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Gross Anatomy
Chapter 13 Biliary system
50
Medical
Professional
08/06/2013

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Term
The biliary system is intimately associated with the
Definition
liver and pancrease
Term
the biliary system consists of
Definition
the gallbladder acting as a reservoir for bile, and the ducts that drain the liver of bile.
Term
the basic function of the biliary system is to
Definition
drain the liver of bile and to store the bile until it is needed to aid digestion
Term
the gallbladder concentrates the bile by
Definition
secreting mucus and absorbing water
Term
what is located on the posteroinferior portion of the right lobe of the liver where the gallbaldder is situated
Definition
the gallbladder fossa
Term
when a gallbladder is totally enclosed by the liver tissue it is called
Definition
intrahepatic gallbladder
Term
with the patient supine the GB can be found just at the inferior lobe of the
Definition
right lobe of the liver, when the pat is turned on their side, it may shift closer to the midline
Term
where the intrahepatic ducts join at the liver hilum, also called porta hepatis to form the
Definition
biliary duct or common duct.
Term
what is the proximal portion of the Cd known as
Definition
common hepatic duct
Term
what is the distal portion of the Cd known as
Definition
the common bile duct
Term
how far does the CHD extend to
Definition
inferiorly form the liver hilum to the level of the gallbladder neck, where it meets the cystic duct. It is anterior to the right portal ven and proper hepatic artery
Term
where does the cystic duct connect to on the gallbladder
Definition
to the CHD , its job is to direct the flow of bile it receives from the CHD directly into the GB
Term
from its origin at the level of the junction of the CHD and cystic duct the ______ runs inferiorly along the right border of the lesser omentum, passes posterior to the first portion of the duodenum; passes throught or lies on the back of the posteriolateral portion of the pancreas head
Definition
common bile duct
Term
The common bile duct enters;
Definition
the posteromedial aspect of the descending portion of the duodenum and terminates
Term
what lies anterior and slightly right lateral to the main portal vein and right lateral to the proper and common hepatic arteries
Definition
common bile duct
Term
the part of the CBD superior tot he duodenum is the
Definition
supradoudenal section
Term
the ifraduodenal portion of the CBD either joins the pancreatic duct to form a single duct or remains separate and enters the
Definition
ampulla of Vater
Term
what is the muscle sheath known as that surrounds the CBD at the ampulla of Vater
Definition
the sphincter of Oddi or Oddi's muscle
Term
what is the job of the sphincter of Oddi
Definition
it aids in regulating bile flow
Term
what is the normal legnth of the GB in a proper fasting state
Definition
8-9 cm
Term
what is the normal diameter of the GB
Definition
approx 3-5cm
Term
how much can the GB hold
Definition
approx 40ml of bile (roughly 8 tsp)
Term
how thick are the walls of the GB
Definition
up to 3mm
Term
name the ducts that carry bile
Definition
hepatic, biliary, cystic and CBD
Term
what is the gateway thru which blood is returned from the GI tract
Definition
the portal veins
Term
the veins drain from the GI ;
Definition
the spleen , pancreas and GB
Term
what supplies the GB and the liver
Definition
the proper hepatic artery, the cystic may on occasion.
Term
what is the diameter of the cystic duct
Definition
approx 3mm, the length varies ranging from 1.0-3.5 cm
Term
what is the range of poss length of the CBd
Definition
8- 11.5 cm
Term
venous drainage of the GB is by way of the
Definition
hepatic portal system
Term
what is the term used to describe venous blood that passes through two capillary exchange system before reaching heart
Definition
portal circulatory route
Term
from its origin at the level of the junction of the CHD and cystic duct the ______ runs inferiorly along the right border of the lesser omentum, passes posterior to the first portion of the duodenum; passes throught or lies on the back of the posteriolateral portion of the pancreas head
Definition
common bile duct
Term
the lumen of the cystic duct contains a series of mucosal folds called
Definition
the spiral of Heister
Term
In the cystic duct there is no flow control or valve
Definition
bile flows freely in both directions through the cystic duct
Term
Bile is produced by the
Definition
liver and carried to the gastrointestinal system by the biliary tract
Term
When closed the sphincter of Oddi forces the Gb to fill with
Definition
bile, it regulates the passage of bile into the duodenum and prevents reflux
Term
When fats and amino acids are ingested the duodenal mucosa releases
Definition
the duodenal cholecystokinin (CCK)a peptide hormaone that stimulates the GB to contract and the sphincter of Oddi to relax increasing bile production
Term
The sonographic appearance of a longitudinal section of the normal , disteded GB is that of an
Definition
anechoic or nearly anechoic pear-shaped structure with thin, bright walls in the right upper quadrant of the abdomen
Term
It is important to identify whether the GB is distended or not, a nonfasting patient will not have a distended GB with that it may
Definition
be mistaken for bowel or pathology
Term
the walls of the GB are well defined, regular and echo-dense, especially when the GB
Definition
is distended, in the empty state the walls are thicker and may appear more irregular
Term
name the 4 landmarks that may be helpful in locating the GB
Definition
portal vein , right kidney,, duodenum and main lobar fissure
Term
from its origin posterior to the pancreas neck, the longitudinal main portal vein can be followed as it coursed toward the liver, it will reveal
Definition
the GB just inferior to the level of the right portal vein branch
Term
what are floating gallstones (protruding masses from the inner wall of the Gb)
Definition
polyps
Term
a small sacculation (outpouching) may be seen in some patients in the area of the gallbladder neck it has been called
Definition
the Harmann's pouch
Term
non visualization of the Gb may occur for a number of reasons
Definition
never developed (agenesis)which is rare, a small tubelike GB may appear as bile duct and be missed on sonography
Term
in an axial plane section s from together, the extrahepatic portal triad to become what is known as the
Definition
mickey mouse sign
Term
specific applications of sonsgraphic examination of the biliary system are
Definition
possible obsturciton of biliary ductal system, presence of stones in the GB (cholelithiasis), presence of stones in the ductal system (choledocholithiasis)
Term
variations in GB shape are very common list some possibilities
Definition
bilobed: hourglass shaped, septeated: or more internal divisions tend to be associated with cholelithiasis and also makes it difficult to identify. folded: may be folded into any of several shapes, Phrygian cap: most common variation, partially folded on to itself so it appears like a phrygian cap worn by the early Roman freed slaves
Term
list congenital abnormalities
Definition
floating GB, low position in abdomen. hypoplasia: underdevelopment, agenesis, complete failure to develop. duplicated GB : with or without duplication of the cystic duct
Term
a common variation in the extrahepatic ducts is
Definition
choledochal or choledochus cyst. The types are congenital cystic dilation, intraduaodenal and congenital diverticulum , the first is the most common
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