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Terms in this set (78)
anatomy of the biliary system
The biliary apparatus consists of the right and left hepatic ducts, the common hepatic duct, the common bile duct, the pear-shaped gallbladder, and the cystic duct.
anatomy of the biliary system
The right and left hepatic ducts emerge from the right lobe of the liver in the what?
porta hepatis, and unite to form the common hepatic duct, which then passes caudally and medially.
the hepatic duct runs parallel with what
common hepatic duct
approximately 4 mm in diameter and descends within the edge of the lesser omentum.
heatic ducts are
joined by the cystic duct to form the common bile duct.
Normal common bile duct has a diameter of up to
The common bile duct is joined by the main pancreatic duct; together they open through
a small ampulla (the ampulla of Vater) into the duodenal wall.
end parts of both ducts (the common bile duct and the main pancreatic duct) and the ampulla are surrounded by circular muscle fibers known as the
sphincter of Oddi.
proximal portion of the CBD is
lateral to hepatic artery and anterior to portal vein.
The hepatic and bile ducts are encased in a common collagenous sheath, forming the
the cystic duct connects the neck of the gallbladder with the common hepatic duct to form
common bile duct
cystic duct is
4 cm long
Pear-shaped sac in the anterior aspect of the right upper quadrant, closely related to the visceral surface of the liver
gallbladder is divided into
the fundus, body, and neck
The rounded fundus of the GB usually projects
below the inferior margin of the liver, where it comes into contact with the anterior abdominal wall at the level of the ninth right costal cartilage.
the body of the GB
generally lies in contact with the visceral surface of the liver and is directed upward, backward, and to the left.
the neck of the GB
becomes continuous with the cystic duct, which turns into the lesser omentum to join the right side of the common hepatic duct to form the common bile duct.
Dilation of the gallbladder is known as
The normal gallbladder generally measures
2.5 to 4 cm in diameter and 7 to 10 cm in length.
walls are less than 3mm thick
The gallbladder may fold back on itself at the neck, forming
Folding of the fundus of GB
is called phrygian cap
With a capacity of 50 ml, the gallbladder serves as a
reservoir for bile
Heister valve in the neck of the gallbladder helps prevent a
kinking of the duct
When the gallbladder is removed (cholecystectomy)
The sphincter of Oddi loses tonus.
Pressure within the common bile duct drops
Bile is no longer retained in the bile ducts; it is free to flow into the duodenum during fasting and digestive phases.
The extrahepatic bile ducts dilate, usually less than 1 cm.
Bile is the principal medium for excretion of
bilirubin and cholesterol.
bile salts from the intestine
stimulate the liver to make more bile
(RUQ) abdominal pain
from GB disease
develops after the ingestion of greasy foods.
Nausea and vomiting
sometimes occur and may indicate the presence of a stone in the common bile duct.
A gallbladder attack may cause pain in the
clinical sign of GB disease
Sludge, or thickened bile, frequently occurs from
is an inflammation of the gallbladder that may take one of several forms
Acute or chronic
Most common cause of acute cholecystitis is
Acute right upper quadrant pain
Positive Murphy's sign
Inspiratory arrest upon palpation of gallbladder area
Increased serum bilirubin and alkaline phosphatase levels
complications of acute cholecystitis
May be serious and include empyema, emphysematous or gangrenous cholecystitis, and perforation.
Most common disease of the gallbladder
Cholelithiasis 5 Fs
fat, female, forty, fertile, and fair.
Is a serious, painful complication of acute cholecystitis that may lead to perforation.
The common echo feature of gangrene is the presence of diffuse medium to coarse
echogenic densities filling the gallbladder lumen in the absence of bile duct obstruction.
Is the acute inflammation of the gallbladder in the absence of cholelithiasis.
Clinically, the patient has a positive Murphy's sign.
Torsion of the Gallbladder
A very rare condition found more often in older women
Associated with a mobile gallbladder with a long suspensory mesentery
Most common form of gallbladder inflammation
transient RUQ pain but not the tenderness as experienced with acute cholecystitis.
Rare occurrence that is defined as calcium incrustation of the gallbladder wall
Porcelain Gallbladder is associated
with gallstones in the majority of patients; a form of chronic cholecystitis
25% of these patients will develop cancer on the gallbladder wall.
Cholesterolosis and adenomyomatosis of the gallbladder are
two types of hyperplastic cholecystitis.
A condition in which cholesterol is deposited within the lamina propria of the gallbladder
referred to as a "strawberry gallbladder" because the mucosa resembles the surface of a strawberry.
small % of patients with Cholesterolosis
show cholesterol polyps
are small, well-defined soft-tissue projections connected by the stalk to the gallbladder wall.
<10 mm in diameter
A hyperplastic change in the gallbladder wall
Papillomas may occur singly or in groups and may
be scattered over a large part of the mucosal surface of the gallbladder.
Various patient positions and compression show
lesion to be immobile in the gallbladder.
Primary carcinoma of the gallbladder is
rare and is nearly always a rapidly progressive disease with a mortality rate approaching 100%.
Adjacent liver is often invaded by direct continuity, extending through tissue spaces,
the ducts of Luschka, the lymph channels, or some combination of these.
Congenital, focal, or diffuse cystic dilation of the biliary tree.
Diagnosis may be confirmed with a nuclear medicine hepatobiliary scan.
Localized cystic dilation of the common bile duct
Diverticulum from the common bile duct
Invagination of the common bile duct into the duodenum
Dilation of the entire common bile duct and the common hepatic duct
Rare congenital abnormality most likely inherited in an autosomal recessive fashion
Two types of Caroli's disease
Simple classic form
More common form associated with periportal hepatic fibrosis
Cystic disease of the kidney (medullary sponge kidney) is strongly associated
with Caroli's disease.
with carolis disease the
ducts may show a beaded appearance as they
extend into the periphery of the liver
Ectasia of the extrahepatic and common bile ducts
may be present with carolis disease
The common hepatic duct has an internal diameter of
The common bile duct has an internal diameter slightly greater than
the hepatic duct
Most common cause is the presence of a tumor or thrombus within the ductal system.
Bile ducts expand centrifugally from the point of obstruction, therefore
extrahepatic dilation occurs before intrahepatic dilation.
the elevation of cholesatic liver parameters may present
Painful jaundice is seen with
acute obstruction or infection that may invade the biliary tree.
Three primary areas for biliary obstruction
Originates between the pancreas and the porta hepatis.
Porta Hepatic Obstruction
This area of obstruction is usually the result of a neoplasm.
Rare malignancy that originates within the larger bile ducts (usually the common duct or common hepatic duct)
a specific type of cholangio-carcinoma that can occur at the bifurcation of the common hepatic duct, with involvement of both the central left and right ducts.
is uncommon cause for extrahepatic biliary obstruction as a result of an impacted stone in the cystic duct, which creates extrinsic mechanical compression of the common hepatic duct.
by dilated bile ducts: Both portal veins and ducts are surrounded by high-amplitude reflections.
Peripheral duct dilation
Visualizing hepatic ducts in the liver periphery is normally unusual, whereas dilated bile ducts may be observed.
Main cause of hemobilia is
biliary trauma secondary to percutaneous biliary procedures or liver biopsies.
Sonographic appearance of blood in the biliary tree
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