Sarah's Notes: Gallbladder, pancreas, spleen ect.

how do bile ducts run?

how do bile ducts run?

follow & parallel the portal venous system

bile ducts flow into ____ major ducts

2 right & left

right & left bile ducts join to make ...

common hepatic duct CHD

right & left bile ducts emerge from ___________ at ______________

from liver at porta hepatis

what is the porta hepatis?

central area where -Main Portal Vein (MPV) -Common Hepatic Artery (CHA) -Common Hepatic Duct (CHD) leave the liver

what is the portal triad?

-Main Portal Vein (MPV) -Common Hepatic Artery (CHA) -Common Bile Duct (CBD)

-portal triad is inferior to portahepatis -mickey mouse sign on US

porta hepatis is aka

transverse fissure

posterior to porta hepatis

caudate

anterior to porta hepatis

-medial left lobe -gallbladder

lateral borders of porta hepatis

-right & left lobe

common hepatic duct is _____ in diameter

4 mm

common hepatic duct descends within ...

the edge of lesser omentum

common hepatic duct is joined by _________________ from the ___________ to form ___________

cystic duct; gallbladder; CBD

CBD is _____ in diameter

6 mm

CBD has how many portions?

3

which portion of CBD descends in edge of lesser omentum?

first

second portion CBD lies ______________

posterior to first portion of DUODENUM

third portion CBD lies where?

in a groove on posterior surface of pancreatic head

anterior to MPV is ______

CBD (CBD is posterior to MPV)

distal CBD is by ...

pancreas (lies in groove on posterior surface of pancreatic head)

CBD pierces which portion of duodenum?

second

what joins CBD & both open into duodenum?

CBD + pancreatic duct (aka duct of wirsung) open into duodenum thru AMPULLA OF VATER

ampulla of vater is surrounded by ...

muscle fibers creating the sphincter of oddi

(ampulla of vater is aka sphincter of oddi)

proximal portion of CBD is ______________ to hepatic artery & __________ to portal vein

lateral anterior

CBD runs _____________ to first portion of duodenum as it enters _____________

mostly posterior; pancreas

what is the mickey mouse sign

portal triad

portal triad is made up by

-hepatic artery -portal vein -common bile duct

at porta hepatis: hepatic artery is _____________ to portal vein

anterior & medial***

at porta hepatis: portal vein is ___________

posterior

at porta hepatis: CBD is _______________ to portal vein

lateral & anterior

all 3 parts of porta hepatis travel in ...

the edge of lesser omentum

what structure serves as a collection & storage place for bile?

gallbladder

how does the gallbladder connect to the common hepatic duct?

via the cystic duct

cystic duct is approx ____ long

4 cm

cystic duct shape

somewhat S-shaped

cystic duct descends in ...

the free edge of lesser omentum

what are the valves at the neck of gallbladder extending into cystic duct?

spiral valves of heister

what does the spiral valves of heister do?

prevents overdistension, collapse, & kinking of duct

(variant of cystic duct) ____% insert mid 1/3 of extrahepatic duct

75

(variant of cystic duct) ___% insert n distal 1/3

10%

some type of anatomic variant of cystic duct occurs in ______% of cases

18-23%

what is mirizzi syndrome?

stones in cystic duct, but CBD is normal in caliber

gallbladder shape & location

pear shape located anteriorly & close to visceral surface of liver

parts of gallbladder

-fundus -body -neck

what is the most inferior & lateral part of gallbladder?

fundus

gallbladder body lies where? how is it directed?

lies in contact w/ liver directed upward, posterior, & to left

gallbladder neck is connected to ...

cystic duct

gallbladder neck is oriented ...

posterior & medial toward the porta hepatis

gallbladder size

variable

gallbladder diameter

3-4 cm

gallbladder length

7-10 cm

gallbladder wall thickness

less than 3 mm thick ***** (GB wall measurement is important!)

gallbladder variations

-folds back on itself -hartman's pouch -may lie intrahepatic -may have internal septations (bilobed) -phrygian cap -duplication of GB is very rare

patient prep gallbladder scan

NPO 8-12 hours prior to exam

what makes the gallbladder contract the most?

fatty foods

gallbladder is anterior to

-right kidney -IVC

gallbladder is lateral to

-head of pancreas -duodenum

word for spleen

lein

spleen is part of what system

reticulo-endothelial system (aka RE system)

spleen is intraperitoneal or retroperitoneal?

intraperitoneal

what covers the spleen?

covered w/ visceral peritoneum -protective capsule (aka splenic capsule)

spleen is good window to ...

left hemidiaphragm

spleen is held in place by ...

peritoneal ligaments -gastrosplenic -leinorenal -phrenicoleinal

spleen has a convex or concave outer surface?

convex outer surface

spleen has convex or concave inner surface?

concave inner surface

spleen's inner surface contains ...

hilum: central portion where arteries & veins go in & out

spleen size & shape

variable

spleen length in adults

should be less than 13 cm

spleen length in children

5.7 + 0.31(age in yrs)

what region is the spleen in?

left hypochondrium

spleen axis is along ...

10th rib

spleen lies between _____________ & ______________

stomach & diaphragm

superior to spleen

diaphragm

posterior & lateral to spleen

left lung & ribs

medial to spleen

-stomach -tail of pancreas -left kidney

inferior to spleen

splenic flexure of colon

types of spleen anatomic variations

-lobulations -position -accessorry splenic tissue -splenic absence -atrophy

variations in spleen position is due to

-embryologic development -ligaments that support it

accessory splenic tissue is seen where?

-adjacent to the hilum -gastrolieneal ligament -greater omentum

accessory splenic tissue size?

can vary in size from pea size to plum size

what is asplenia

absence of a spleen -is rare

asplenia can be associated w/

-asplenic syndrome -complex cardiac malformations -bronchopulmonary abnormalities -situs inversus (malrotation) -interrupted IVC w/ azygous continuation

polysplenia

condition where there is more than one spleen -more rare than asplenia

spleen atrophy can occur in ...

-older patients -can be sign of disease

pancreas has _________ & ____________ glands

exocrine and endocrine

endocrine

directly into bloodstream

exocrine

secretions into ducts

pancreas lies where?

anterior to 1st & 2nd lumbar

pancreas is located in what regions?

deep in left hypochondrium & epigastrium

pancreas is behind the ...

lesser omental sac

pancreas lies in what kind of position?

horizontal/oblique

pancreas extends from _____________ to ____________

2nd portion of duodenum to hilum of spleen

is pancreas intraperitoneal or retroperitoneal?

most of pancreas is retroperitoneal

what portion of pancreas is surrounded by peritoneum?

small portion of head

parts of pancreas

-head -neck -body -tail

pancreas head is anterior to

IVC

pancreas head is inferior to

caudate

pancreas head is medial to

second portion of duodenum

pancreas head is posterior to

SMA & SMV

SMV lies anterior to ...

uncinate process of pancreas