Biliary System Review

86 Questions

What is the function of the Ampulla of Vater?

To empty bile and pancreatic enzymes into the duodenum

Which condition presents sonographically with edematous, thickened gallbladder walls?

Cholecystitis

What stimulates the gallbladder to contract and the sphincter of Oddi to relax?

Cholecystokinin (CCK)

What is the main portion of the gallbladder referred to as?

Body

What is the function of bile ducts?

To drain the liver of bile

What is the meaning of cholecystectomy?

Surgical removal of the gallbladder

Which structure directs bile flow into the gallbladder?

Cystic Duct

What is the overall length of a normal gallbladder?

8 to 9 cm

Which section of the common bile duct is also referred to as supraduodenal?

Distal portion

What regulates bile flow into the duodenum at the ampulla of Vater?

Sphincter of Oddi

Where does the common bile duct enter the duodenum?

Posterior aspect

Which structure joins with the pancreatic duct(s) at the ampulla of Vater?

Common Bile Duct (CBD)

What is the approximate diameter of a normal gallbladder?

3 to 5 cm

What is the function of the Common Hepatic Duct (CHD)?

Extends inferiorly from liver hilum to gallbladder neck

What is another term for the Common Bile Duct (CBD) based on its location relative to the duodenum?

Retroduodenal section

What is the maximum volume of bile that a normal gallbladder can hold?

40 mL

Where does the CBD continue along after passing posterior to the first portion of the duodenum?

Right border of lesser omentum

What is the typical wall thickness of the gallbladder?

3-4 mm

Which artery perfuses the gallbladder?

Celiac artery

What connects the gallbladder to the common bile duct?

Cystic duct

What is the length range of the common hepatic duct?

4-6 cm

What is the typical diameter of the cystic duct?

3-4 mm

What is the length range of the common bile duct?

9-12 cm

How is the gallbladder drained?

Cystic duct

What is the typical diameter of the common bile duct?

10.5

Which vein serves as the gateway for venous blood returning from the gastrointestinal tract and accessory organs?

Hepatic portal vein

What is the acceptable size range of the common hepatic duct's diameter?

4-6 mm

In which condition can gallbladder walls thicken?

Cholecystitis

What is the function of the Common Bile Duct (CBD)?

Transport bile from the gallbladder and duodenum for digestion

What is the role of the Cystic Duct?

Transport bile from the gallbladder into the neck of the gallbladder

Which structure is a small sacculation in the area of the gallbladder neck?

Hartmann's Pouch

What is the function of the Hepatic Portal System?

Venous drainage of the gastrointestinal tract

What does Cholelithiasis refer to?

Presence or formation of gallstones in the gallbladder or biliary duct

What do Liver Function Tests indicate?

How well the liver is functioning

What is the purpose of Intrahepatic bile ducts?

Direct bile produced in the liver to the biliary duct

What does the Biliary System do?

Drain bile from the liver and store it in the gallbladder

What is the role of Normal Measurements in this context?

Anatomical measurements for structures associated with digestion

What does the term 'Extrahepatic' refer to?

Structures outside liver tissue

What is the definition of 'Bile'?

Fluid that aids in digestion, produced by liver

What is meant by 'Pancreas and Associated Ducts'?

Emptying bile and pancreatic enzymes into duodenum

What is the role of the rugae inside the gallbladder?

Aid in bile concentration through water absorption and mucus secretion

Which part of the gallbladder resembles a pear shape?

Fundus

What prevents the overdistending or collapsing of the cystic duct?

Spiral valves of Heister

Which structure regulates bile passage into the duodenum and prevents gastrointestinal fluid reflux?

The sphincter of Oddi

What stimulates gallbladder contraction and duodenal mucosa relaxation, increasing bile production?

Cholecystokinin (CCK)

Which vessels accompany portal veins within the liver?

Hepatic arteries

Where does blood converge into after passing through hepatic sinusoids?

Hepatic veins and inferior vena cava

What are the three layers of the gallbladder?

Inner mucosa, middle fibromuscular layer, and outer serous layer

Where are hepatic ducts, intrahepatic bile ducts, and hepatic arteries found?

Within the liver

What role do hepatic sinusoids play in the circulation of blood?

Act as exchange vessels

What is the primary function of the biliary tract?

Carry bile from the liver to the gastrointestinal system

What contributes to making the gallbladder appear as anechoic or nearly anechoic on sonography?

Thin walls

What is the function of the Sphincter of Oddi?

Regulating bile flow into the duodenum

Where are the Spiral Valves of Heister located?

Within the lumen of the cystic duct

Where is the Supraduodenal Common Bile Duct located?

Superior to the duodenum

Where is the Gallbladder located?

Posteroinferior portion of the right lobe of the liver

How do bile from the liver reach the gallbladder?

Through hepatic ducts

What does an ultrasound visualize in regards to the biliary tract?

Gallbladder, common hepatic duct, common bile duct, pancreatic duct, and duodenum

What is the Main Lobar Fissure?

A fissure in the liver near the gallbladder

What components are involved in the biliary and pancreatic systems?

Head of the pancreas, terminal pancreatic duct, and sphincter of Oddi muscle

What structures form the common bile duct at the liver hilum?

Left and right intrahepatic ducts

What is the relationship between Common Hepatic Duct and Right Portal Vein?

Located anterior to the right portal vein and axial section of proper hepatic artery

What structures are visualized in FIGURE 15-2?

Gallbladder, common hepatic duct, common bile duct, and pancreas

What does FIGURE 15-1 illustrate?

Illustration of biliary system including gallbladder, common hepatic duct, common bile duct, and pancreas

Match the following structures with their descriptions:

Common Bile Duct (CBD) = Distal portion of the biliary duct that transports bile from the gallbladder and duodenum for digestion Cystic Duct = Carries bile from the gallbladder into the neck of the gallbladder Hepatic Portal System = System responsible for venous drainage of the gastrointestinal tract, including the spleen, pancreas, and gallbladder Portal Triad = Intrahepatic bile ducts run alongside portal veins and hepatic arteries, surrounded by connective tissue and radiating through the lobes and segments of the liver

Match the following terms with their meanings:

Intrahepatic = Describes the location of structures within the liver tissue Extrahepatic = Describes the location of structures outside of the liver tissue Cholelithiasis = Condition characterized by the presence or formation of gallstones in the gallbladder or biliary duct Bile = Fluid produced by the liver that aids in digestion

Match the following structures with their functions:

Hartmann's Pouch = Small sacculation in the area of the gallbladder neck, an outpouching named after Henri Hartmann Common Hepatic Duct (CHD) = Proximal portion of the biliary duct that transports bile from the liver to the cystic duct and continues as the distal portion of the CBD Gallbladder = Bile reservoir on the posteroinferior surface of the liver, has three descriptive divisions: fundus, body, and neck Hepatic Ducts (Right, Left) = Right and left intrahepatic ducts that direct the bile produced in the liver to the biliary duct

Match the following biliary system structures with their locations:

Sphincter of Oddi = Ampulla of Vater Spiral Valves of Heister = Cystic duct Common Hepatic Duct = Liver hilum Main Lobar Fissure = Gallbladder

Match the following biliary system structures with their functions:

Supraduodenal Common Bile Duct = Portion of common bile duct superior to the duodenum Hepatic Ducts = Bile from the liver reaches the gallbladder through these ducts Pancreas = Involved in the biliary and pancreatic systems Biliary Tract = Visualized with ultrasound, includes gallbladder, common hepatic duct, common bile duct, pancreatic duct, and duodenum

Match the following biliary system terms with their descriptions:

Gallbladder = Located on the posteroinferior portion of the right lobe of the liver, changes location with patient position (left lateral decubitus) Biliary Tract = Located in various areas such as the main lobar fissure, right kidney, and liver Common Hepatic Duct and Right Portal Vein = Located anterior to the right portal vein and axial section of the proper hepatic artery Common Bile Duct (CBD) = Often mistaken as the common hepatic duct, located superior to the duodenum

Match the following gallbladder components with their respective measurements:

Gallbladder wall thickness = Typically a few millimeters Common hepatic duct (CHD) length = Variable (3-6.5 cm) Cystic duct diameter = Approximately 3 mm Common bile duct (CBD) diameter = 1-10 mm

Match the following statements with the correct descriptions of gallbladder perfusion and drainage:

Perfusion of gallbladder = Hepatic artery, a branch of the celiac artery Drainage of gallbladder = Portal venous system through the cystic duct Gallbladder perfusion source = Hepatic artery Gallbladder drainage route = Portal venous system through the cystic duct

Match the following ducts with their variable length and diameter ranges:

Common hepatic duct (CHD) = Length: 3-6.5 cm, Diameter: 1-7 mm Cystic duct = Length: 1-3.5 cm, Diameter: Approximately 3 mm Common bile duct (CBD) = Length: 8-11.5 cm, Diameter: 1-10 mm Variable ducts = Common hepatic duct (CHD), Cystic duct, Common bile duct (CBD)

Match the following structures with their location in the biliary system:

Common hepatic duct = Forms from the union of right and left main hepatic ducts Cystic duct = Connects the gallbladder to the common hepatic duct Hepatic sinusoids = Located within the liver and play a role in blood circulation Sphincter of Oddi = Regulates bile passage into the duodenum and prevents gastrointestinal fluid reflux

Match the following anatomical features with their function in the gallbladder:

Rugae = Aid in bile concentration through water absorption and mucus secretion Gallbladder layers = Provide structural support and protection for the gallbladder Spiral valves of Heister = Prevent overdistending or collapsing of the cystic duct Pear shape division = Divides the gallbladder into fundus, body, and neck

Match the following descriptions with their corresponding anatomical structures in the biliary system:

Anechoic pear-shaped structure with thin walls on sonography = Healthy gallbladder appearance Convergence into hepatic veins and inferior vena cava = Path of blood from hepatic sinusoids Accompany portal veins within the liver = Location of hepatic ducts, intrahepatic bile ducts, and hepatic arteries Carries bile to the gastrointestinal system = Function of the biliary tract

Match the following bile duct sections with their alternate names based on location relative to duodenum:

Supraduodenal = CBD Retroduodenal = CBD Infraduodenal = CBD Intraduodenal = CBD

Match the following structures with their functions:

Cystic Duct = Directs bile flow into the gallbladder Sphincter of Oddi = Regulates bile flow into duodenum Common Bile Duct (CBD) = Empties bile and aids in digestive process Gallbladder = Holds up to 40 mL of bile

Match the following descriptions with the corresponding gallbladder measurement:

Length varies with bile volume = Gallbladder Normal size approximately 8 to 9 cm = Gallbladder 3 to 5 cm in diameter = Gallbladder Holding up to 40 mL of bile = Gallbladder

Match the following structures with their locations or relationships:

Common Hepatic Duct (CHD) = Extends inferiorly from liver hilum to gallbladder neck Cystic Duct = Connects gallbladder to CHD Common Bile Duct (CBD) = Distal portion continues inferiorly along right border of lesser omentum Sphincter of Oddi = Surrounds CBD at ampulla of Vater

Match the following key words with their definitions:

Ampulla of Vater (Hepatopancreatic Ampulla) = Dilatation or opening formed by the common bile duct and pancreatic duct(s) as they enter the duodenum, where they empty bile and pancreatic enzymes that assist in the digestive process. Bile Ducts = Drain the liver of bile. Bilirubin = A bile pigment. Green when oxidized. Cholecystitis = Condition in which the gallbladder is inflamed. Presents sonographically with edematous, thickened gallbladder walls.

Match the following terms with their functions:

Cholecystectomy = Surgical removal of the gallbladder. Cholecystokinin (CCK) = Peptide hormone that stimulates the gallbladder to contract and the sphincter of Oddi to relax and increases hepatic production of bile. Choledochal (Choledochus) Cyst = Normal, localized dilatation of the common bile duct. Choledocholithiasis = Presence of gallstones in the biliary tract.

Match the following structures with their roles:

Common Hepatic Duct (CHD) = Drains bile from the liver and joins with the cystic duct to form the common bile duct. Cystic Duct = Connects the gallbladder to the common bile duct. Sphincter of Oddi = Regulates bile passage into the duodenum and prevents gastrointestinal fluid reflux. Hepatic Sinusoids = Play a role in the circulation of blood in the liver.

Match the following terms with their ultrasound appearance:

Cholecystitis = Presents sonographically with edematous, thickened gallbladder walls. Choledochal (Choledochus) Cyst = Normal, localized dilatation of the common bile duct. Choledocholithiasis = Presence of gallstones in the biliary tract. Ampulla of Vater (Hepatopancreatic Ampulla) = Dilatation or opening formed by the common bile duct and pancreatic duct(s) as they enter the duodenum, where they empty bile and pancreatic enzymes that assist in the digestive process.

Match the following terms with their diagnostic tests:

Cholecystokinin (CCK) = An injectable form can be used to stimulate the gallbladder during sonographic examination for a type of function test. Choledochal (Choledochus) Cyst = May be examined using diagnostic tests to assess its presence and characteristics. Choledocholithiasis = Can be identified using diagnostic tests to detect gallstones in the biliary tract. Bile Ducts = May be assessed using diagnostic tests to evaluate drainage and flow from the liver.

Match the following terms with their descriptions:

Bilirubin = A bile pigment. Green when oxidized. Cholecystokinin (CCK) = Peptide hormone that stimulates the gallbladder to contract and increases hepatic production of bile. Hepatic Portal System = Responsible for directing venous blood from abdominal organs to the liver for processing and detoxification. Common Bile Duct (CBD) = Drains bile from both the liver and gallbladder into the duodenum.

Study Notes

Sphincter of Oddi (Oddi's Muscle): a muscle sheath surrounding the common bile duct (CBD) at the ampulla of Vater, aids in regulating bile flow into the duodenum.
Spiral Valves of Heister: mucosal folds within the lumen of the cystic duct.
Supraduodenal Common Bile Duct: portion of common bile duct superior to the duodenum.
Gallbladder: located on the posteroinferior portion of the right lobe of the liver, not totally surrounded by hepatic tissue, changes location with patient position (left lateral decubitus).
Hepatic Ducts: left and right intrahepatic ducts join at the liver hilum to form the common bile duct, proximal portion referred to as common hepatic duct, bile from the liver reaches the gallbladder through hepatic ducts.
Biliary Tract: gallbladder, common hepatic duct, common bile duct, pancreatic duct, and duodenum are visualized with ultrasound, located in various areas such as the main lobar fissure, right kidney, and liver.
Main Lobar Fissure: a fissure in the liver, the gallbladder is located near it.
Pancreas: head of the pancreas, terminal pancreatic duct, and sphincter of Oddi muscle (at the ampulla of Vater) are involved in the biliary and pancreatic systems.
FIGURE 15-1 and FIGURE 15-2: illustrations of the biliary system, including the gallbladder, common hepatic duct, common bile duct, and pancreas.
Common Hepatic Duct and Right Portal Vein: relationship explained, common hepatic duct is often mistaken as the common bile duct, located anterior to the right portal vein and axial section of the proper hepatic artery.
Common Hepatic Duct (CHD): extends inferiorly from liver hilum to gallbladder neck, anterior to right portal vein and proper hepatic artery.
Cystic Duct: connects gallbladder to CHD, directs bile flow into the gallbladder.
Common Bile Duct (CBD): distal portion of common duct, continues inferiorly along right border of lesser omentum, passes posterior to first portion of duodenum, and enters posteromedial aspect of descending portion of duodenum.
CBD: also referred to as supraduodenal, retroduodenal, infraduodenal, or intraduodenal sections based on location relative to duodenum.
Gallbladder: overall length varies depending on bile volume, normal size is approximately 8 to 9 cm, and 3 to 5 cm in diameter, holding up to 40 mL of bile, roughly equivalent to 8 teaspoons.
CBD: joined to pancreatic duct(s) to form a single duct or remains separate and enters ampulla of Vater, where it empties bile and aids in digestive process.
Sphincter of Oddi: surrounds CBD at ampulla of Vater, regulates bile flow into duodenum.

Test your knowledge of the anatomical structures of the hepatobiliary system, including the common hepatic duct, cystic duct, and common bile duct.

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