Biliary System Heartland Society of Gastroenterology Nurses and Associates Mary Ganley RN CGRN BSHA

Objectives Describe the normal structure and histology of the biliary system. Name three diseases or diagnoses of the biliary tract and treatment.

Diagram

Biliary System Consist Of: Gallbladder Hepatic Duct Cystic Duct Common Bile Duct Four Functions of the Biliary System Collect Concentrate Store Release This is accomplished by motility and secretion

Four Divisions of the Gallbladder 1. Fundus 2. Funnel shaped body 3.Transitional region between the body and the neck. This is where gallstones get impacted 4. The neck which narrows at the cystic duct The cystic duct combines with the hepatic duct to form the common bile duct. The ampulla empties into the duodenum at the papilla of Vater or major papilla

Sphincter of Oddi Smooth muscle surrounding the common bile duct, , the pancreatic duct, and the ampulla of Vater. The functions of the sphincter of Oddi are: Regulate the flow of bile and pancreatic juices into the intestine. Inhibit entry of bile into the pancreatic duct. Prevent reflux of intestinal contents in the ducts. (When the gallbladder is removed the sphincter of Oddi regulates bile flow.) Under normal condition Sphincter of Oddi remains open.

Gallbladder The gallbladder wall is made up of serosa, a fibro- muscular layer and mucosa. The blood is supplied to the gallbladder by the hepatic artery. The maximum amount of bile that can be stored in the gallbladder is 50ml. The major component of bile that is produced in the liver is water. The functions of bile are emulsification of undigested fats, facilitating the absorption of fat soluble vitamins, and activation of intestinal and pancreatic enzymes.

BILE Provision of a route for excretion of bilirubin, cholesterol, and certain sex, thyroid, and adrenal hormones.

Diseases of the Biliary System Cholelithiasis is the presence of stones or calculi in the gallbladder. Accounts for 90% of biliary diseases. Two types of gallstones: #1 is cholesterol Make up 80%- yellow green in color. Made up primarily of cholesterol-associated with hepatic production of bile. #2 is Pigment stones - black pigment made up of bilirubin. Forty, female, fat

Cholelithiasis Symptoms: Steady pain mainly 3-6 hours after a meal Pain radiates - can be similar to MI Nausea and vomiting Fever and chills Ultrasound - most effective diagnostic CT, MRCP, ERCP Treatment: Surgery Dissolution -- Disadvantage stones may return

Choledocholithiasis Stones in the common bile duct or the hepatic duct. Symptoms : Biliary colic, right upper quadrant abdominal pain, obstructive jaundice and pruritus, fever, and chills Treatment: ERCP WITH SPHINCTEROTOMY

Cholangitis Cholangitis is a rare bacterial infection of the bile duct associated with obstruction 85% = stone in common bile duct. Is a medical and surgical emergency Decompression or drainage should produce immediate benefits

Cholecystitis Is an acute or chronic inflammation that causes painful distention of the gallbladder. 90% gallstones impacted in the cystic duct known as acute calculus cholecystitis - upper right quadrant abdominal pain, nausea, vomiting, fever, chills, tachycardia, abd tenderness with rebounding pain, and intolerance to fatty foods and heavy meals. Ultrasound , labs, and ERCP Decompression or stents

Primary Sclerosing Cholangitis PSC is a rare inflammation process that results in multiple strictures of the bile duct causing chronic cholestatic liver disease. Symptoms: fatigue, jaundice, Pruritis, abdominal pain, and elevated serum alkaline phosphate. US, ERCP or PTC

Questions Classic radiological findings in primary sclerosing cholangitis would be: a. multiple short biliary strictures and areas of dilation resulting in a beaded appearance b. progressive dilation of the pancreatic duct of Santorini c. ’double duct’ sign (BILIARY+PANCREATIC OBSTRUCTION). d. diminishing intrahepatic ducts on the cholangiogram

Questions 2. The gall bladder is connected to the common bile duct by the: a. Hepatic Duct b. Cystic Duct c. Pancreatic duct

Questions 3. Clinical manifestation of primary sclerosing cholangitis may include: a. Pruritis b. Jaundice c. Abdominal Pain d. Portal Hypertension e. All of the above

Questions 4. Progression of disease in a patient with primary sclerosing cholangitis has been listed to include the following: a. Progressive stricture formation b. Cirrhosis c. Cholangiocarcinoma d. All of the above