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abdomen > Gallbladder and biliary test 3 > Flashcards

Gallbladder and biliary test 3 Flashcards

0
Q

What plays a role in the digestive process to store and transport bile?

A

Biliary System

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1
Q

What is the biliary system?

A

consists of right and left hepatic duct

common hepatic duct

cbd

GB

cystic duct

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2
Q

What ducts emerge from the right lobe of the liver in the porta hepatis?

A

right and left hepatic ducts

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3
Q

What size is the common hepatic duct?

A

approx 4 mm

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4
Q

What joins with the cystic duct to form the CBD?

A

common hepatic duct

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5
Q

What is the measurement of the CBD?

A

< 6mm

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6
Q

Where is the common bile duct in the first part of its course?

A

it lies in the right free edge of the lesser omentum

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7
Q

Where is the CBD in the second part of its course?

A

situated posterior to the first part of the duodenum

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8
Q

The CBD is joined by the main pancreatic duct and together they open though the ____________into the duodenal wall

A

ampulla of Vater

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9
Q

What circular muscle fibers surround the CBD, main pancreatic duct, and the ampulla?

A

Sphincter of Oddi

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10
Q

What is the cystic duct?

A

connects neck of GB with common hepatic duct for form the CBD

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11
Q

What helps prevent kinking of the cystic duct?

A

Heister valve aka spiral valve

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12
Q

Where is the GB found?

A

RUQ - anterior aspect

related to the visceral surface of the liver fossa

pear-shaped sac

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13
Q

Where is the GB found?

A

posterior to the rt lobe of the liver

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14
Q

Is the GB in the intraperitoneal or the retroperitoneal?

A

Intraperitoneal

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15
Q

what are the three segments of the GB?

A

fundus

body

neck

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16
Q

sonographically what is the superior part of the GB?

A

fundus

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17
Q

Where is the fundus?

A

projects below the inferior margin of the liver and comes into contact with the anterior abd wall

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18
Q

Where is the body of GB?

A

lies in contact with the visceral surface of the liver

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19
Q

Where is the neck of the GB?

A

continuous with the cystic duct

which turns to join the right side of the common hepatic duct to form the common bile duct

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20
Q

What are the cellular layers of the GB?

A

outer serosal

subserous

muscular

inner mucosal

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21
Q

What is found in the outer serosal layer of the GB?

A

Rokitanksy - Aschoff sinus

little sections in the GB wall

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22
Q

what does the muscular layer of the GB contract to?

A

Cholecystokinin (hormone that secrets bile) CCK

23
Q

What is the arterial supply of the GB?

A

cystic artery

branch of the rt hepatic artery

24
Q

What is Hartmann’s pouch?

A

when the gallbladder folds back on itself at the neck

gallstones tend to collect here

25
Q

What is the most common variant of the folds in the gallbladder?

A

junctional fold

appears between the body and neck

26
Q

What is phrygian cap??

A

folding of the fundus of the gallbladder

27
Q

Partial septations and folds in the gallbladder are normal variants….true or false?

A

true

28
Q

What is the primary function of the extrahepatic biliary tract?

A

transportation of bile from liver to the intestine

regulation of flow

29
Q

When does concentration of bile in the GB occur?

A

during a state of fasting

30
Q

How does the wall of the gallbladder look when it’s contracted?

A

thickened

31
Q

What happens to the extrahepatic bile ducts after a cholcystectomy?

A

they dilate…usually less than 10mm

patients older than 60 - duct can be up to 10mm and be normal

32
Q

What is the criteria for a sonographic eval of the GB?

A

NPO 8-12 hrs

begin patient supine

second roll patient LLD or upright position
transverse, sag, and oblique scans are made over the upper abd

identify: GB, biliary system, liver rt kidney and head of pancreas

33
Q

What are the indications that a GB scan is needed?

A

RUQ pain

positive Murphy’s sign

pain radiating to shoulder

nausea and vomiting

loss of appetite

jaundice

34
Q

What is the typical wall thickness of the GB wall?

A

< 3mm

35
Q

What is hydrops?

A

dilation of the gallbladder (>5 trv, >10 sag)

not related only to gb

36
Q

when the right and left hepatic ducts merge what does it create?

A

the common hepatic duct

37
Q

the hepatic duct runs ___________ to the portal vein

A

parallel

38
Q

In the third part of its course, the CBD lies where?

A

in a groove on the posterior surface of the head of the pancreas

39
Q

where does the common bile duct end?

A

by piercing the medial wall of the second part of the duodenum

40
Q

The cystic vein drains directly into what?

A

the portal vein

41
Q

What is another name for the normal variant “complete septation” as it refers to the GB?

A

double gallbladder

42
Q

What stimulates the GB to contract and what is the result?

A

the influence of food

resulting: outpouring of bile into the duodenum

43
Q

why would you roll a patient into a steep decubitus or upright position when you suspect stones?

A

to separate small stones from gallbladder wall or cystic duct

44
Q

what is the main lobar fissure?

A

a bright linear reflector within the liver connecting the gallbladder and the right or main portal vein is a reliable indicator of the location of the gallbladder

45
Q

What makes the “Mickey Mouse” sign?

A

common duct, hepatic artery, and portal vein

46
Q

the hepatic artery lies __________ and __________ to the portal vein

A

anterior

medial

47
Q

the CBD lies _________ and ___________ to portal vein

A

anterior

lateral

48
Q

What is bile made of?

A

water

bile salts

and other organic substances

49
Q

What is the bile’s two major functions in the body?

A

breaks down the fats that you can eat so that your body can utilize them

bile is a very powerful antioxidant

50
Q

When you have increased WBC what do you most likely have?

A

cholecystitis

51
Q

When evaluating the lab values for serum bilirubin, unconjugated/indirect what would you be looking for?

A

pre-hepatic or hepatic abnormality

elevates for hematologic disease

52
Q

when considering the lab values for serum bilirubin, conjugated/direct, what clues will it give you?

A

post hepatic abnormality

elevates in hepatocellular disease

elevates for biliary obstruction

53
Q

When you have a biliary obstruction what lab value is elevated?

A

alk phos (ALP)

54
Q

What do AST and ALT lab values indicate?

A

liver disease

55
Q

what is PT?

A

prothrombin time - clotting time

abdomen (11 decks)

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