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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
What is Hartmann's pouch?
when the gallbladder folds back on itself at the neck gallstones tend to collect here
25
What is the most common variant of the folds in the gallbladder?
junctional fold appears between the body and neck
26
What is phrygian cap??
folding of the fundus of the gallbladder
27
Partial septations and folds in the gallbladder are normal variants....true or false?
true
28
What is the primary function of the extrahepatic biliary tract?
transportation of bile from liver to the intestine regulation of flow
29
When does concentration of bile in the GB occur?
during a state of fasting
30
How does the wall of the gallbladder look when it's contracted?
thickened
31
What happens to the extrahepatic bile ducts after a cholcystectomy?
they dilate...usually less than 10mm patients older than 60 - duct can be up to 10mm and be normal
32
What is the criteria for a sonographic eval of the GB?
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
What are the indications that a GB scan is needed?
RUQ pain positive Murphy's sign pain radiating to shoulder nausea and vomiting loss of appetite jaundice
34
What is the typical wall thickness of the GB wall?
< 3mm
35
What is hydrops?
dilation of the gallbladder (>5 trv, >10 sag) not related only to gb
36
when the right and left hepatic ducts merge what does it create?
the common hepatic duct
37
the hepatic duct runs ___________ to the portal vein
parallel
38
In the third part of its course, the CBD lies where?
in a groove on the posterior surface of the head of the pancreas
39
where does the common bile duct end?
by piercing the medial wall of the second part of the duodenum
40
The cystic vein drains directly into what?
the portal vein
41
What is another name for the normal variant "complete septation" as it refers to the GB?
double gallbladder
42
What stimulates the GB to contract and what is the result?
the influence of food resulting: outpouring of bile into the duodenum
43
why would you roll a patient into a steep decubitus or upright position when you suspect stones?
to separate small stones from gallbladder wall or cystic duct
44
what is the main lobar fissure?
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
What makes the "Mickey Mouse" sign?
common duct, hepatic artery, and portal vein
46
the hepatic artery lies __________ and __________ to the portal vein
anterior medial
47
the CBD lies _________ and ___________ to portal vein
anterior lateral
48
What is bile made of?
water bile salts and other organic substances
49
What is the bile's two major functions in the body?
breaks down the fats that you can eat so that your body can utilize them bile is a very powerful antioxidant
50
When you have increased WBC what do you most likely have?
cholecystitis
51
When evaluating the lab values for serum bilirubin, unconjugated/indirect what would you be looking for?
pre-hepatic or hepatic abnormality elevates for hematologic disease
52
when considering the lab values for serum bilirubin, conjugated/direct, what clues will it give you?
post hepatic abnormality elevates in hepatocellular disease elevates for biliary obstruction
53
When you have a biliary obstruction what lab value is elevated?
alk phos (ALP)
54
What do AST and ALT lab values indicate?
liver disease
55
what is PT?
prothrombin time - clotting time

abdomen (11 decks)

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