Exam 4

Question 1

formation of stones

Answer 1

Lithiasis

Question 2

What does the gallbladder do?

Answer 2

• receives and stores bile from liver
• releases bile into duodenum

Question 3

gallbladder position in different body types

Answer 3

hypersthenic: high and well away from the midline
sthenic: not on midline and lower than in hypersthenic
hyposthenic: closer to midline but higher then in asthenic
asthenic: low and near the spine

Question 4

Stratification of stones in gallbladder, which projection?

Answer 4

lateral decubitus view

Question 5

Position of head and tail of pancreas

Answer 5

head: broadest portion, extends inferiorly and is enclosed within the curve of the duodenum at the level of the second or third lumbar vertebra
body & tail: pass transversely behind the stomach and in front of the left kidney, with the narrow tail terminating near the spleen

Question 6

Parts and ducts of the biliary tree.

Question 7

T-tube cholangiography

Answer 7

Performed via a T-shaped catheter left in the common hepatic and common bile ducts for postoperative drainage.
Performed to show:
- caliber and patency of the ducts
- status of the sphincter of the hepatopancreatic ampulla
- presence of residual or previously undetected stones or other pathologic conditions

Question 8

• Formed by the common bile duct and pancreatic duct as they join in the second (descending) segment of the duodenum
• Located at the major duodenal papilla.
• Delineates the foregut from the midgut

Answer 8

Ampulla of Vader

Question 9

• Muscular valve / regulates the flow of bile
• Refers to the smooth muscle that surrounds the end portion of the common bile duct and pancreatic duct. This muscle relaxes during a meal to allow bile and pancreatic juice to flow into the intestine
• The sphincter also controls the CBD and the hepatic duct

Answer 9

Sphincter of Oddi

Question 10

• Produced continuously by the liver (800- 1000mL per day)
• Pigmented with bilirubin (yellow) and biliverdin (green)
• Surfactant
• Aids in absorption of fat soluble vitamins (A,D,E, and K)
• Excretion of bilirubin
• Secreted into duodenum

Answer 10

Bile

Question 11

acts on proteins, fats, and carbohydrates

Answer 11

pancreatic juice

Question 12

responsible for glucose metabolism

Answer 12

insulin and glucagon

Question 13

an imaging technique that uses X-rays and a contrast dye to visualize the bile ducts

Answer 13

Cholangiogram

Question 14

Different types of cholangiography (pictures)

Answer 14

PTC: uses Chiba (skinny) needle
T-tube: uses t-shaped catheter
ERCP: uses endoscope

Question 15

Portion of the liver in which the ducts and vascular structures enter and leave the liver

Answer 15

Porta Hepatis

Question 16

Reactions to iodinated contrast

Answer 16

Major reaction include contrast-induced nephropathy and both acute and delayed reactions. Common minor adverse reactions include rash, pain at the injection site, nausea, vomiting, and minor hemodynamic changes, which are all usually self-limiting

Question 17

• Inflammation w/o Stone involvement
• Critically ill patients with fever

Answer 17

Acalculous cholecystitis

Question 18

• Endoscope placed through mouth, down
  past stomach and into duodenum
• Inserts through ampulla
• Cannulate/Contrast injected retrograde

Answer 18

ERCP (Endoscopic Retrograde
CholangioPancreatography)