Gallbladder and Biliary System PDF

Gallbladder and Biliary System LCCC DMS Objectives Discover the size shape and positioning of the GB Identify normal anatomy of the GB and Ducts and surrounding anatomy Identify functions of the Biliary system Correlate functions of the biliary system with lab values and appearance on ultrasou...

Gallbladder and Biliary System LCCC DMS Objectives Discover the size shape and positioning of the GB Identify normal anatomy of the GB and Ducts and surrounding anatomy Identify functions of the Biliary system Correlate functions of the biliary system with lab values and appearance on ultrasound Recognize proper biliary tree protocol identifying patient anatomy Gallbladder Anatomy Review Draw and label the biliary system and Gallbladder The Biliary System Overview qHepatic Ducts qCommon Bile Duct qCystic Duct qGallbladder qWhere is the GB located in the body? Gallbladder Landmarks Identify the landmarks for the gallbladder GB Location and Landmarks  Inferior margin of the liver Neck = Posterior Fundus = Anterior Landmarks: MLF PV MHV Gallbladder Anatomy Variable shape “Pear-like” or “Thumb-like” 3 Main Parts Neck Body Fundus Heister’s Valve valve in neck prevents from kinking Gallbladder Anatomy Size: 2.5-4 cm AP diameter 7-10 cm length GB wall < 3mm Holds ~ 50 ml of bile Gallbladder Anatomy Anatomical Variations  Hartmann’s Pouch  Outpouching near the GB neck (stones get stuck here)  Phrygian Cap  Folding of the fundus  Junctional Fold  Fold at neck  Partial or full Septation  Double GB Bile Duct Anatomy Superior Portion Intrahepatic ◦ Part of portal triads ◦ Right and Left Main intrahepatic ducts Cystic Duct ◦ Continuation of GB neck ◦ Connects neck of GB with the Common Hepatic duct Extrahepatic ◦ Common Hepatic Duct ◦ Common Bile Duct Bile Duct Anatomy Inferior portion ◦ Passes through pancreas head and joined by the panc duct ◦ Enters Duodenum Ampulla of Vater ◦ Sphinctor of Oddi muscular opening in duodenum Bile Duct Anatomy Size ◦ Common Hepatic Duct (CHD) ◦ 4mm ◦ Common Bile Duct (CBD) ◦ Up to 6mm ◦ +1 mm for each decade of life GB Vascular Supply Cystic Artery ◦ Branch of the right hepatic artery Cystic Vein ◦ Drains into portal vein Name the anatomy What is the scan plane? 3 1 What is this? 2 Name the anatomy 5 4 1 2 3 Biliary Physiology Layers of the Gallbladder Wall Outer (Serosal) Middle (fibromuscular) aids in contraction Inner (mucosal) has rugal folds to aid in secretion of mucus & absorption of water 10/13/2024 17  Layers of the Gallbladder Wall Inner layer contains sinuses ◦Rokitansky-Aschoff Sinuses ◦Invasion of epithelium into the wall ◦Increase surface area ◦Stones can become lodged 10/13/2024 18 GB Primary Functions ◦ Transportation of bile from liver to intestine ~ 1-2 liters per day ◦ Concentrates and Stores Bile ◦ Stimulated by Cholecystokinin CCK ◦ What does the GB not do?  82% water 12% bile acids Bile Principle route for excretion of bilirubin and cholesterol Breaks down fats Aids in absorbing Fatty Acids 10/13/2024 20 Removal of GB Cholecystectomy Sphincter of Oddi loses tonus as pressure within system increases Bile flows freely into duodenum Dilation of extrahepatic ducts