Chapter 17 - Biliary System

Question 1

The sphincter of oddi is a complex arrangement of smooth muscles around the CBD, pancreatic duct and the ampulla of Vater. What is its fuction?

Answer 1

1. Regulates flow of Bile and pancreatic juices
2. Inhibits Bile into pancreatic duct
3. Prevents reflux of intestinal contents into ducts

Question 2

Blood supply to the Biliary system is delivered by the ___ artery and is drained through the ___ vein.

Answer 2

Hepatic artery and cystic vein

Question 3

What hormone when released makes the gallbladder contract to release bile?

Answer 3

cholecystokinin-pancreozymin (CCK-PZ)

Question 4

Bile is an alkaline made up of 97% water, bile salts, fatty acids, lipids, cholesterol, electrolyte, bilirubin and other substances secreted from which organ?

Answer 4

liver

Question 5

What are some functions of bile?

Answer 5

1. Combines undigested fats
2. Absorption of fat-soluble vitamins
3. Activation of intestinal and pancreatic enzymes
4. Neutralize gastric acid in duodenum

Question 6

What is cholelithiasis?

Answer 6

Presence of stones in the gallbladder

Chole = Bile duct or gall
lithiasis = formation of stones

Question 7

Name two types of gallstones.

Answer 7

1. Cholesterol stones (yellow-green in colour, made primarily of hardened cholesterol)
2. Pigment stones (black or brown)

Question 8

What is the term used to refer to pain when a gallstone is being passed and is blocking a Bile duct?

Answer 8

Biliary colic

Question 9

What are the treatments for minor and major symptomatic pts for cholelithiasis?

Answer 9

Minor symptoms - Pain relief & dietary control to reduce fat

Major symptoms - Surgery, typically laproscopic cholecystectomy

Question 10

What is choledocholithiasis?

Answer 10

Presence of gallstones in the CBD or hepatic duct

choledocho = occurring in the CBD

lithiasis = formation of stones

Question 11

What are some symptoms of choledocholithiasis?

Answer 11

1. Biliary colic
2. Cholangitis with fever, chills & jaundice (aka Charcot triad)
3. Loss of appetite, nausea and vomiting
4. Acute gallstone pancreatitis

Question 12

What symptoms is associated with Charcot triad?

Answer 12

Cholangitis with fever, chills and jaundice

Question 13

Acalculous cholecystitis is inflammation of the gallbladder without evidence of gallstones.

Treatment consists of:
1.
2.

Answer 13

1. Urgent cholecystectomy or cholecystostomy

2. Antibiotics

Question 14

What is cholangitis?

Answer 14

Bacterial infection of the bile duct often associated with choledocholithiasis (gallstones in CBD).

It can also be associated with:
cancer
tumor
stricture
and other

Cholangitis is a medical and surgical emergency requiring IV hydration, antibiotics and drainage of biliary tree. 🌳

Question 15

What is the term used for acute or chronic inflammation that causes painful distention of the gallbladder?

Answer 15

Cholecystitis

chole = Bile duct or gall
cystitis = inflammation of the bladder

Treatment: cholecystectomy

Question 16

What is primary sclerosing cholangitis? (PSC)

Answer 16

Inflammation of the bile ducts causes scarring and then stricturing.

This blockage in bile flow will result in gradual liver cell damage or cirrhosis.

Treatment may consist of nothing for minor PSC or endoscopic Dilatation or placement of Biliary Stent.

Etiology is unknown.

Question 17

The gallbladder wall is made up of:

Answer 17

Serosa, a fibromuscular layer and mucosa

Question 18

By far the most common disease affecting the Biliary system is:

a. Choledocholithiasis
b. Cholecystitis
c. Cholelithiasis
d. Cholangitis

Answer 18

c. Cholelithiasis