Gallbladder Normal

Is the gallbladder intraperitoneal or peritoneal?

intraperitoneal

What is the shape of the gallbladder?

thin walled saccular or peared shaped

Where is the Gb located?

RUQ in GB fossa

What portion of the liver is the GB located on ?

Viseral/posterior surface of liver

What is the Gb located between?

Quadrate lobe and RT lobe

What vein- can be used as a landmark to identify the GB?

Middle Hepatic vein

What does the GB lie anterior to?

The Rt kidney,Transverse colon

What is the GB inferior to?

Rt lobe of liver

What does the normal GB measure?

7-10 X 2-3 X 3-5 cm.

What is the normal bile capacity of the GB?

30-60ml

What amount should the normal GB wall not exceed in thickness?

3mm

Normally 1-2mm

What is the method used to evaluate the GB function?

Volume = 0.52 (Lx W x H)

What and when is the standard fatty meal given?

(Lipomul or Neo-Cholax) is given and the GB volume obtained 45-60 minutes post meal

What are the 3 layers of the GB?

Serosa-outermost

Subserosa-middle

Mucosa-innermost

What are the segments of the GB?

Fundus-(most distal,below the info margin of the liver, close to colon and duedenum, lateral to duedenum)

Body-(between neck and fundus, contact with viseral surface of liver)

Neck-(continues with cystic duct, is post medical to porta hepatic)

How long is the cystic duct?

4cm long

Where does the cystic duct connect?

GB neck with the CHD.

Where does the Cystic duct join?

CHD to form the CBD

What does the Cystic duct contain?

mucosal folds, spiral valves of Heister, that help in preventing it

from kinking or collapsing.

What may the Cystic ducts contain that may cause shadowing?

Valves of Heister

What are the Normal GB varients?

Hartman pouch- when the neck fold on itself

Phrygian cap-when the fundus kink or fold on itsself

Junctional fold- when the Gb fold at the neck and body

Which Gb normal varients is the most common?

Junctional

What is and intrahepatic GB?

The GB is completely imbedded in hepatic tissue

can contain a liver cyst

What is a double GB?

rare

only occurs in 1-3000/4000 cases

2:1 (F-M)

Are 2 parrel cystic structures in GB fossa

What do the cystic artery and veins do?

CA-branch of Rt hepatic Artery and supply GB

CV- drains the blood from the GB, drain directly into the PV

What is the function of the GB?

reservior to store and concentrate bile

Bile contatins(water,cholesterol,bile salts,bilirubin,microproteins)

What does the Bile ducts do?

Transport bile from liver or GB to Duedenum

What is the Gb divided into?

Intrahepatic and Extrahepatic

What are the intrahepatic and extrahepatic fo the bile ducts?

- intrahepatic bile ducts include right and left hepatic ducts.

-extrahepatic bile ducts include CHD &CBD.

What are a bile duct surrounded by?

Connective tissue sheaths(give the walls and echogenic appearance)

What are the Intrahepatic ducts formed by?

canaliculi from liver lobule

What does the intrahepatic ducts drain into?

rt and LT hepatic ducts and join to form the CHD

How does the Intrahepatic ducts run?

Rt and Lt hepatic ducts run parallel and anterior to RT and Lt portal vein

Where does the Intrahepatic ducts drain bile from?

Rt and Lt lobe of liver

What does the CHD measure?

4-5mm in diameter and is directly anterior to the RPV

What is the CBD formed by?

By the union of the cystic duct and CHD

What is the CBD joined by?

Pancreatic duct and ampulla that are surrounded by the sphincter of Oddi

How long is the CBD?

6cm

Where is the CBD located?

Anterlaterla to MPV

Posterior to head of pancreas

What does the CBD measure?

<4-5mm in adults

should not measure more than 4mm in children

What are the GB laboratory values?

Serum Alkaline Phosphatase

- indicates biliary obstruction

Serum Bilirubin is increased in:

- choledocholithiasis (highest)

- subacute cholecystitis

- GB carcinoma

- Injury or damage to bile ducts

Prothrombin Time is decreased in:

- GB carcinoma

- subacute cholecystitis

- Injury or damage to bile ducts

- prolonged extrahepatic biliary obstruction