UNIT 2: GI Accessory Organs and Biliary Flashcards
Liver and Biliary System are located in the
RUQ/R Hypochondrium and Epigastric regions
Lobes of the liver
-Four (4) Lobes
Left Lobe
Right Lobe
Caudate lobe
Quadrate lobe
Liver Hilum (porta hepatis) is an entry/exit point for
-Portal vein
-Hepatic artery
-Biliary Tree
Functions of the Portal System
-Drains blood from digestive tract
-Metabolizes nutrients and medications in the liver
-Hepatic veins convey blood from the liver to the IVC
Functions of the Liver
-Clears blood of drugs and harmful substances
-Produces Bile
-Aids in the digestion and break down of fatty foods
-Stores and releases glucose
-Both an excretion AND a secretion
-Secretion: aids in the emulsification of fats
-Excretion: aids in the removal of waste products from red blood cell production (Bilirubin)
A function of bile is to
Emulsify fats
Secretion vs Excretion
-Secretion: aids in the emulsification of fats
-Excretion: aids in the removal of waste products from red blood cell production (Bilirubin)
The Biliary System
-Bile ducts and gallbladder
-Hepatic Ducts (right and left)
-Common Hepatic Duct
-Cystic Duct
-Common Bile Duct
-Pancreatic Duct
-Hepatopancreatic ampulla/Ampulla of Vater
The Gallbladder
-Narrow neck, body, fundus
-Concentrates bile through absorption of water
-Stores bile for digestion
-Contraction activated by hormone
-Cholecystokinin (CCK) that is secreted by the duodenum in response to ingestion of fats
Where is bile stored for digestion?
Gallbladder
Contraction activated by which hormone
cholecystokinin (CCK)
cholecystokinin (CCK) is
a hormone secreted by the duodenum in response to ingestion of fats
Body Habitus
-Asthenic: very slender
-Hyposthenic: intermediate between asthenic and sthenic
-Sthenic: moderate heavy build
-Hypersthenic: large build
The Pancreas
-Head, neck, body, and tail
-Head is enclosed in the curvature of the duodenum
-Exocrine and endocrine gland
-Exocrine: produces digestive enzymes
-Endocrine: produces insulin and glucagon
Exocrine vs Endocrine Glands in the Pancreas
Exocrine: produces digestive enzymes
Endocrine: produces insulin and glucagon
The Spleen
-Lymphatic organ
-Stores lymphocytes and stores/removes dead red blood cells
-Located in the left upper quadrant below the diaphragm and retrogastric
____________ has become the modality of choice for the gallbladder
Sonography
Cholegraphy is the
radiographic study of the biliary system
Cholecystography is the
radiographic study of the gallbladder
Cholangiography is the
radiographic study of the biliary ducts
Common procedures for Diagnostic Radiology
-Percutaneous Transhepatic Cholangiography (PTC)
-Postoperative (T-tube) Cholangiography
-Endoscopic Retrograde Cholangiopancreatography (ERCP)
-Intraoperative Cholangiogram (IOC)
Percutaneous Transhepatic Cholangiography (PTC)
-Patient admits to hospital with acute symptoms
Jaundice
Pain in upper right quadrant
Nausea/vomiting
-Imaging reveals blockage of the biliary ducts
-Patient placed supine on table and right abdomen surgically prepped
-Local anesthetic (Lidocaine)
-Chiba needle is inserted through the right lateral intercostal space and advanced to the hilum of the liver
-Water-soluble iodinated contrast is injected under fluoro or CT guidance
-Often a drain can be placed in the biliary tree in order for excess bile and fluid build-up to drain
-Drain will be left in place until patient goes to operating room to have gallbladder removed
Post-operative Cholangiography (T-tube)
-Patient who has had gallbladder removed has a drain left in place from surgery
-Severe infection of the biliary system
-Drain left in place until infection clears
-Drain is clamped prior to procedure (24 hours)
-Patient is NPO before the exam
-Cleansing enema may be administered the day of the exam
-25-30% concentrated Water-soluble iodinated contrast is injected into T-tube drain
-Images taken in AP, RPO, and Lateral positions to evaluate
-Caliber and patency of ducts
-Status of the sphincter of the hepatopancreatic ampulla
-Presence of residual stones or sludge
Endoscopic Retrograde Cholangiopancreatography (ERCP)
-Patient is most likely under general anesthesia either in Radiology suite or an Endoscopy suite
-Fiberoptic endoscope passed through the mouth into the duodenum under fluoro guidance
-Ampulla of Vater located and physician inserts a catheter
-Contrast is injected retrograde to fill the biliary system
-Stones may be removed via a balloon or basket
-Stents may be placed in the biliary ducts to ensure patency of ducts if infection or a mass is present
Intraoperative Cholangiogram (IOC)
-Patient has been diagnosed with gallstones or infection of the biliary system
-Images taken with the C-arm during Laparoscopic or Open Cholecystectomy
-Catheter inserted into the cystic duct and clamped into place
-Contrast is injected to visualize ductal system
-Ensure ducts are clear of stones and sludge
-Evaluate patency of Ampulla of Vater
-Stones may be removed and cholangiogram repeated until clear
Abdominal Fistulae and Sinuses
-A fistula is an abnormal connection between 2 body parts or to the outside of the body
-A sinus is an abnormal channel leading to an abscess
-Can occur after abscess or surgery on any area of the body
-For fistulas involving the colon, a water-soluble iodinated contrast enema can be done
-For fistulas involving the small bowel, the patient may ingest either thin barium or water-soluble contrast
-For the bladder, a cystogram may be performed using iodinated contrast media
What divides the right and left lobe of the liver?
Falciform ligament
What are the two minor lobes located on the medial side of the right lobe of the liver?
-caudate lobe on the posterior surface
-quadrate lobe on the inferior surface
The hilum of the liver is also called the
Porta hepatis
The common bile duct and the pancreatic duct join together and enter into the
Ampulla of vater (hepatopancreatic ampulla)
The spleen is part of of what system in the body?
Lymphatic
What veins convey the blood from the liver sinusoids to the inferior vena cava?
Hepatic
The two main hepatic ducts join to form the
Common hepatic duct
The structures that join together to form the common bile duct are the
Cystic duct and common hepatic duct
the ____________________ joins the ___________________ and they enter together into the ampulla of vater (hepatopancreatic ampulla)
common bile duct, pancreatic duct
The distal end of the common bile duct is controlled by the
Choledochal sphincter
The Ampulla of vater (hepatopancreatic ampulla)is controlled by the
Sphincter of the hepatopancreatic ampulla aka sphincter of oddi
The hepatopancreatic ampulla is also known as the
ampulla of vater
