The gall bladder and biliary tree (Dave's notes) Flashcards
Describe the shape, volume and components of the gall bladder
Globular pear shaped viscus of 50mL approx, consisting of fundus, body and neck
What are the relations of the gall bladder?
Liver anteriorly, anterior abdominal wall to the bulbous part (TPP/Rt costal margin, commencement of TC??), D1 to the body of the gall bladder
Describe the cystic duct with lenght and distance to significant structures
The neck of the gall bladder continues into the cystic duct (2-3cm/2-3mm), which travels towards teh porta to join the common hepatic duct 1cm above the duodenum
What is the blood supply of the gall bladder?
Cystic artery which is a branch of the right hepatic. Found in Calot’s triangle. The cystic artery is an end artery but the gall bladder can ve sustained by supply from the bed.
What constitutes the borders of Calot’s triangle?
Liver, common hepatic duct, cystic duct.
Describe the venous drainage of the gall bladder
??? I thought all via bed but dave says via veins running from the neck to the right branch of the portal vein
Describe the lymphatic drainage of the gall bladder
To porta hepatis nodes, cystic node in calots triancle, epiploic foramen node, coeliac group and then to preaortic nodes
What and where is mucous secreted in the gall bladder?
Mucous is secreted by columnar epithelium (not goblet cells) in the neck
Describe the confluence of the common hepatic duct
R and left hepatic ducts emerge from the porta hepatis uniting on the right side in a Y shaped manner.
What are the dimensions of the common hepatic duct?
4cm long and 4mm in diameter
Where does the cystic duct meet the common hepatic duct?
The cystic duct usually meets the common hepatic duct on the right side about 1cm above the duodenum but there is significant variation
Describe the dimensions of the common bile duct
8cm long and 8mm diameter.
What is the blood supply of the common bile duct?
Branches of the cystic, hepatic and gastroduodenal arteries
What are the three divisions of the common bile duct?
Upper (supraduodenal), middle (retroduodenal) and lower (paraduodenal).
What are the relations of the upper/supraduodenal segment of the common bile duct?
The supraduodenal segment of the common bile duct lies in the free edge of the lesser omentum, anterior to the portal vein and right of the hepatic artery
What are the relations of the middle/retroduodenal segment of the common bile duct?
The retroduodenal segment of the common bile duct runs behind D1 and slopes down to the right away from the portal vein
What are the relations of the lower/paraduodenal segment of the common bile duct?
The paraduodenal segment slopes further to teh right behind the head of the pancreas and D2, joinging the pancreatic duct
What is the nerve supply of the gall bladder?
Sympathetic and parasympathetic.
What is the origin and action of the parasympathetic supply to the gall bladder?
The parasympathetic supply to the gall bladder is via the hepatic branch, and stimulates contraction
What is the origin and action of the sympathetic supply to the gall bladder?
?? Origin, inhibits contraction
What provides the majority of control over the gall bladder?
Hormonal control
Where is biliary pain felt?
Usually in the right hypochondrium and epigastrium, but may radiate to the back and infrascapular region
