Bile Ducts

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Measurement of Common Hepatic Duct:

4mm or less

Dilated Common duct measurement:

> 8mm Patients with previous cholecystectomy may be considered normal with maximum diameter of 10 mm (1mm for every 10 years of life) ex 6mm is normal for 60 year old patient

Most common cause of cholangitis:

Bile duct obstruction

From the gallbladder the bile travels to.....

Bile travels from the GB to the cystic duct to the CBD towards duodenum. Meets at pancreatic duct and Ampulla of Vater

Cholangiocarcinoma

Biliary tree cancer

Jaundice is accumulation of ___________ within tissues of the body

Bilirubin (yellowish pigment in bile)

Carolis Disease

Dilatation of INTRAhepatic bile ducts

Cholecystokinin

Hormone released by ingestion of fatty foods, causes GB to contract

Biliary atresia is associated with

Von Hippel Lindau syndrome polysplenia situs inversus cardiac septal defects absent IVC

Stellate confluence

bile ducts branch into star shaped configuration

Extrahepatic ducts include:

cystic duct common bile duct common hepatic duct Everything else is INTRAhepatic

Bile is a _________ fluid produced by the ________

digestive, liver

Most common Choledochal cyst:

dilatation of CBD

"Parallel channel sign" or "Shotgun Sign" refers to:

dilated hepatic duct adjacent to portal vein

Klatskin tumor

is a cholangiocarcinoma located at hepatic hilum- junction of RT and LT hepatic duct. Causes dilatation of intrahepatic ducts

Symptoms of Choledocholithiasis

jaundice* RUQ pain* elevated bilirubin elevated alk phos elevated GGT

Sphincter of Oddi

muscle that allows bile and pancreatic juices to flow through Ampulla of Vater into duodenum AKA hepatopancreatic sphincter

bile is _______________ by the liver

produced

Function of Biliary tree:

provide a conduit for bile to drain from liver into small intestine

Bile is composed of:

*bilirubin, bile acids, cholesterol

Sonographic appearance of Caroli's disease

- multiple intrahepatic cysts - dilated biliary ducts

Mirizzi Syndrome

-uncommon -cycstic duct obstruction (EXTRAhepatic obstruction) leads to INTRAhepatic dilatation

* 2 most common causes of biliary obstruction:

1. Gallstones 2. Carcinoma of the pancreas

Caroli's disease is typically associated with:

1. Polycystic Kidney disease 2. Congenital hepatic fibrosis 3. Choledochal cysts

Biliary atresia

Absence of extrahepatic ducts (CHD and CBD) - may or may not have GB

Choledochal cysts are more prevelant where?

Asia (33% reported cases are from japan)

Pneumobilia

Air within the biliary tree -echogenic linear structure within the ducts Most commonly seen after endoscopic retrograde cholangiopancreatogram (ERCP) (Pneumo= air/ lung)

* Where do cholangiocarciomas typically occur?

Can occur anywhere in biliary tree. *Typically originate in EXTRAhepatic ducts (CBD and CHD)

Choledochal cyst

Congenital BILE DUCT anomalie consisting of cystic dilation of intra or extra hepatic bile ducts. -usually dilated CBD -separate from gallbladder -more common in Asian women -5 classes

Biliary obstruction is most commonly due to pathology in the _______________

Distal CBD

Cholangitis

Inflammation of bile ducts

Choledocholithiasis

gallstones in bile ducts

biled is _____________ in the gallbladder

stored

The most distal segment of the biliary tree

the CBD closest to pancreatic head

Spiral valves of Heister

tiny folds within the cystic duct to prevent it from collapsing


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