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abd / ss > Module 4 : The Biliary System > Flashcards

Module 4 : The Biliary System Flashcards

1
Q

The biliary tree path

A

lobules (bile canaliculi) - lobular bile ducts - right and left hepatic duct - common hepatic duct + cystic duct - common bile duct

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2
Q

bile canaliculi

A
  • located between the hepatocytes
  • intercommunicating network
  • anastomose to form lobular bile ducts
  • travel with portal vein and hepatic artery (portal triad)
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3
Q

right and left hepatic duct

A
  • formed by union of multiple lobular bile ducts

- at level of porta hepatis right and left join to form common hepatic duct

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4
Q

common hepatic duct

A
  • anterior to the portal vein
  • anterior and lateral to right hepatic artery
  • travels in free edge of lesser omentum
  • 4 mm diameter
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5
Q

common bile duct

A
  • length determined by insertion point
  • anterior and lateral to main portal vein’
  • 4mm through 40’s then add 1mm/10yrs
  • 10mm normal with cholecystectomy
  • ## TRAVELS THROUGH HEPATODUODENAL LIGAMENT
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6
Q

mickey mouse

A

CBD anterolateral HA anteromedial MPV posterior

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7
Q

4 segments of CBD

A
  • 1st (supraduodenal)
  • 2nd (retroduodenal)
  • 3rd (infra duodenal)
  • 4th (intraduodenal)
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8
Q

intraduodenal segment of CBD

A
  • 4th part
  • enters 2nd portion of duodenum and inserts into ampulla of Vater
  • narrowest portion of extrahepatic biliary tree
    + where stones like to sit
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9
Q

sphincter of oddi

A
  • regulates bile for into duodenum
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10
Q

cystic duct

A
  • joins CHD 1-2cm above duodenum to form CBD
  • arise from superior aspect of tech of GB
  • s shaped
  • 3mm diameter 4cm in length
  • contain spiral valves of heister
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11
Q

spiral valves of heister

A
  • not true valves
    + mucosal folds
  • prevent duct from over distending or collapsing
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12
Q

intrahepatic ducts

A
  • within the liver
  • no more than 2mm in diameter
  • branching pattern
  • portal veins are landmarks for them
  • TOO MANY TUBES = INTRAHEPATIC DUCT DILATION
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13
Q

gallbladder location

A
  • posterior inferior surface of right lobe of liver
  • GALLBLADDER FOSSA
  • posterior and caudal to distal end of MLF
  • intraperitoneal
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14
Q

GB position

A
  • variable with patient position
  • neck of GB fixed
  • body and fundus are mobile
  • neck most dependent in supine fundus most dependent in LLD
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15
Q

landmarks for GB

A
  • MAIN LOBAR FISSURE = most reliable
  • rpv
  • duodenum
  • right kidney
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16
Q

size and shape of GB

A
  • pear/tear drop shape

- 8-9cm in length and 2-5cm in diameter

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17
Q

divisions of GB

A

fundus, body, neck

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18
Q

fundus of GB

A
  • widest portion

- MOST DEPENDENT IN LLD

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19
Q

body of GB

A
  • middle portion

- aka corpus

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20
Q

neck of GB

A
  • tapered portion
  • fixed position
  • MOST DEPENDENT IN SUPINE
21
Q

gallbladder wall

A
  • in FASTING STATE LESS THAN 3mm
  • 4 layers
    + mucosa
    + muscular layer
    + subserous layer
    + serous layer
22
Q

mucosa layer

A
  • inner epithelial lining

- concentrates bladder

23
Q

muscular layer

A
  • muscle
24
Q

sub serous layer

A
  • connective tissue
25
Q

serous

A
  • outer layer = in contact with peritoneum
26
Q

Rokitansky - Aschoff sinuses (RA sinuses)

A
  • multiple folds along inner border of GB coated with epithelial cells
  • not seen unless pathology
27
Q

function of biliary ducts

A
  • drain liver of bile and carry to GI system
28
Q

function of GB

A
  • reservoir for bile
    + stored until required to aid in digestion
    + holds 40-70ml
    + concentrates bile by secreting mucus and absorbing water
29
Q

hormone control of bile secretion

A
  • ingestion of fats and amino acids duodenum releases CCK (cholecystokinin)
30
Q

Cholecystokinin (CCK)

A
  • released by duodenum with ingestion of fats and amino acids
  • stimulates GB to contract and sphincter of oddi to relax
31
Q

GB contraction time

A
  • contracts 30 minutes following a meal
32
Q

bile

A
  • yellowish green liquid produced and secreted by hepatocyte
  • consists of water, cholesterol, bilirubin, inorganic salts, bile acid
  • breaks down fat and absorb fatty acids
33
Q

bile salts

A
  • 1gram of bile salts/day in liver
  • cholesterol is precursor of bile salts
    + supplied by diet or synthesized by liver
34
Q

bilirubin

A
  • end product of hemoglobin decomposition
  • bile pigment
  • conjugates in liver
35
Q

jaundice/icterus

A
  • yellowish tint seen in body tissue due to large quantities of bilirubin
36
Q

blood supply to GB

A
  • arterial blood supply from cystic artery

- venous drainage occurs via cystic vein drains directly into portal vein

37
Q

GB variants

A
  • junctional fold
  • Hartmans pouch
  • phyrgian cap
  • septations
  • excessively mobile
  • ectopic
  • low lying
  • embedded in liver
38
Q

junctional fold

A
  • occurs at junction of BODY AND NECK

- similar look as septation

39
Q

Hartmans pouch

A
  • OUTPOUCHING in area of GB neck
40
Q

phyrigian cap

A
  • GB partially folded onto itself in region of FUNDUS
41
Q

sonographic appearance of GB

A
  • anechoic or nearly anechoic
  • thin echogenic walls
  • sagital pear shaped
  • trans is circle
42
Q

GB exam

A
  • px in supine and decubitus to move stones
  • size, shoe, wall thickness, and fluid
  • liver as wind to minimize reverb
  • LPO good for measure CBD
  • measure duct INNER TO INNER
    + distal to HA
43
Q

lab tests

A
  • bilirubin
  • alkaline phosphatase
  • leukocytes
  • HIDA scan
  • ERCP
44
Q

bilirubin

A 
- indirect = increased values
   \+ hemolysis
   \+ RBC degradation
   \+ abnormal hepatocellural uptake
- direct = increased values
   \+ extra hepatic obstruction
   \+ bile duct disease
   \+ intraheptaic disruption
45
Q

alkaline phosphatase (alk phos)

A
  • increased value in EXTRAHEPATIC BILIARY OBSTRUCTION
46
Q

leukocytes

A
  • MEASURES REACTION OF BODY TO INFECTION

-

47
Q

HIDA scan

A
  • nuke med test

- ASSES GB FUNCTION

48
Q

ERCP

A
  • like fluoroscopy

- asses for obstruction

abd / ss (14 decks)

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