The biliary system

Ro's quizlet

When can you see the gallbladder best?

On an empty stomach.

What are the sections of the gallbladder?

Fundus, body, neck.

What is the gallbladder fossa?

Indentation located on the posteroinferior portion of the right lobe of the liver where the gallbladder is situated.

What is the phrygian cap?

Gallbladder variant in which part of the fundus is bent back on itself.

What is the main lobar fissure?

Boundary between the right and left lobes of the liver; seen as a hyperechoic line on the sagittal image extending from the portal vein to the neck of the gallbladder.

What is the landmark for the gallbladder/gallbladder fossa?

Main lobar fissure.

What forms the common bile duct?

Common hepatic duct and cystic duct.

What forms the common hepatic duct?

Right and left hepatic ducts.

What are the Spiral Valves of Heister?

A series of mucosal folds within the lumen of the cystic duct that move bile in either direction.

What is the CBD measurement?

1-7mm.

What is the cystic duct measurement?

Less than 4mm.

What is the ampulla of Vater?

Small opening in the duodenum where the pancreatic and common bile duct enter to release secretions.

Where does the common bile duct meet the pancreatic duct?

At the ampulla of Vater.

What is the sphincter of Oddi?

The valve controlling release of bile and pancreatic juice into the bloodstream.

What is Cholecystokinin (CCK)?

A hormone secreted by the small intestine in response to fats; promotes release of bile and pancreatic juice and reduces stomach motility.

What is a choledochal cyst?

The cystic dilatation of the common bile duct, a normal variant.

What is the composition of bile?

92% water; the other is bile salts.

Where is the CBD located?

Anterior to the portal vein, exiting at the porta hepatis.

What is Hartman's pouch?

Small part of the gallbladder that lies near the cystic duct where stones may collect.

What does the Mickey Mouse Sign represent?

The portal triad.

How can you tell the difference between a gallstone and a polyp?

Gallstones have posterior shadowing and they move around.

What are indications for biliary system sonograms?

RUQ pain, Murphy's sign, nausea, vomiting, pain radiating to the right shoulder, jaundice or abnormal liver function tests, loss of appetite, intolerance to fatty foods/dairy.

What does LFT stand for?

Liver function test.

What is Murphy's Sign?

Pain with palpation of the RUQ during inspiration, indicative of cholecystitis.

Where is the pancreas located?

In the 'C' loop of the duodenum; it is retroperitoneal.

What are the sections of the pancreas?

Uncinate process, head, neck, body, tail.

The head of the pancreas lies __ to the IVC.

Anterior.

Where is the CBD in reference to the pancreas?

In the posterolateral portion of the pancreas head.

Where is the GDA in reference to the pancreas head?

Anterolateral to the head of the pancreas.

Where is the neck of the pancreas?

Anterior to the SMV and confluence.

Where is the body of the pancreas?

Anterior to the aorta, SMA, and SV.

Where is the tail of the pancreas?

Extends to the hilum of the spleen; located between the stomach anteriorly and left kidney posteriorly.

What is the uncinate process?

The posteromedial extension of the pancreatic head, posterior to the SMV and anterior to the IVC.

What is the physiology of the pancreas?

It functions as both an endocrine (hormones) and exocrine (digestive function) gland.

What percentage of pancreatic function is exocrine?

90% of function is exocrine.

What is pancreatic juice composed of?

Amylase, lipase, trypsin, chymotrypsin, carboxypeptidase, nucleases, sodium bicarbonate.

What is the function of amylase?

Enzyme that helps digest carbohydrates.

What is the function of lipase?

Breaks down fats.

What is the function of nucleases?

Breaks down nucleic acids into nucleotides.

What is the function of sodium bicarbonate?

Neutralizes pH of chyme.

What is the function of trypsin, chymotrypsin, and carboxypeptidase?

Digest protein.

What do acini cells do?

Perform exocrine functions by secreting digestive enzymes.

What do beta cells secrete?

Insulin (glucose to glycogen); they bring sugar down.

What do alpha cells secrete?

Glucagon (glycogen to glucose); they bring sugar up.

What do delta cells secrete?

Somatostatin (alpha/beta inhibitor).

What is the Duct of Wirsung?

The main pancreatic duct.

What is the Duct of Santorini?

A small accessory duct of the pancreas found in the head of the gland.

What is the normal sonographic appearance of the pancreas?

Homogeneous, hyperechoic compared to liver, smooth wall margins, and variable contour.

What is an annular pancreas?

Developmental malformation where the pancreas forms a ring around the duodenum, risking duodenal obstruction.

What is ectopic pancreatic tissue?

Pancreatic tissue without vascular or structural connection.

What is a partial duplication of the tail?

A rare variation of the pancreas where the tail appears enlarged.

What are the sonographic applications for pancreatic evaluation?

Biliary obstruction, pancreatitis, evaluation of pancreatic pseudocysts, endoscopic evaluation to look at lesions.