Sos- Biliary System Flashcards
produce and secrete bile
hepatocytes
___% of bile is stored in the gallbladder
50
R and L hepatic duct join together to form ____
common hepatic duct
cystic duct and common hepatic duct join together to form ______
common bile duct
common bile duct and pancreatic duct empty through this sphincter into ampulla of vater of duodenum
sphincter of oddi
artery that supplies galbladder
cystic artery
what layer of mucosa is not seen in the gallbladder
muscularis mucosa
gallbladder histology
gallbladder comes from what during embryologic development
foregut
digestive hormone released by I cells of duodenum
Cholecystokinin (CCK)
when chyme enters duodenum; and stimulation by HCl, AA’s, or fatty acids entering duodenum
release of CCK
stimulates the gallbladder to contract
CCK
stimulates secretion of pancreatic juice
CCK
____ and ____ act as negative feedback loop blocking acid production
CCK and secretin
secretin’s effect on the pancreas
HCO3- production to neutralize acidic chyme
malformation of extrahepatic biliary ducts
biliary atresia
this is associated with situs inversus or polysplenia/asplenia
biliary atresia
cirrhosis and death within 3 years if no liver transplant performed
biliary atresia
jaundice
enlarged abdomen
pale stool
slow weight gain
biliary atresia
portal triad on bottom left
central vein top right
portal fibrosis and bile duct hyperplasia
what caused this
biliary atresia
trichrome stain of what
portal fibrosis
fibrosis of ducts
what is enlarged and why
gallbladder; due to an obstruction and bile backup
6 week old presents w/ jaundice and large abdomen
biliary atresia
best Rx to cure biliary atresia if available
liver transplant
triangle of Calot borders
top: lower liver margin
lateral: cystic duct
medial: common hepatic duct
what to clamp when removing gallbladder
cystic a. and cystic duct
what does the liver mainly live off of
nutrients from portal vein (20% O2 from hepatic a.)
what to do if pt. has RUQ pain
exam, U.S. labs
elevated Alk Phos can mean what
bone issues or biliary tract damage
labs for biliary tract damage
elevated bilirubin
elevated GGT and ALP
decreased liver fxn lab
decreased albumin
elevated ____ levels during clinical f/u are often liver or bone induced elevations
ALP
biliary disease sx’s
jaundice
RUQ pain that radiates to back
N/V
fatigue
fever
itching
pt has RUQ pain that radiates to back
postprandial pain
cholelithiasis (stone)/biliary colic (sludge)
inflammation to gallbladder due to stones or sludge
acute cholecystitis
RUQ pain that radiates to back
fever, N/V
+ murphy’s sign
acute cholecystitis
inflammation of duct system
cholangitis
abd pain + fever + jaundice (charcot triad)
ascending cholangitis
abd pain + fever + jaundice (charcot triad) + confustion and hypotension
reynolds pentad (for cholangitis)
gallstone that gets trapped in pancreatic duct
gallstone pancreatitis
what makes up biliary sludge
bile, cholesterol, and Ca2+
starts from biliary sludge; sudden RUQ pain that radiates to back; N/V
cholelithiasis (gallstones)
85% of gallstones are made of what; diet induced
cholesterol
radiolucent stone but can be seen with U.S
cholesterol gallstone
blood involved in the stone
black stone (gallstone)
seen in alcoholic liver disease and chronic hemolysis (anemia)
black stones
these stones are radiopaque but still seen on US
black stones
greasy stones seen in parasitic infection
brown stones
the 2 arrows in the circle
top: sludge
bottom: gallstone
compression of common hepatic duct caused by obstruction of cystic duct (no bile coming out of system and liver backup)
Mirizzi Syndrome
sudden RUQ pain due to obstruction from sludge or stone
biliary colic
biliary colic due to obstructed duct
acute cholecystitis
neutrophils seen in this cholecystitis
acute
result of recurrent acute cholecystitis
chronic cholecystitis
chronic inflammation w/ fibrosis and trapped mucosal glands
chronic cholecystitis
Rokitansky-Aschoff sinuses
trapped mucosal glands seen in chronic cholecystitis
lymphocytes and macrophages seen in this cholecystitis
chronic cholecystitis
chronic cholecystitis
inflammation of biliary duct system mainly due to obstruction
cholangitis
obstructed areas
cholangitis
choledocholithiasis
gallstones in common bile duct
complication of chronic cholecystitis when a stone passes through a fistula b/t the gallbladder and small bowel and travels to ileum
gallstone ileus
seen in gallstone ileus
dystrophic calcification of gallbladder wall; may lead to gallbladder cancer if left in
porcelain gallbladder
porcelain gallbladder
porcelain gallbladder
autoimmine attacking of the INTRAhepatic ducts (women in their 50’s)
primary biliary cholangitis
this leads to cirrhosis
primary biliary cholangitis
inflammation that will eventually lead to scarring
primary biliary cholangitis (cirrhosis)
scarring leading to trapped bile in liver and cyst formation
primary biliary cholangitis
chronic inflammatory destruction of INTRA and EXTRAhepatic bile ducts
primary sclerosing cholangitis
fibrosis and blocked ducts trap bile (bead on string) and leads to cirrhosis
primary sclerosing cholangitis
primary sclerosing cholangitis
primary sclerosing cholangitis
cirrhosis
cirrhosis
80% of patients who have primary sclerosing cholangitis will have what
ulcerative cholitis
what has an increased risk of cholangiocarcinoma
primary sclerosing cholangitis
men more than women
bile ducts affected from intra + extrahepatic
80% will have ulcerative cholitis
primary sclerosing cholangitis
women more than men
intrahepatic bile ducts affected
medical treatment offered
primary biliary cholangitis
cancer of biliary duct system
cholangiocarcinoma
biliary disease and cholangiocarcinoma
risk factors include:
primary sclerosing cholangitis
smoking
age>50
chronic liver disease
cholangiocarcinoma
uncommon
female predominance
60-70 yrs of age
gallbladder adenocarcinoma
gallbladder adenocarcinoma
