Abdomen Exam 2: Pancreas, Gallbladder, Biliary Tree

Name the 2 parts that the hepaticdiverticulum divides into. What does each part form?

Pars hepatica forms liver

Pars cystica forms gallbladder

3 layers of the gallbladder

Mucosa, Muscularis, Serosa

innermost layer of the GB

Mucosa

outermost layer of the GB

Serosa

GB layer comprised of blood vessels and muscles

Muscularis

GB is located in______ Fissure

Main Lobar/Interlobar

GB located along _________ surface of liver

posterior/inferior

GB divides into 3 parts

neck, body, fundus

Part of GB continuous with the cystic duct

Neck

Part of GB hangs below inferior liver margin

Fundus

Part of GB contacts the visceral surface of the liver

Body

GB length

7-10cm

GB Diameter

2.5-4cm

GB Wall

<3mm

vessel that supplies blood to GB

Cystic Artery

Vessel that drains GB

Cystic vein

Most common varient of GB

Phrygian cap, bent fundus

GB septation

Epithelial folds

form 3-10 communicating compartments

Small outpouching in the GB

Hartman's Pouch

Hartman's pouch AKA...

infundibulum

T/F

Junctional folds are commonly seen and can sometimes resolve by changing the patient position

True

T/F

Its possible to have a complete or partial duplication of the GB

True

Double GB

Complete septate

GB agenesis

Failure of GB to develop

Hourglass shaped GB

Segmented GB

Ducts found IN the liver

Intrahepatic

Ducts found OUTSIDE the liver

extrahepatic

Intrahepatic ducts run with the_____

Portal triad

Extrahepatic ducts

-Common hepatic

-CBD

-Central portions of R/L Hepatic ducts

-cystic duct

Duct continuous with the GB neck

Cystic Duct

The cystic duct unites with the ______ to form the ______.

Common hepatic duct, CBD

helps cystic ducts prevent kinking

Heister Valves, AKA spiral valves of heister

T/F

The cystic duct is commonly seen on US

False (normally too small)

Normal diameter of common hepatic duct

4mm

Common hepatic duct is formed by

R and L hepatic ducts

CHD lies ____ to the cystic duct

above, superior

CBD lies _____ to cystic duct

below, inferior

Normal diameter of common bile duct

6mm

T/F

The CBD diameter gets larger with age

True

CBD is formed by union of ____

- Common hepatic duct

- Cystic Duct

CBD unites with the ______ at the _____

Pancreatic duct

Ampulla of Vater

Muscle fibers that surround Ampulla of Vater

Sphincter of Oddi

CBD unites with pancreatic duct and enters the _____

Duodenum

Portal triad

Portal vein, Hepatic artery, CBD

MPV lies ______ to the CBD

posterior

MPV lies _____ to the hepatic artery

Posterior

Hepatic artery lies ____ to the CBD

Left

How to measure CBD

- inner to inner walls

- 2 places

- proximal : in liver

- distal: Pancreatic head

Function of GB

-resevoir for bile

-concentrates, stores, releases bile

-aids in digestion

Transports bile from liver to intestines

Biliary ducts

Bilirubin

breakdown of RBC's

Bilirubin lab tests

total

indirect= unconjugated

direct= conjugated

total bilirubin

sum of direct and indirect bilirubinn

Direct bilirubin Elevations

Liver dz, obstruction

Indirect bilirubin elevations

Blood (hematologic) conditions

Jaundice

Presence of bile in tissues

yellow skin & eyes

jaundice indicated an obstruction between ____ and _____

GB and intestine

Lab tests that indicate GB disease and/or obstruction

-AST

-ALT

-PT

-Lactic acid dehydrogenase

-ALP

Normal value for direct bilirubin

0.3 mg/dL

Normal value for indirect bilirubin

0.2-0.8 mg/dL

Normal value of total bilirubin

1.0-1.2 mg/dL

Normal ALT

7-55 U/L

Normal AST

8-48 U/L

Normal ALP

40-129 U/L

Normal PT

9.4-12.5 seconds

Normal LDH

122-222 U/L

GB lumen

Anechoic

GB shape

Pear

GB Location

Main lobar fissure near porta hepatis

T/F

GB contracts after eating and the wall will thicken

True

endocrine gland

Secretes directly into the bloodstream

exocrine gland

secretes through a ductal system

Is the pancreas endocrine or exocrine?

both

endocrine function of the pancreas

Hormonal

exocrine function of the pancreas

digestive

location of the pancreas where endocrine function is achieves

islets of langerhans

islets of langerhans

alpha, beta, delta cells

alpha, beta, delta cells produce...

hormones

Hormone alpha cells produce

glucagon

hormone beta cells produce

insulin

hormone delta cells produce

somatostatin

what does glucagon do

glycogen to glucose

releases glucose to meet the energy needs of the body

what does insulin do

glucose to glycogen

decrease blood sugar

what does somatostatin do

alpha and beta inhibitor

- inhibits production of glucagon and insulin

where in the pancreas is the exocrine function achieved

acini cells

pancreatic juices acini cells produce

amylase, lipase, trypsin, chymotrypsin, carboxypeptidase, nucleases

amylase

digests carbohydrates

lipase

digests fat

Trypsin, chymotrypsin and carboxypeptidase

digests protein

nucleases

digest nucleic acids

regions pancreas is found in

epigastric and L hypchondrium

Pancreas lies _____ to lesser omentum

posterior

Pancreas divided into

Head, neck, body, tail

T/F

pancreas is completely retroperitoneal

False

Portion of pancreas that lies within peritoneum

Small piece of the head

Pancreatic head lies _____ to the IVC

Anterior

Pancreatic head lies _____ to duodenum

Medial

Pancreatic body lies anterior to....

Aorta, SMA, L renal vein, Splenic vein, splenic artery

Most cephalad portion of pancreas

Tail

Most caudad portion of pancreas

Uncinate process