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82 Cards in this Set
- Front
- Back
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The biliary system includes:
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* right & left hepatic ducts (intrahepatic)
* CHD * CBD * GB * Cystic duct |
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Where does the gallbladder lie?
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* in the RUQ of the abdomen
* on the posterior surface of the liver * on the caudal end of the main lobar fissure between the rt/lt/ hepatic lobes * in the gallbladder fossa lateral to the 2nd part of the duodenum |
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Is the gallbladder a vital organ?
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NO
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Is the GB interperitoneal or intraperitoneal?
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Intraperitoneal
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How does the GB aid in digestion?
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*it collects, stores, concentrates and transports bile to the intestines
*promotes fat absorption *regulates pressure w/in the biliary tract |
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What is bile?
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* It is the product of broken-down RBC, that are worn out or defective.
* It facilitates the actions of Lipase. |
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What is Lipase?
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breaks down fats and aids in fat digestion
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What are major segments of the GB?
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fundus, body, neck
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Describe the fundus
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* it is the hemispheric blind end, may be anterior to the superior pole of the rt. kidney
* extends caudally, projecting below the inf. margin of liver * may extend as low as the RLQ & as far lt. as the lt anterior axillary line |
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Describe the body
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* varied position between fundus & neck
* lies in contact w/ the visceral surface of the liver * directed upward, bkward, and to left |
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Describe the neck
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* narrow tube like structure that tapers, fixed in it's position in the MLF
* lies to rt of the porta hepatis * may fold bk on itself |
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What is a Hartman's pouch?
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* The GB neck folds back on itself forming funnel-shaped passage.
* small diverticulum found between the junctional fold and neck |
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Name the internal structures of the GB.
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1. inner surface - epithelial mucosa with folds
2. middle layer - muscular 3. a subserous layer 4. outer subserosal surface (Adventitia) |
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Why does the GB vary in size?
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Varies based on amount of bile it is storing.
Storage capacity of 30-60 ml. |
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Average diameter, length, and shape.
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3-4 cm in diameter
7-10 cm long (length wise to organ) pear shaped, teardrop walls no more than 2mm thick |
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What changes the thickness of the wall?
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The walls vary in thickness based on whether or not the patient has eaten and released stored bile.
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Where should the GB wall be measured?
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measure the anterior wall
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What is the GB an accessory organ to?
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the digestive system
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What manufactures bile?
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the liver
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What is bile?
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a fat emulsifier and a carrier of liver waste and is stored and concentrated in the GB
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How does the bile travel?
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via the bile ducts to the small intestine when needed to aid in digestion
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What does the gallbladder regulate?
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biliary pressure
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What chemical triggers the release of bile?
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cholecystokinin
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Where is bile produced? What cells?
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it is produced continually by the hepatic parenchymal cells
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What does bile facilitate?
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the actions of lipase (pancreatic enzyme)
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What role does the cystic duct play in transport?
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The cystic duct drains the GB and joins the common hepatic duct to form the CBD.
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What does the GB do at the completion of a meal?
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The GB will contract squeezing the bile out to flow through the Ductal system to the small intestine to aid in digestion
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Describe the cystic duct.
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* 2-6 cm. long
* arise from sup. aspect of GB neck * S shaped |
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What are the valves of Heister?
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* spiral valves located in the lumen of the cystic duct/ mucosal folds
* control the inward/outward flow of bile and help keep duct from kinking * prevent collapse or over distention due to sudden positional changes |
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How are the bile ducts divided and what do they form?
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Divides into the intrahepatic and extrahepatic ducts, then join to form the right and left main hepatic ducts.
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What forms the right and left main hepatic ducts?
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The division of the intrahepatic and extrahepatic ducts.
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What do the intrahepatic bile ducts do?
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run along side hepatic arteries & accompany portal veins in the portal triads
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Where are the portal triads located?
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they radiate through the lobes and segments of the liver
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What ducts combine to form the Common Hepatic Duct?
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The right & left main ducts that emerge from the porta hepatis.
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What forms the Common Bile Duct?
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The joining of the Common Hepatic Duct and the cystic duct.
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What is superior to the CBD?
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The GB
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An alternate location of the CBD....may also lie ___ to GB.
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posterior
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The CBD is __ _____ to the CHA.
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right lateral
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The CBD is anterior to the
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portal vein
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The CBD courses _______ ______ towards the pancreas
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inferiorly medial
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What forms the right and left main hepatic ducts?
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The division of the intrahepatic and extrahepatic ducts.
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What do the intrahepatic bile ducts do?
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run along side hepatic arteries & accompany portal veins in the portal triads
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Where are the portal triads located?
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they radiate through the lobes and segments of the liver
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What ducts combine to form the Common Hepatic Duct?
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The right & left main ducts that emerge from the porta hepatis.
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What forms the Common Bile Duct?
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The joining of the Common Hepatic Duct and the cystic duct.
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What is superior to the CBD?
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The GB
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An alternate location of the CBD....may also lie ___ to GB.
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posterior
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The CBD is __ _____ to the CHA.
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right lateral
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The CBD is anterior to the
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portal vein
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The CBD courses _______ ______ towards the pancreas
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inferiorly medial
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The CBD narrows and enters the posterormedial aspect of the
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duodenum.
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What joins the CBD to empty into the duodenum?
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The CBD joins with the pancreatic duct to empty through the ampulla of Vater into the duodenum lumen at the sphincter of Oddi.
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Is the CBD straight, curved, or angled?
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ANY
They vary in their course and length/size depending on amt of bile w/in it. |
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What is the Ampulla of Vater?
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The portion of the mucosal lining of the duodenum where the pancreatic duct and CBD empty.
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What is the sphincter of Oddi?
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1. Circular muscle fibers surrounding the Ampulla of Vater
2. Controls flow of bile and pancreatic enzymes into duodenum |
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What affects the normal bile duct average measurements?
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Whether or not the patient has a GB
* 7mm w/ GB * <= 10mm/1 cm w/out GB |
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Describe the CBD walls.
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* thin
* remain constant throughout day |
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What is the 1mm/decade rule?
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Add 1mm for decade of life after about 30-50
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Who has a "floppy duct"?
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elderly patients
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The Portal Vein lies immediately anterior to the ?
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IVC
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The CBD is anterior and _____ to the PV.
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lateral
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How can the distal CBD best be seen?
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on a transverse scan in the region of the posterior-lateral portion of the pancreas
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What is the max measurement of the intrahepatic bile duct wall?
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2mm
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What is the equivocal measurement of the bile duct in adults?
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6-7 mm
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What is the difference between bile ducts and vessels?
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* Intrinsic pulsations of the arteries
* Absence of blood flow in bile ducts. |
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Who could present with biliary atresia?
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pediatric patients
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What are some normal GB variants?
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* size and shape
* biliary atresia * duplication of GB * junctional folds and septations * Phrygian cap - fundus folds back on body |
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What is Hartman's pouch?
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a junctional fold between neck and body of GB
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What might help the visibility of a GB with a pedriatic/thin patient?
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a smaller transducer
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The GB is posterior and caudal to
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main lobar fissure.
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What are some alternate locations of the GB?
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It is very mobile....
* on left * in midline * positioned transversely * situs inversus (reversed) * lying low in RLQ * abdominal wall/falciform lig. * retroperitoneum * above the liver |
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Name the steps through the biliary system.
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1. food enters sm. intestine
2. CCK is secreted by sm int. 3. causes GB to contract 4. Sphincter of Oddi relaxes 5. bile releases into cystic duct 6. Flows through CBD & into duodenum |
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White Blood Count (WBC) test
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elevated with infection
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AST & ALT tests
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mildly to moderately elevated w/ biliary obstruction
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Lactic Dehydrogenase (LDH) test
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mildly elevated w/ obstructive jaundice
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Alkaline phosphatase test
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markedly increased with obstructive jaundice
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Direct bilirubin test
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elevated w/ obstructive jaundice
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Indirect bilirubin test
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elevated in hepatocellular disease and hemolytic anemias
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What are symptoms of GB disease?
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* intermittent RUQ pain
* Murphys sign * nausea and vomiting * pain may radiate to R shoulder * increased "gas" * jaundice w/ obstruction |
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What is Murphy's sign?
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tenderness over area of GB
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What are the patient positions for scans and how many?
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* supine
* LLD * LPO scan at least 2 |
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What are some congenital anomalies?
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* biliary atresia
* choledochal cysts * interposition of GB |
