CHAPTER 11 The Gallbladder and the Biliary System

the normal gallbladder measures ____________ in diameter

2.5 to 4 cm

The cystic duct is about ______ long

4 cm

*The common hepatic duct is approximately ______ in diameter

4 mm

the gallbladder serves as a reservoir for bile with a capacity of _______.

50 ml

The normal common bile duct has a diameter of up to ______.

6 mm

the normal gallbladder measures ___________ in length.

7 to 10 cm

_________ form micelles, solubilize triglyceride fat, and assist in its absorption and that of calcium, cholesterol, and fat-soluble vitamins from the intestine.

Bile salts

Smaller arteries and veins run ________ the liver and the gallbladder.

between

The gallbladder serves as a reservoir for ________.

bile

the extrahepatic biliary tract transports ______ from the liver to the _________.

bile intestine

common hepatic duct (term)

bile duct system that drains the liver into the common bile duct

Secretion is largely caused by a ______________________, and ductal flow is controlled by secretion.

bile salt-dependent mechanism

Bile is the principal medium for excretion of _________________.

bilirubin and cholesterol

porta hepatis (term)

central area of the liver where the portal vein, common duct, and hepatic artery enter

Dilation of the extrahepatic bile ducts (usually less than 1 cm) occurs after _____________.

cholecystectomy

The end parts of both ducts (common bile duct and main pancreatic duct) and the ampulla are surrounded by ______________.

circular muscle fibers known as the sphincter of Oddi

The hepatic and bile ducts are encased in a common ____________, forming the portal triad.

collagenous sheath

The common hepatic duct is the bile duct system that drains the liver into the ______________.

common bile duct

The cystic duct connects the neck of the gallbladder with the common hepatic duct to form the _______________.

common bile duct

The right and left hepatic ducts unite to form the _______________, which then passes caudally and medially.

common hepatic duct

It is nearly impossible to see luminal or wall abnormalities when the gallbladder is _________.

contracted

The arterial supply of the gallbladder is from the ________, which is a branch of the _________.

cystic artery, right hepatic artery.

The common hepatic duct is joined by the ___________ to form the common bile duct.

cystic duct

The neck becomes continuous with the ___________, which turns into the ___________ to join the right side of the common hepatic duct to form the ________________.

cystic duct lesser omentum common bile duct

common bile duct (term)

duct that extends from the point where the common hepatic duct meets the cystic duct; drains into the duodenum after it joins with the main pancreatic duct

pancreatic duct (term)

duct that travels horizontally through the pancreas to join the common bile duct at the ampulla of Vater

When the gallbladder is removed....Bile is no longer retained in the bile ducts but is free to flow into the ________ during fasting and digestive phases.

duodenum

The common hepatic duct descends within the __________.

edge of the lesser omentum.

During the ___________ state, very little bile flows into the duodenum.

fasting

Concentration of bile in the gallbladder occurs during a state of _________. It is forced into the gallbladder by an increased pressure within the common bile duct, which is produced by the action of the ________________ at the distal end of the gallbladder.

fasting sphincter of Oddi

This potential space between the liver and the gallbladder is an area for __________________ to collect. If this migration does not occur, the gallbladder remains intrahepatic or it may be enveloped in the visceral peritoneum, hanging into the lower abdomen.

infection or inflammation

patients with agenesis of the GB may still have the biliary ductal system, which can become ______________________.

inflamed or filled with stones

Several anatomic variations may occur within the gallbladder to give rise to its ___________ on the sonogram.

internal echo pattern

Bile salts activate ____________.

intestinal and pancreatic enzymes

The bile salts from the _________ stimulate the liver to make more bile.

intestine

The gallbladder lies in the _______ position, but as it migrates to the surface of the liver during development it acquires a peritoneal covering over most of its surface. The remainder of the gallbladder surface is covered with _________ that merges with the connective tissue with the liver.

intrahepatic adventitial tissue

Occasionally the gallbladder lies in an ____________ location, and it may be difficult to detect by sonography if the entire upper abdomen is not examined.

intrahepatic or other anomalous

The proximal portion of the common bile duct is ______ to the hepatic artery and ______ to the portal vein.

lateral, anterior

The fundus is situated _____________ to the neck.

lateral, caudal, and anterior

The walls are __________.

less than 3 mm thick

The cystic duct descends for a variable distance in the right free edge of the _____________.

lesser omentum.

*Each hepatic duct is formed by the union of bile canaliculi from the ____________.

liver lobules.

hydrops (term)

massive enlargement of the gallbladder

Common Bile Duct ends by piercing the __________________ about halfway down the duodenal length.

medial wall of the second part of the duodenum

Stimulation produced by the influence of food causes the gallbladder to contract, resulting in an ___________.

outpouring of bile into the duodenum

The distal duct lies _______ to the anterior wall of the vena cava.

parallel

Other anomalies include __________________________.

partial septation, complete septation (double gallbladder), and folding of the fundus (Phrygian cap)

Together with the liver and pancreas, the biliary system ______.

plays a role in the digestive process.

The right and left hepatic ducts emerge from the right lobe of the liver in the _____________.

porta hepatis

*The hepatic duct runs parallel with the ________.

portal vein

The cystic vein drains directly into the _________.

portal vein

Within the liver parenchyma, the bile ducts follow the same course as the ________________.

portal venous and hepatic arterial branches

The duct moves more ______ after it descends behind the duodenal bulb and enters the pancreas.

posterior

The second part of the Common Bile Duct is situated _________ to the first part of the duodenum.

posterior

The neck of the gallbladder is oriented ____________ toward the porta hepatis.

posteromedially

Sonographic evaluation of the gallbladder and biliary system is used as a _________________and has proven to be effective in diagnosing various types of gallbladder diseases.

primary diagnostic tool

the extrahepatic biliary tract _______ its flow of bile.

regulates

The primary functions of the extrahepatic biliary tract are

(1) the transportation of bile from the liver to the intestine and (2) the regulation of its flow. This is an important function as the liver secretes approximately 1 to 2 liters of bile per day.

the liver secretes approximately _______ of bile per day.

1 to 2 liters

The gallbladder may fold back on itself at the neck, forming __________.

Hartmann's pouch

____________ in the neck of the gallbladder helps to prevent kinking of the duct.

Heister's valve

Cystic Duct is usually somewhat _______.

S-shaped

Failure of the gallbladder to develop is rare; this is known as _________________________.

agenesis of the gallbladder

At the END of the common bile duct it is joined by the main pancreatic duct, and together they open through a small ______ into the duodenal wall.

ampulla (the ampulla of Vater)

The gallbladder is a pear-shaped sac in the _________ aspect of the right upper quadrant, closely related to the visceral surface of the liver.

anterior

The rounded fundus usually projects below the inferior margin of the liver, where it comes into contact with the _______.

anterior abdominal wall at the level of the ninth right costal cartilage.

the ballbladder is divided into the _______.

fundus, body, and neck.

Small amounts of bile secreted by the liver are retained in the common duct and forced into the __________.

gallbladder

bile is drained from the ________ in the liver.

hepatic ducts

the gallbladder has the ability to concentrate the bile. To aid this process, its mucous membrane contains folds that unite with each other, giving the surface a __________.

honeycomb appearance

Dilation of the gallbladder is known as _________.

hydrops

The first part of the Common Bile Duct lies in the ____________.

right free edge of the lesser omentum

sphincter of Oddi (term)

small muscle that guards the ampulla of Vater

ampulla of Vater (term)

small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions

Hartmann's pouch (term)

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

When the stomach is emptied, duodenal peristalsis diminishes, the gallbladder relaxes, the tonus of the __________ increases slightly, and thus very little bile passes into the duodenum.

sphincter of Oddi

The products of ___________ are also excreted in the bile, as are drugs and poisons (e.g., salts of heavy metals).

steroid hormones

gallbladder (GB) (TERM)

storage pouch for bile

gallbladder diseases including

the more common problems of cholelithiasis, cholecystitis, and dilation of the ductal system.

The third part of the Common Bile Duct lies in a groove on ___________________.

the posterior surface of the head of the pancreas

The biliary apparatus consists of

the right and left hepatic ducts the common hepatic duct the common bile duct the pear-shaped gallbladder the cystic duct

The contracted gallbladder appears as a _________ structure with a slit for the bile.

thick-walled

When the gallbladder is removed, the sphincter of Oddi loses _____, and pressure within the common bile duct drops to that of intraabdominal pressure.

tonus

The size and shape of the gallbladder are __________.

variable

The gallbladder has been found to lie in _______________ (suprahepatic, suprarenal, within the anterior abdominal wall, or in the falciform ligament).

various ectopic positions

the gallbladder and bile ducts are functioning normally, they respond in a fairly uniform manner in __________.

various phases of digestion

The body generally lies in contact with the _________________ and is directed upward, backward, and to the left.

visceral surface of the liver