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Anatomy (TOPNOTCH SUPPLEMENT) > Gallbladder > Flashcards

Gallbladder Flashcards

0
Q

Pear-shaped sac lying on the inferior surface of the liver

Receives, stores and concentrates bile by absorbing water and salts

Contracts to expel bile upon release of cholecystokinin from duodenum

Capacity of 30-50ml

A

Gallbladder

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1
Q

Relations:
ANTERIOR - anterior abdominal wall, inferior surface of liver

POSTERIOR - transverse colon, 1st-2nd parts of duodenum

A

Gallbladder

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2
Q

Cystohepatic triangle

A

Triangle of Calot

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3
Q

Boundaries of Triangle of Calot

A

Liver - SUPERIOR

Cystic duct - INFERIOR

Common hepatic duct - MEDIAL

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4
Q

Parts of GB

A

Fundus - rounded blind end

Body - major part

Neck - narrow part directed toward the portahepatis which gives rise to cystic duct

Hartmann’s pouch - infundibulum of the GB, junction between neck and cystic duct

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5
Q

The cystic artery usually originates from the ____ artery:

A

Right hepatic

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6
Q

Blood supply

A

CYSTIC ARTERY from R HEPATIC ARTERY

Celiac artery
Left gastric
Splenic
Hepatic - common hepatic - R/L hepatic - gastroduodenal

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7
Q

Valve of Houston is associated with what organ?

A

Rectum

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8
Q

Common site of an impacted gallstone; patients exhibit referred pain in the epigastric region

A

Hepatopancreatic ampulla

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9
Q

May cause enlargement of the GB; patients exhibit BILIARY COLIC (severe colicky pain that begins in the epigastric region but moves to a point where the 9th costal cartilage intersects the lateral border of the rectus sheath

A

A STONE BLOCKING THE CYSTIC DUCT

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10
Q

Stimulation of visceral pain fibers that innervated a GIT structure results in a DULL, poorly localized pain that is referred over the T5 through L1 dermatome a

A

Referred pain

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11
Q

Has a fundus (anterior portion), body & neck (posterior portion)

Hartmann pouch may extend from neck
- common site for gallstones to lodge

A

Gallbladder

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12
Q

Occurs when the mucosa of the gallbladder penetrates deep into the muscularis externa

Early indicator of pathologic changes

A

Rokitansky-Aschoff sinuses

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13
Q

Venous drainage

A

Cystic veins –> portal vein or directly to liver sinusoids

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14
Q

Lymphatic drainage

A

Hepatic & pancreaticoduodenal lymph nodes

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15
Q

Sensory fibers

A

Great thoracic splanchnic nerves to spinal level T7-10

16
Q

Parasympathetic

Action:

  • GB contract
  • sphincter of Oddi relax (bile release)
A

Vagus nerve (pre & postganglionic)

17
Q

Sympathetic

Action:

  • GB relax
  • sphincter of Oddi contract
A

Greater thoracic splanchnic nerve (Preganglionic)

Celiac plexus (postganglionic)

18
Q

Hormone secreted by I cells of small intestine

Mimics parasympathetic functions of vagus nerve on GB & sphincter of Oddi

A

Cholecystokinin (CKK)

19
Q

Functions of GB

A

Bile storage & concentration (10 fold)

Bile calcification, addition of mucus (“white bile”)

20
Q

R & L hepatic ducts –> common hepatic duct

Common hepatic duct + cystic duct –> CBD
- mucosa of cystic duct is arranged in a spiral fold with a core of smooth muscle called SPIRAL VALVE OF HELSTER

CBD passes posterior to pancreas –> ends at hepatoduodenal ampulla (ampulla of Vater) where it joins the pancreatic duct

A

Extrahepatic biliary ducts

21
Q

Surrounds CBD as it transverses the ampulla

A

Sphincter of Oddi

22
Q

Produced by hepatocytes

Average rate: 600 ml/day

Composition:

  • water
  • electrolytes
  • bilirubin glucoronide (bile pigment)
  • Cholic acid
  • chenodeoxycholic acid conjugated to glycine or taurine (bile salts)
  • cholesterol
  • lecithin (lipids) calcium
  • secretory IgA

Function: emulsify fats

Lactated Ringer solution: good replacement fluid for bile loss

A

Bile

23
Q

Large & smooth

Obesity, chronic disease, cystic fibrosis, clofibrate, estrogen, rapid weight loss

A

Cholesterol stones

24
Q

Smooth, green/black

Hemolysis (sickle cell, spherocytosis)

Cirrhosis, biliary infection

More common in Asia

A

Pigment (bilirubin) stones

25
Q

Infection or inflammation of biliary

A

Calcium bilirubinate

26
Q

GALLSTONE OBSTRUCTION

within the cystic duct

A

Biliary colic, pain shifts to R hypochondriac region

Causes acute cholecystitis

Bile precipitates in the GB –> “milk of calcium” bile

No jaundice because bile flow from liver, remains open

27
Q

Large gallstone impacted in cystic duct extrinsically obstruct the common hepatic duct

A

Mirizzi syndrome

28
Q

GALLSTONE OBSTRUCTION

within the CBD

A

Obstructs bile flow GB & the liver

Jaundice (1st observed under the tongue)
- moderate, fluctuates because a stone rarely causes complete obstruction

29
Q

GALLSTONE OBSTRUCTION

at hepatoduodenal ampulla

A

Obstruct bile flow from both the GB & the liver

Pancreatic duct may be blocked

Jaundice & pancreatitis are common

Anatomy (TOPNOTCH SUPPLEMENT) (71 decks)

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