Biliary System (Gallbladder)

Front 1

The gallbladder is _____peritoneal.

Back 1

intra

Front 2

The gallbladder is situated in the _________ of the right liver lobe.

Back 2

gallbladder fossa

Front 3

The gallbladder is located on the _______ surface of the liver.

Back 3

posterior-inferior

Front 4

You can locate the neck of the gallbladder by following the __________.

Back 4

Main Lobar Fissure

Front 5

Name the four layers of the gallbladder.

Back 5

outer serosal layer (visceral peritoneum)
subserous layer
muscular layer
epithelial layer

Front 6

What is the approximate length of the gallbladder?

Back 6

7-10 cm long, usually about 8 cm in length

Front 7

What is the approximate width of the gallbladder?

Back 7

3-5 cm

Front 8

Name the 3 segments of the gallbladder.

Back 8

Fundus
Body
Neck

Front 9

Name the 3 main biliary system functions.

Back 9

concentrates bile
*stores concentrated bile
*transports bile through the *ducts from the liver to the GB and then to the duodenum

Front 10

What does bile do?

Back 10

Bile emulsifies ingested fat and aids in fat absorption.

Front 11

What does bile contain?

Back 11

*bile salts
*cholesterol
*amino acids
*conjugates of steriod hormones

Front 12

Bile is released when the ____ contracts and the _____ relaxes.

Back 12

gallbladder, Sphincter of Oddi

Front 13

What hormone causes the gallbladder to contract and the Sphincter of Oddi to relax?

Back 13

cholecystokinin

Front 14

What will stimulate the release of cholecystokinin?

Back 14

food entering the duodenum (especially fatty foods)

Front 15

Bile will flow if intraductal pressure is _____ than hepatic secretory pressure.

Back 15

less

Front 16

What affects hepatic secretory pressure?

Back 16

*activity of the sphincter at the distal end of the CBD
*GB filling and resorption of bile in the GB
*bile flow from the liver

Front 17

The gallbladder's smooth thin walls usually measure ____.

Back 17

1-2 mm in thickness, should not measure more than 3 mm

Front 18

How do you measure the gallbladder?

Back 18

TRV, AP, anterior wall only
outer to inner
center of the screen
normal GB wall measures less than 3 mm

Front 19

Name 4 normal variants of the GB.

Back 19

*junctional fold
*Hartman's pouch
*phrygian cap
*septation

Front 20

What is the most common normal variant of the gallbladder?

Back 20

junctional fold

Front 21

Junctional Fold

Back 21

When the GB folds in on itself.
Located between the body and the neck of the GB.

Front 22

Another name for the Hartman's Pouch

Back 22

infundibulum

Front 23

Hartman's Pouch

Back 23

GB folds back on itself at the neck.
A small sacculation (outpouching).
Stones ofter collect here.

Front 24

A complete septation is also known as _____.

Back 24

a double GB

Front 25

What supplies blood to the GB?

Back 25

cystic artery, a branch of the right hepatic artery

Front 26

What drains the gallbladder?

Back 26

cystic vein, it drains directly into the portal vein

Front 27

Name the 3 major biliary ducts.

Back 27

*cystic duct
*common hepatic duct
*common bile duct

Front 28

How are biliary ducts divided?

Back 28

into intrahepatic and extrahepatic ducts

Front 29

In the liver parenchyma (intrahepatic), the bile ducts follow the same course as the _______.

Back 29

portal venous and hepatic arterial branches. ie, Mickey Mouse sign.

Front 30

The right and left bile ducts lie ____ to the portal vein.

Back 30

anterior

Front 31

The hepatic artery usually lies ___ to the portal vein, however, the left hepatic vein is often _____ to the Left Portal Vein.

Back 31

anterior, posterior

Front 32

True or False: Outside of the liver (extrahepatic), the common ducts (CHD, CBD) do not follow the same course as the hepatic artery and portal vein branches.

Back 32

True

Front 33

____ emerge from the liver at the porta hepatis and unite to form the CHD.

Back 33

Right and left hepatic ducts

Front 34

The common hepatic duct is joined by the cystic duct to form the ____.

Back 34

common bile duct

Front 35

The common bile duct courses _____ through the head of the pancreas.

Back 35

posterior

Front 36

The common bile duct joins with the main pancreatic duct at the ________ and enters the second portion of the duodenum.

Back 36

ampulla of Vater

Front 37

The Ampulla of Vater is also known as _____.

Back 37

hepatopancreatic ampulla

Front 38

The Ampulla of Vater is formed by _____.

Back 38

the union of the pancreatic duct and the CBD

Front 39

What is the opening of the duodenum?

Back 39

The Ampulla of Vater

Front 40

Sphincter of Oddi

Back 40

a muscular valve that controls the flow of digestive juices through the ampulla of Vater into the 2nd part of the duodenum.

Front 41

What are abnormal measurements of the ducts?

Back 41

anything more than:
4 Cystic
6 Common Hepatic
8 Common Bile

Front 42

Duct that drains the GB

Back 42

cystic

Front 43

The cystic duct joins the common hepatic duct to form the ______.

Back 43

common bile duct

Front 44

average length of the cystic duct

Back 44

2-6 cm

Front 45

The cystic duct contains internal mucosal folds, also known as _______.

Back 45

spiral valves of Heister

Front 46

What is the normal AP diameter of the Cystic Duct?

Back 46

2-4 mm is normal, above 4 mm is abnormal

Front 47

Function of the spiral valves of Heister

Back 47

to prevent cystic duct from overdistending or collapsing

Front 48

What is the average AP diameter of the common hepatic duct?

Back 48

4 mm, any measurement less than 6 is considered normal

Front 49

The common bile duct is formed by the junction of the _____ and ______.

Back 49

common hepatic duct, cystic duct

Front 50

When are CHD and CBD seen sonographically?

Back 50

extrahepatically

Front 51

How do you differentiate ducts from vessels?

Back 51

*intrinsic pulsations of arteries
*absence of blood flow in ducts
*follow structure back to its origin

Front 52

If the duct is close to the liver.

Back 52

proximal

Front 53

If the duct is near the pancreas head and duodenum.

Back 53

distal

Front 54

If the duct is in the area of the hilum or porta hepatis.

Back 54

central

Front 55

List the 4 lab values.

Back 55

*WBC
*serum bilirubin
*alk phos
*LFTs

Front 56

What LFTs?

Back 56

SGOT/AST
SGPT/ALT
prothrombin time (PPT)

Front 57

An increased WBC would indicate _____.

Back 57

*inflammation of the GB wall cholecystitus
*injury to the bile ducts

Front 58

An increase in serum bilirubin would indicate _____.

Back 58

*cholecystitus
*injury to bile ducts
*GB carcinoma
*internal biliary fistula
*retained bile duct stones

Front 59

Increased ALP indicates _____.

Back 59

obstruction of post-hepatic jaundice

Front 60

AST and ALT both contain ________.

Back 60

transferase