Biliary System

Question 1

maintains a direct connection between
the liver and the GIT and thus, serves as an essential link in the entero-hepatic circulation.

Answer 1

The extra-hepatic system– GB and the extra hepatic bile ducts,

Question 2

The ducts passively transfer bile from the liver to the duodenum directly or via the __.

Answer 2

Gall Bladder

Question 3

• In the adult, ___ lying in a fossa in the undersurface of the (R) lobe of the liver.

Answer 3

Gall Bladder

Question 4

• Biliary System is divided into 3 regions;

Answer 4

Fundus
Body
Neck

Question 5

• the hemispheric blind end which is most inferior;

Answer 5

Fundus

Question 6

• The relaxed GB measures

Answer 6

7 to 10cm in length and 2-3cm in width and has a capacity of 30-50cc.

Question 7

• From each lobe of the liver, a Hepatic duct emerges and unite to form the ___ which passes between the __

Answer 7

Common Hepatic ducts
2 layers of the lesser omentum for about 4cm.

Question 8

• It is joined at an acute angle by the Cystic duct to create the ___ having an approximate diameter of ___ and it empties into the ___ through a small dilatation called the __ which has a sphincter called ___

Answer 8

Common Bile duct,
0.5 to 0.7cm
2nd portion of the duodenum
Ampulla of Vater
“sphincter of oddi”

Question 9

HISTOLOGICALLY, THE GB WALL HAS 4 DISTINCT LAYERS:

Answer 9

Mucosal Layer
Fibro-muscular Layer
Perimuscular Layer
Serous Peritoneal Layer

Question 10

The ___ of the GB is formed by a single layer of tall columnar cells that are thrown up into numerous, interlacing tiny folds creating a honeycombed mucosal surface.

Answer 10

Mucosal layer

Question 11

Beneath the Mucosa is a __ composed of smooth muscle cells and elastic fibrilsthat provides contractility to the GB.

Answer 11

Fibro-muscular layer

Question 12

A __ of connective tissue and elastic fibers often infiltrated with lymphocytes is interposed between the muscular wall and the outer wall of the GB.

Answer 12

Perimuscular layer

Question 13

A __ which covers all but the bare area of the hepatic bed.

Answer 13

Serous Peritoneal layer

Question 14

– is the presence or the formation of calculi in the Biliary tract particularly in the Gall Bladder.

Answer 14

Cholelithiasis

Question 15

• but occasionally stone formation may occur within the major bile ducts or liver.

Answer 15

Almost all stones form in the GB,

Question 16

STONES ARE COMPOSED OF 3 CONSTITUENTS OF THE BILE:

Answer 16

1. Cholesterol (Cholesterol stones)
2. Calcium Bilirubinate (Pigment stones)
3. Calcium Carbonate (Calcium carbonate stones)

Question 17

• The former are usually pure concretions of bile pigment, while the latter are most often mixtures of cholesterol with pigment and carbonates, although sometimes pure cholesterol are found.

Answer 17

Most stones contain either Bilirubin or Cholesterol.

Question 18

•whatever their compositions, are commonly found in chronically inflamed GB.

Answer 18

Gall stones

Question 19

– the portion between the fundus and the neck;

Answer 19

Body

Question 20

– a narrow tube-like structure which tapers into the cystic duct

Answer 20

Neck

Question 21

Approximately 10% of all gall stones are pure composition, cholesterol being the commonest type which usually occur single, varying in size up to egg-shaped structures 5-6cm in greatest diameter.

Answer 21

Cholesterol Stones

Question 22

• have a gray-yellow translucency and, when small, have an obvious crystalline external appearance.

Answer 22

Cholesterol stones

Question 23

• As they get larger, and perhaps polished in the gall bladder, they develop a ___

Answer 23

smooth egg shell surface.

Question 24

• These are less common than the pure cholesterol stones in Western countries but are quite common in Asiatic.

Answer 24

Calcium Bilirubinate Stones (Pigment Stones)

Question 25

Two Main Theories to Explain their Formation:

Answer 25

• Excessive hepatic secretion of bilirubin which surpasses its solubility in the bile. • Extrahepatic conversion of a normal bile pigment into an insoluble precipitate.

Question 26

This theory explains the high incidence of pigment stones in diseases characterized by excessive production of bilirubin such as the chronic hemolytic anemia and pernicious anemia.

Answer 26

• Excessive hepatic secretion of bilirubin which surpasses its solubility in the bile.

Question 27

This theory may be the mechanism responsible for the high incidence in the orient.

Answer 27

• Extrahepatic conversion of a normal

Question 28

Is the rare type encountered that appear gray-white with smooth, usually articulated surfaces that vary in size from sand-like grains to faceted polyhedral shapes up to 2cm in diameter.

Answer 28

Calcium Carbonate Stone

Question 29

An inflammation of the GB which maybe an Acute or Chronic.

Answer 29

CHOLECYSTITIS

Question 30

• The Acute response is subdivided on the basis of the severity of the inflammatory response into:

Answer 30

# Acute Suppurative Cholecystitis # Gangrenous Cholecystitis

Question 31

• was regarded by most investigators as a primary bacterial infection of the Gall Bladder.

Answer 31

Acute Cholecystitis

Question 32

• The diagnosis is usually only established by __ study that discloses either a malfunctioning GB or the presence of stones.

Answer 32

Cholecystogram

Question 33

– is also commonly designated as “Strawberry Gall Bladder” because the focal deposits of lipid in the epithelium and sub-epithelial region of the GB evoke the pale yellow-gray seeds that punctuate the surface of a strawberry.

Answer 33

Cholesterolosis

Question 34

 Histologically, the diagnostic features are enlargement and distention of the mucosal folds into club-shapes with aggregations of round to polyhedral histiocytes

Answer 34

Cholesterolosis

Question 35

#Cholesterol Stones Approximately __ of all gall stones are pure composition, cholesterol being the commonest type which usually occur single, varying in size up to egg-shaped structures __ in greatest diameter.

Answer 35

10% 5-6cm

Question 36

HYDROPS OF THE GALL BLADDER Hydrops of the GB is also known as __ of the GB,

Answer 36

“Mucocele”

Question 37

referring to distention of the GB by a clear, watery, mucinous secretion.

Answer 37

HYDROPS OF THE GALL BLADDER

Question 38

* This condition may occur in a normal or previously inflamed GB and is invariably due to total obstruction of the Cystic duct.

Answer 38

HYDROPS OF THE GALL BLADDER

Question 39

* Presumably, the trapped bile is reabsorbed and the GB becomes filled with clear, mucinous secretion derived from the GB wall.

Answer 39

HYDROPS OF THE GALL BLADDER

Question 40

 Anatomically, the __ is usually tense and enlarged and has a translucent appearance before being opened.

Answer 40

Gall Bladder

Question 41

 On __ the clear mucinous contents disclose the nature of the condition wherein stones may of course be present but are not intrinsic to the Hydrops.

Answer 41

opening of the GB,

Question 42

* Histologically, depending upon the severity of the condition, there is more or less atrophy of the epithelium so that, in Far advanced cases, no columnar or flattened cuboidal epithelial cells are present with the wall of the GB is composed only of an inner layer of connective tissue surrounded by the usual muscularis and the other layers.

Answer 42

memorize

Question 43

Tumors range from Benign to Malignant and occur in all possible sites within the ducts and Gall Bladder.

Answer 43

TUMORS OF THE GALL BLADDER

Question 44

* Although Fibromas, Myomas, Neuromas, Hemangiomas and the malignant counterparts of these lesions as well as Carcinoids have been described in this organ, the only neoplasms of sufficient frequency and clinical importance to merit description are the

Answer 44

Papilloma, Adenoma and Adenomyoma of the GB, Carcinoma of the GB and Carcinoma of the Bile ducts.

Question 45

is a conical, musculo-membranous sac

Answer 45

Gall Bladder