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Anatomy 206 > Extrahepatic Biliary System > Flashcards

Extrahepatic Biliary System Flashcards

1
Q

Extrahepatic biliary system

A
  1. Hepatic ducts
  2. Cystic ducts
  3. Common bile duct
  4. Gall bladder
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2
Q

Hepatic ducts: origin

A

Right and left hepatic ducts emerge from liver right and left lobes near porta hepatis right end and anterior to hepatic artery and portal vein branches

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3
Q

Hepatic ducts: course

A
  1. Both ducts unite forming common hepatic duct (3-4 cm long)
  2. Descends in lesser omentum free border on hepatic artery right side and in front of portal vein
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4
Q

Hepatic ducts: end

A

Common hepatic duct joins cystic duct at acute angle forming common bile duct

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5
Q

Cystic duct

A
  1. S-shaped duct
  2. 3-4 cm long
  3. Arises from gall bladder neck
  4. Ends by joining common hepatic duct forming common bile duct
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6
Q

Cystic duct spiral valve

A

Mucous membrane of cystic duct and gall bladder neck projects into their lumina to form spiral valve keeping them patent

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7
Q

Common bile duct: formation

A

Union of common hepatic duct and cystic duct below porta hepatis

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8
Q

Common bile duct: size

A

3-4 inches long and about 6 mm wide

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9
Q

Common bile duct: parts

A
  1. Supraduodenal part
  2. Retroduodenal part
  3. Infraduodenal part
  4. Intraduodenal part
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10
Q

Supraduodenal part

A
  1. Passes in
    - Lesser omentum free border
    - In front of portal vein
    - On hepatic artery right side
  2. Separated from IVC behind by Epiploic foramen
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11
Q

Retroduodenal part

A

Lies behind 2nd inch of duodenum 1st part with gastroduodenal artery on its left side and portal vein behind separating them from IVC

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12
Q

Infraduodenal part

A

Lies behind pancreas head (may be embedded in it) and in front of IVC

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13
Q

Intraduodenal part

A
  1. Common bile duct terminal part unites with main pancreatic duct forming ampulla of vater
  2. Opens at major duodenal papilla in middle of Posteromedial aspect of duodenum 2nd part
  3. Surrounded by sphincter of Oddi
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14
Q

Common bile duct: applied anatomy

A

Common bile duct may be compressed in pancreas head cancer leading to obstructive jaundice

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15
Q

Gall bladder: site

A

Lies in gallbladder fossa on inferior surface of liver right lobe just to right of quadrate lobe

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16
Q

Gall bladder is fixed to the liver by:

A
  1. Visceral peritoneum of liver inferior surface
  2. Loose connective tissue containing cystic artery
  3. Small veins from gall bladder to liver
17
Q

Gall bladder: shape

A

Pear shaped

18
Q

Gall bladder: size

A

3-4 inches long
3 cm wide
30-50ml capacity

19
Q

Gall bladder: function

A

Concentration (10 times) and storage of bile

20
Q

Gall bladder: parts

A
  1. Fundus
  2. Body
  3. Neck
21
Q

Fundus relations

A

Protrudes below liver inferior border
1. Anterior: anterior abdominal wall
2. Posterior: transverse colon

22
Q

Body relations

A
  1. Superior: liver inferior surface (gall bladder bed)
  2. Inferior:
    - transverse colon
    - end of duodenum 1st part and beginning of 2nd part
23
Q

Neck relations

A
  1. Uppermost and narrowest part
  2. Give rise to cyctic duct
  3. Its right wall presents dilation (Hartman’s pouch)
  4. Superior: cystic artery separated it from liver
  5. Inferior: 2nd inch of duodenum 1st part
24
Q

Gall bladder: surface anatomy

A

Fundus corresponds to tip of right 9th costal cartilage where:
1. Transpyloric plane
2. Right linea semilunaris
Or
3. Right lateral vertical plane
Crosses right costal margin (murphy’s point)

25
Q

Gall bladder: peritoneal covering

A
  1. Fundus is completely covered with peritoneum as it projects below liver inferior border
  2. Body and neck are only covered on their inferior surface
26
Q

Gall bladder: arterial supply

A
  1. Cystic artery
  2. Many small arteries: pass to gall bladder from its bed in liver
27
Q

Cystic artery

A
  1. Right hepatic artery branch
  2. Reaches gall bladder by passing in calot triangle between:
    - Cystic duct
    - Common hepatic duct
    - Liver inferior surface
28
Q

Gall bladder: venous drainage

A

Cystic veins: open directly into hepatic veins or into portal vein right branch

29
Q

Lymphatic drainage

A
  1. Superior surface lymph vessels: communicate with liver lymph vessels
  2. Remaining parts lymph vessels: pass to cystic node (at junction of cystic duct and common hepatic duct) and hepatic nodes (in porta hepatis along hepatic artery)
30
Q

Nerve supply

A
  1. Parasympathetic
  2. Sympathetic
  3. Phrenic nerve
31
Q

Parasympathetic

A

Vagus nerve through coeliac plexus

32
Q

Sympathetic

A

Greater splanchnic nerves (T5-9) through coeliac plexus along hepatic artery

33
Q

Right phrenic nerve fibers

A

Through its communication with hepatic plexus, also reach gall bladder through hepatic plexus

34
Q

Applied anatomy: cholecystitis

A

Pain is felt in right hypochondrium and radiates to:
1. Shoulder tip (C3 and C4 give both phrenic and lateral supraclavicular nerves)
2. At back below scapula (T5-9 spinal segments give greater splanchnic nerve and supply the skin below scapula)

35
Q

Applied anatomy: Hartman’s pouch stone

A

Can cause obstruction of gall bladder neck and common hepatic duct leading to obstructive jaundice

36
Q

Gall bladder has double arterial supply

A

Which explains rarity of bladder gangrene in case of acute cholecystitis

Anatomy 206 (98 decks)

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