks down starches
- Lipase- Breaks down lipids
*DIscarged through the pancreatic duct into the duodenum)
describe the endocrine function of the pancreas
Pancreas is composed of specialized cells ( Islets of langerhans)
these cells are categorized as:
- Alpha cells- produce glucagon
- Beta cells- produce insulin
- these two regulate carb metabolism
Both are discharged in the blood
What is pnuemobilia
gas in the biliary tree
What does PTC stand for?
What is it _____?
What does it do ?
- Percutaneous Transhepatic Cholangiography
- Exam done to visualize the biliary tree with the use of a Chiba needle inserted in the tree.
- Identify medical jaundice (hepatocellular dysfunction
) from surgical jaundice (biliary obstruction)
or identify a tumor in the distal common bile duct
what is the difference between medical jaundice and surgical jaundice
which exam determines this
medical= hepatocellular dysfunction
surgical = biliary obstruction
determine with PTC
jaundice caused from biliary obstruction is known as ____
Sugical jaundice
Jaundice caused by hepatocellular dysfunction is known as ___
Medical jaundice
- What does ERCP stand for?
- What is it____
- What does it examin
- Endoscopic Retrograde Cholangiopancreatogram
- Procedure done by a GI doctor with the use of an endoscope to vizualize the biliary system and pancreatic duct. The endoscope travels to the duodenum and then a catheter is pushed to the common bile duct / pancreatic duct in which retrograde injection of contrast is injected
- used for :
non-dilated ducts, stone extraction and stent placement
what does ERCP stand for
Endoscopic Retrograde Cholangiopancreatogram
Stones in the biliary tree are seen radiographically as ____
Air bubbles
What is operative cholangiography
Exam done during surgery in which a needle is inserted into the Cystic duct or CBD with contrast to vizualize biliary calculi or need for CBD exploration
Why is it important that no air bubbles be injected into the ductal system during an operative cholangiogram?
becuase the bubbles can mimic stones
What is a T-tube cholangiography
exam performed after cholecystectomy to check the patency of the CBD and for calculi with the use of T-tube and contrast.
What is the modality of choice to evaluate the gallbladder
why???
Real time sonography
can also evaluate: Portal hypertension and portosytemic collateral circulation
Because:
- Non-invasive
- No radiation exposure
- Body size and type does not matter
When is CT used to visualize the hepatobiliary system
when there is suspected malignancy and to examine the masses of gallbladder, liver and pancreas
What is a Cholescintigraphy
Nuclear medicine study
Describe Cirrhosis
Classifications
Pathology
Chronic liver condition that destroys the function and structure of the liver
Inflammatory
Both additive. And subtractive
Caused by hepatocyte damage
Portal hypertension can result in what 2 conditions
- ____
- ____
- Esophageal variaces
(dilation of the esophageal veins) - Ascites= Fluid collection in the perotoneal cavity
Describe viral hepatits
- There are 6 types of hepatits A-E & G
- They cause acute inflammation of the liver that then interferes with excreting bilirubin which is a pigment in bile.
- Results in jaundice fatigue and anorexia
When is hepatits classified as chornic
If liver inflammation persists over 6 months
Describe hepatitis A
- Most common and highly contagious.
- Short period of time and does not lead to chronic hepatitis or cirrhosis
- Spread through food or fecal material that is contaminate
inflammatory
None
Describe hepatits B
Contraction___
classification
pathology
- Contracted through perenteral routs of serum or blood
- longer incubation period and can result in chronic hepatits and liver failure
inflammatory
none
Describe Hep C
Contaction____?
- Contracted by parenteral RNA virus such as blood transfusions
- Can cause acute or chronic hepatits
- 10 - 20% of cases lead to cirrhosis
Inflammatory
None
What percent of hepatits C cases leads to cirrhosis
10-20 %
What is cholelitiasis
classification
pathology
Gallstones -occurs mostly in woman - Can be single stone or multiple stones (small stones can become stuck in the bile duct causing obstruction or jaundice )
inflammatory
additive
Acute inflammation of the gallbladder
Cholecystitis
inflammatory
None
If left untreated can cause infarction and gangrenous state which results in rupture of the walls
Obstruction in the small bowel that results from a gallstone that erodes from the gallbladder and creates a fistula to the small bowel
gallstone ileus
Define gallstone ileus
Obstruction in the small bowel that results from a gallstone that erodes from the gallbladder and creates a fistula to the small bowel
what is pancreatitis
Exam to diagnose___
classification
pathology
inflammation of the pancreas
* Most complex and challenging disorder of the abdomen
Exam: CT scan
2 types:
- acute: does not affect the makeup of the pancreas
- Chronic
affects the histologic makeup of the pancreas = Irreversible changes
inflammatory
none
what is Most complex and challenging disorder of the abdomen
pancreatitis
inflammatory
none
Fluid collection caused by pancreatitis
pseudocyst
Discoloration of the skin to yellow that is a sign of a disease
calcification -
Pathology
Jaundice
inflammatory
none
2 types:
*Medical (non-obstructive) occurs when there is destruction of RBC
*Surgical (Obstructive) occurs when bile can not enter the duodenum due to obstruction
Describe hepatocellular adenoma
Exam to diagnose
classification
pathology
Benign tumor of the liver
Seen by CT and U/S
neoplastic
additive
Describe hemangioma
Exam to diagnose
most common tumor of the liver *Benign neoplasm of blood vessels Subtractive Neoplastic *CT scan
What is the most common liver tumor
classification
pathology
hamangioma (benign)
( Neoplasm of blood vessels)
Neoplastic
Subtractive
Port wine stain is used to decribe ____
heangioma
A primary neoplasm of the liver is known as
Hepatocellular carcinoma
Additive
Neoplastic
A secondary liver cancer is known as
Where does it come from____
Exam to diagnose __
Metastatic liver disease
- more common than primary neoplasm because of the blood filtration in the liver
- Comes from: Colon, pancreas, stomach, lung and breast
Exam: Ultrasound
Neoplastic
Subtractive
Describe carcinoma of the gallbladder
Exam to diagnose:
Radiographic appearacnce ___
Malignant neoplasms of the gallbladder.
Does not often occur
Neoplasic
None
CT and U/S
Porcealin gallbladder
Appearance of a porecelain gallbladder can indicate which pathology
classification
Pathology
Carcinoma of the gallbladder
neoplastic
None
-Malignant neoplasm of gallbaldder.
Describe carcinoma of the pancrease
Exam to diagnose_
fatal cancer of the pancreas
- when the carcinoma is located in the head of the pancrease it may be visible on barium studies
CT scan
Neoplastic
Additive
fatal cancer of the pancreas
Classification
pathology
carcinoma of the pancreas
neoplastic
additive
Malignant neoplasms of the gallbladder.
Classification
Pathology
Gallbladder carcinoma
neoplastic
None
____ Used to see Solitary, round increased echogenic lesion
sonography
____ Used to Label red cells attracted to vascular tumor
nuclear medicine
Why exam identifies medical janders from surgicals jaundice
PTC
Percutaneous Transhepatic Cholangiography
Term for gas in biliary tree
Pneumobilia
