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Ch 14 Biliary

Biliary Tract Section

What is a common site for for impaction, or lodging of gallstones? Duodenal Papilla
Where is the gallbladder found on the following body habitus; Asthenic, Hypersthenic, Hyposthenic Asthenic gallbladder is located near the mid-sagittal plane. Hypersthenic gallbladder is located to the right of the mid-sagittal plane. Hyposthenic gallbladder is to the right of the mid sagittal plane.
(T/F) Cholecystitis may produce a thickened gallbladder wall? True
How much bile does a healthy adult liver produce per day? 800-1000 ml/day
What is the average weight of the adult human liver? 3-4 pounds
What are the 3 primary functions of the gallbladder? To store bile, To concentrate bile, To contract when stimulated & release bile,
What is the order of events for the contraction of the gallbladder? Fat in the duodenum. Duodenum secretes enzyme Cholecystokin (CCK). CCK is secreted directly to the blood stream. CCK goes throughout body. When CCK reaches gallbladder it signals gallbladder to contract. Gallbladder contracts & releases bile.
What is the start of the chain of events for the contraction of the gallbladder to release Cholecystokin (CCK)? Fat in the Duodenum
What happens if too much water is absorbed or if the cholesterol becomes too concentrated? May form Choleliths (Gallstones).
What patient position will best demonstrate gallstones & move the gallbladder away for the spinal cord? Right Lateral Decubitis
Where is bile formed? Where is bile stored? What is the path the bile travels to be stored? Bile is formed in the liver. Bile is stored in the gallbladder. Bile travels down the right & left hepatic ducts, down the common hepatic duct, through cystic duct to the gallbladder to be stored.
What are the folds along the length on the inside of the cystic duct? The spiral valves
What is the exam oral cholecystogram a study of? What does it measure? How does it measure the liver function? The anatomy & function of the gallbladder. Measures if the gallbladder contracts, if the gallbladder works, measures the patency of the ducts, measures the liver function. Measures if the liver takes contrast out of the blood stream.
Where does the gallbladder sit when viewing from a lateral position? Where does the common bile duct sit when viewing from a lateral view? It sits in the anterior 1/3. It sits midline when viewed laterally.
What are some of the risks for a percutaneous transhepatic cholangiogram? Why? Risk of liver hemorrhage, because the liver is highly vascular. Risk of pneumothorax, if the needle nicks the diaphragm. Tha's why it should be done on full expiration. Risk of bile escaping into the peritoneal cavity.
What is a percutaneous transhepatic cholangiogram? Why is the contrast media injected? What can be done? A direct puncture of the biliary ducts by a chiba (skinny ) needle. The contrast media is injected to see where the stricture is. Can then do a biliary drainage & stone extraction.
What is a T-Tube Cholangiogram? What are the chain of events? Bile is drained through common bile duct to the outside of the body through a T-Tube. Contrast is injected demonstrate the stone. The patient comes back to get more contrast to see if the stone is has drained. If stone is gone, then the T-Tube is removed.
What are some of the clinical manifestations of a T-Tube cholangiogram? Cholelithiasis or biliary calculi. Cholecystitis. Neoplasms. Biliary Stenosis-Stricture (closing off of biliary ducts).
What does ERCP stand for? What is it? Endoscopic Retrograde Cholangiopancreotography. The duodenoscope goes through the duodenum to see where the ducts are connected to the duodenum. The biliary ducts is injected with contrast & an exposure is taken.
What are the 4 advantages of a gallbladder ultrasound instead of an operative cholnagiogram? There is no ionizing radiation. There is better detection of small calculi, There is less patient preparation. No contrast media is required.
Where is the endoscope inserted for a Laparoscopic cholangiogram? Why is a laparoscopic cholangiogram done vs. an operative cholangiogram? Through the umbilicus. It is less invasive & has less cost.
When should an exposure be taken during an operative cholangiogram? Why is this done? Exposure should be taken when the anesthesiologist stops the breathing. To verify there's no stones after removing the gallbladder & closing the patient.
Created by: jamestkelley