Hepatobiliary System

Question 1

The hepatobiliary system is made up of :

Answer 1

liver, gallbladder, pancreas, biliary tree

Question 2

what is the larges organ in the body ?

Answer 2

liver

Question 3

what quadrant is the liver located in ?

Answer 3

RUQ

Question 4

what keeps the liver in position?

Answer 4

peritoneal ligaments, intraabdominal pressure from the m. of the abdominal wall

Question 5

Functions of the liver (4)

Answer 5

metabolism - particuls via portal vein synthesis - clotting factors storage - vita B and other materials detoxification

Question 6

what two structures supply blood to the liver?

Answer 6

hepatic artery portal vein

Question 7

hepatic artery

Answer 7

brings in O2 blood to the liver originates from the celiac axis

Question 8

portal vein

Answer 8

return venous blood from the abdominal viscera to IVC formed by union of the superior mesenteric and splenic veins

Question 9

define biliary stystem

Answer 9

system of ducts that drain bile produced in the liver to the duodenum

Question 10

the liver right and left lobes are drained by what.. and what is being drained ?

Answer 10

bile right and left hepatic duct

Question 11

what do the right and hepatic ducts join to form

Answer 11

common hepatic duct

Question 12

common bile duct is formed by what

Answer 12

cystic duct and common hepatic duct

Question 13

what joins the common hepatic duct into the medial aspect of the duodenum ?

Answer 13

pancreatic duct (from the head of the pancreas

Question 14

ampulla of vader

Answer 14

short part of the common bile duct (after junction with pancreatic duct) just before entering the duodenum

Question 15

sphincter of oddi

Answer 15

regulates flow of bile and pancreatic juice into duodenum

Question 16

what triggers the release of bile into duodenum?

Answer 16

cholecystokinin

Question 17

;what is cholecystokinin

Answer 17

hormone released by the presence of fatty foods in the stomach. purpose is to emulsify fats to that they may be absorbed

Question 18

Gallbladder:

define

location

function

linning of the gallbladder and measurements

Answer 18

digestive organ

undersurface on right lobe of liver

sole function -store and concentrate bile (produced in liver)

recieves it via the hepatic duct - empties into duodenum

linning should be thin— inflammation may cause thickening

<3mm norm. >10cm

Question 19

Pancrease

define

locate

function

Answer 19

long flat powerful digestive organ

left side of abdomen, behind stomach

exocrine, endocrine, digestion

Question 20

exocrine function of pancrease

(3) enzymes

Answer 20

exocrine - producing enzymes that aid in digestion

Trypsin - digest proteins

Amylase - catabolize starch –maltose

Lipase- catabolize lipid, glycerol

Question 21

Endocrine function of Pancrease

cell classification

Answer 21

islets of langerhans

alpha cells - glucagon

beta cells - insuln , storing glucose ( liver and m.) breaking down glucose

released directly into blood

regulate carb and lipid metabo

Question 22

hyperglycemic

(explain body homeostasis mech)

hypoglycemic

Answer 22

insulin relased form pancreas via portal vein

glucagon is released stim liver to break down glycogen into glucose

Question 23

what are gallstones composed of?

how do they show on radiograph?

Answer 23

cholesterol, bilirubin, ca2 salts, milk of ca ( sludge

Question 24

ERCP

Answer 24

endoscopic retrograde cholangiopancreatogram

duodudenum c-loop - visual of ampulla of vater with contrast

proceeded with US or CT

Question 25

PTC

Answer 25

percutaneous transhepatic cholangiography

visualise billiary tree

puncure abdomen

Question 26

what procedure is used to detect biliary caliculi

Answer 26

operative cholangiography

needle placed into cystic or common bile duct

contrast injection and radiograph

and then repeated

**air bubbles can mimic stones

Question 27

T tube angiography

Answer 27

check patency of common bile duct

check calculi

Question 28

What is the modality of choice for imaging gallbladder and biliary tree?

Answer 28

US

noninvasive

Pt fasting

Question 29

how do gallstones apperar on US ?

Answer 29

echogenic

gallbladder is anechoic ?

Question 30

What does doppler do to enhance US of hepatobiliary system

Answer 30

shows blood folw to indicate abnomalaties

cicrulatory dynamics folowing liver Tx-

portal blood flow

hepatic artery thrombosis following

differenciates between blood floow and biliary flow based on characteristics

Question 31

Other patologies detected by US ?

(6)

what do echogenic structures facilitate ?

Answer 31

common bile duct obstructions

eval of intrahepatic biliary ductal system

id of absesses 1cm

cystic lesions -anechoic

solid masses echogenic

liver -hepatic lesions

—-asperation and biopsy—-

Question 32

computed tomography is used for what

Answer 32

following malignancies and following masses

eval complications of cholesystites

Question 33

cholecystitis complications:

Answer 33

perferations and absess formations

Question 34

SPECT

Answer 34

single photon emission tomography

dection of hepatobiliary lesions

eval function and anatomical

Question 35

spell the functional portion of visceral organ

Answer 35

p-a-r-e-n-c-h-y-m-a

Question 36

what to nuc med and CT provide togeather

Answer 36

best method for early detection of pathology

Question 37

cholescintigraphy

Answer 37

nuc med procedure

confirm acute from chronic cholecysitis

visualize biliary dranage

hepatobiliary leaks

segmental obstruction

and trauma or surgery

Question 38

role of MRI in hepatobiliary system

Answer 38

acqusiton of total liver in one breath

peritoneum and retroperitoneal stuctures

diferentate tumors form hemangiomas

Question 39

Alaholic induced liver pathologies

Answer 39

fatty liver

hepatitis

cirrhosis

hepatocellular carcinoma

liver converts alchol into oxidized forms and prevents carb and lipid metabo

reduced gluconeogenesis

Question 40

alcohol induced fatty liver

Answer 40

changes in liver function

tryglicerides deposited in hepatocytes

hepatomegaly

fatty infiltration demonstrated in US/ CT -hypodence

Question 41

alcohol hepatitis

Answer 41

prsent with jaundice

liver necrosis

progresses to cirrhosis

Question 42

Fatty liver

NAFLD

Answer 42

Pre conditions —–obese

type II

hyperlipidemia

metobalitic disease

lipids accumilate in hepatocytes – free radicals

cannot dispose of triglicerides

leads to fatty infiltration of liver

Question 43

steatosis

Answer 43

fatty infltration of the liver

Question 44

Cirrhosis

Answer 44

cirr-ho-sis

chornic liver condition - liver parenchyma and functional anatomical structures are destroyed– fibrous tissue formes

end-stage condition caused by

drugs, alcohol autoimmune metabolic and genetic hepatitis cardiac problems and chronic biliary obstruction

Question 45

functional imparments caused by liver cirrhosis

Answer 45

jaundice

portal hypertension

esophageal varices

tendency to bleed - lack of clotting factors

Question 46

Ascites

Answer 46

accumulation of fluid within the peritoneal cavity

result of portal hypertension

leakage of fluids form capilaries (portal)

US is used for confirmation and guide paracentesis to remove fluid *

Question 47

US doppler is used to detect

Answer 47

portosystemic collateral circulation

size of portal vein

.64cm- 1cm (adult)

>1.3cm indicates portal hypertension

Question 48

normal portal vein flow is

Answer 48

to the liver

in portal hypertension it is shunted away, goes to splenic vein –causing splenic varieces

Question 49

US aids in the eval of what with portal hypertension

Answer 49

splenic and mesenteric veins

Dx via biopsy of liver