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Surgery.(GIT 2).Gallbladder > Gall bladder.1. Anatomy and Physiology of The Biliary system > Flashcards

Gall bladder.1. Anatomy and Physiology of The Biliary system Flashcards

1
Q

Anatomy of The Biliary system

A
  1. Components
  2. Blood supply
  3. Lymphatic drainage
  4. Nerve supply
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2
Q

Components in Anatomy of The Biliary system

A
  1. Gall bladder

2. Extra-hepatic biliary tracts

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3
Q

Gall bladder in Components in Anatomy of The Biliary system

A
  1. SHAPE
  2. VOLUME
  3. LOCATION
  4. PARTS
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4
Q

SHAPE of Gall bladder in Components in Anatomy of The Biliary system

A

pear-shaped

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5
Q

VOLUME of Gall bladder in Components in Anatomy of The Biliary system

A

with a normal capacity of about 50 ml.

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6
Q

LOCATION of Gall bladder in Components in Anatomy of The Biliary system

A
  • on the visceral surface of the liver

* at the plane dividing its 2 surgical lobes.

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7
Q

PARTS of Gall bladder in Components in Anatomy of The Biliary system

A
  1. The fundus
  2. The body
  3. The infundibulum
  4. The neck
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8
Q

The fundus in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A
  • usually located at the tip of the ninth costal cartilage

* completely covered by peritoneum.

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9
Q

The body in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A

occupies the gall bladder fossa of the liver.

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10
Q

The infundibulum in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A
  • Definition

* Alternative name

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11
Q

Definition of The infundibulum in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A

It’s the angulated portion of the body

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12
Q

Alternative name for The infundibulum in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A

Hartmann’s Pouch

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13
Q

The neck in PARTS of Gall bladder in Components in Anatomy of The Biliary system

A

connected to the cystic duct

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14
Q

Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

a. Common hepatic duct (CHD)
b. Cystic duct
c. Common bile duct (CBD)

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15
Q

Common hepatic duct (CHD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

It is formed by the union of the right and left hepatic ducts in the porta hepatis.

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16
Q

Cystic duct in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  • Size

* Mucosa

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17
Q

Size of Cystic duct in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

It is 2-3 cm long and 2-3 mm in diameter.

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18
Q

Mucosa of Cystic duct in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Its mucosa is thrown into crescent-like folds called spiral valve of Heister.

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19
Q

spiral valve of Heister in Mucosa of Cystic duct in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

crescent-like folds of the mucosa of the cystic duct

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20
Q

Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  1. Beginning
  2. Ending
  3. Dimensions
  4. Parts
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21
Q

Beginning of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

begins at the union of the cystic duct & CHD

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22
Q

Ending of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

ends at the ampulla of Vater in the postero-medial part of the 2nd part of the duodenum.

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23
Q

The ampulla of Vater in Ending of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

surrounded by the sphincter of Oddi.

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24
Q

Dimensions of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

It varies in length from 5 to 10 (7.5) cm and the average diameter is about 3-8 mm

” i.e the decade + 2”. maximum the 6th decade

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25
Q

Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

It can be divided into 4 parts ( or 3 parts) :

  1. Supra-duodenal
  2. Retro-duodenal
  3. Infra-duodenal
  4. Intra-duodenal
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26
Q

Supra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  1. Visibility by U/S
  2. Size
  3. Location
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27
Q

Visibility by U/S of Supra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

The only part seen by U/S

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28
Q

Size of Supra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

About 2.5 cm long

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29
Q

Location of Supra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

runs in the free margin of the lesser omentum

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30
Q

Retro-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  1. Visibility by U/S

2. Location

31
Q

Visibility by U/S of Retro-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Not seen by U/S

32
Q

Location of Retro-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Passes behind the 1st part of the duodenum

33
Q

Infra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  1. Visibility by U/S

2. Location

34
Q

Visibility by U/S of Infra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Not seen by U/S

35
Q

Location of Infra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Lies in a groove in the posterior surface of the pancreas.

36
Q

Intra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A
  1. Location

2. Formation of ampulla of Vater

37
Q

Location of Intra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Passes through the wall of the 2nd part of the duodenum

38
Q

Formation of ampulla of Vater in Intra-duodenal part in Parts of Common bile duct (CBD) in Components of Extra-hepatic biliary tracts in Components in Anatomy of The Biliary system

A

Intra-duodenal part Joins the main pancreatic duct, & together form a dilated segment that is known as the ampulla of Vater.

39
Q

Blood supply in Anatomy of The Biliary system

A
  1. The Gall Bladder

2. The extrahepatic bile ducts

40
Q

The Gall Bladder in Blood supply in Anatomy of The Biliary system

A
  1. Arteries

2. Veins

41
Q

Arteries of The Gall Bladder in Blood supply in Anatomy of The Biliary system

A

It is supplied by the cystic artery, which usually arises from the right hepatic artery.

42
Q

Veins of The Gall Bladder in Blood supply in Anatomy of The Biliary system

A

Venous return consists of

  • small veins that directly enter the liver bed
  • a cystic vein that enters the right branch of the portal vein.
43
Q

The extrahepatic bile ducts in Blood supply in Anatomy of The Biliary system

A
  • The cystic artery above
  • The gastro-duodenal artery below

The blood vessels supplying the ducts usually run longitudinally at the 3 and 9 o’clock positions

44
Q

Lymphatic drainage in Anatomy of The Biliary system

A

cystic lymph node of Lund

45
Q

cystic lymph node of Lund in Lymphatic drainage in Anatomy of The Biliary system

A
  1. Site
  2. Afferent vessels
  3. Efferent vessels
46
Q

Site of cystic lymph node of Lund in Lymphatic drainage in Anatomy of The Biliary system

A

lies in front of the junction of the cystic and common hepatic duct

47
Q

Afferent vessels of cystic lymph node of Lund in Lymphatic drainage in Anatomy of The Biliary system

A

The lymph vessels of the gall bladder

48
Q

Efferent vessels of cystic lymph node of Lund in Lymphatic drainage in Anatomy of The Biliary system

A

pass to the hilar and to the celiac lymph nodes

49
Q

Nerve supply in Anatomy of The Biliary system

A
  1. Parasympathetic fibres
  2. Sympathetic fibres
  3. Sensory supply
50
Q

Parasympathetic fibres in Nerve supply in Anatomy of The Biliary system

A
  1. Origin

2. Action

51
Q

Origin of Parasympathetic fibres in Nerve supply in Anatomy of The Biliary system

A

From the hepatic division of the anterior vagal trunk

52
Q

Action of Parasympathetic fibres in Nerve supply in Anatomy of The Biliary system

A
  1. Secreto-motor
  2. Responsible for contraction of the gall bladder
    and relaxation of the sphincter of Oddi .
53
Q

Origin of Sympathetic fibres in Nerve supply in Anatomy of The Biliary system

A

From the celiac plexus from the greater splanchnic nerve.

54
Q

Sensory supply in Nerve supply in Anatomy of The Biliary system

A
  1. Transmitted along the Greater splanchnic nerve to T 7-9

2. Right phrenic nerve C 3-5

55
Q

The reason why Pain of Gall bladder may be referred to the epigastrium

A

as It’s transmitted along the Greater splanchnic nerve to T 7-9

56
Q

the reason why Pain of Gall bladder may be referred to the right shoulder

A

as it’s transmitted along Right phrenic nerve C 3-5

57
Q

Physiology of The Biliary system

A
  1. Amount of Bile Per day
  2. Control of Bile secretion
  3. Composition of Bile
  4. Function of Gall bladder
58
Q

Amount of Bile Per day in Physiology of The Biliary system

A

Normal adults secrete 500-1000 ml bile per day.

59
Q

Control of Bile secretion in Physiology of The Biliary system

A
  1. Neurogenic Control

2. Hormonal Control

60
Q

Main Control of Bile secretion in Physiology of The Biliary system

A

Hormonal control

61
Q

Neurogenic Control in Control of Bile secretion in Physiology of The Biliary system

A
  1. Vagal stimulation increases secretion.

2. Splanchnic stimulation decreases bile flow

62
Q

Hormonal Control in Control of Bile secretion in Physiology of The Biliary system

A

Bile flow is stimulated by cholecystokinin

63
Q

cholecystokinin in Hormonal Control in Control of Bile secretion in Physiology of The Biliary system

A
  1. Alternative name

2. Site of release

64
Q

Alternative name for cholecystokinin in Hormonal Control in Control of Bile secretion in Physiology of The Biliary system

A

Previously called pancreozymin

65
Q

Site of release of cholecystokinin in Hormonal Control in Control of Bile secretion in Physiology of The Biliary system

A

released from the duodenal mucosa and small intestine.

66
Q

Composition of Bile in Physiology of The Biliary system

A
  1. Water
  2. Electrolytes
  3. Bile salts
  4. Cholesterol and phospholipids.
  5. bile pigments
67
Q

Percentage of water in Composition of Bile in Physiology of The Biliary system

68
Q

Concentration of Electrolytes in Composition of Bile in Physiology of The Biliary system

A

The same concentration as the plasma.

69
Q

Bile salts in Composition of Bile in Physiology of The Biliary system

A

formed from The major bile acids which are cholic, deoxycholic, and chenodeoxycholic acids.

70
Q

Bile pigments in Composition of Bile in Physiology of The Biliary system

A

The yellow colour of bile

71
Q

The reason of the yellow color of bile in Bile pigments in Composition of Bile in Physiology of The Biliary system

A

due to the presence of the pigment bilirubin diglucuronide which is the breakdown product of haemoglobin

72
Q

Function of Gall bladder in Physiology of The Biliary system

A
  1. Storage and Concentration of bile
  2. Secretion of mucus
  3. Excretion of excess cholesterol and conjugated bilirubin
73
Q

Function of Secretion of mucus in Function of Gall bladder in Physiology of The Biliary system

A
  1. Protects the mucosa from the lytic action of bile

2. Facilitates passage of bile through the cystic duct.

Surgery.(GIT 2).Gallbladder (3 decks)

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