5 Biliary System Consist Of: GallbladderHepatic DuctCystic DuctCommon Bile DuctFour Functions of the Biliary SystemCollectConcentrateStoreReleaseThis is accomplished by motility and secretion
6 Four Divisions of the Gallbladder 1. Fundus2. Funnel shaped body3.Transitional region between the body and the neck. This is where gallstones get impacted4. The neck which narrows at the cystic ductThe 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
7 Sphincter of OddiSmooth 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.
8 GallbladderThe 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.
9 BILEProvision of a route for excretion of bilirubin, cholesterol, and certain sex, thyroid, and adrenal hormones.
10 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 cholesterolMake 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
11 Cholelithiasis Symptoms: Steady pain mainly 3-6 hours after a meal Pain radiates - can be similar to MINausea and vomitingFever and chillsUltrasound - most effective diagnosticCT, MRCP, ERCPTreatment:SurgeryDissolution -- Disadvantage stones may return
12 CholedocholithiasisStones in the common bile duct or the hepatic duct.Symptoms : Biliary colic, right upper quadrant abdominal pain, obstructive jaundice and pruritus, fever, and chillsTreatment: ERCP WITH SPHINCTEROTOMY
13 CholangitisCholangitis is a rare bacterial infection of the bile duct associated with obstruction85% = stone in common bile duct.Is a medical and surgical emergency Decompression or drainage should produce immediate benefits
14 CholecystitisIs 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 ERCPDecompression or stents
15 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
16 QuestionsClassic radiological findings in primary sclerosing cholangitis would be:a. multiple short biliary strictures and areas of dilation resulting in a beaded appearanceb. progressive dilation of the pancreatic duct of Santorinic. ’double duct’ sign (BILIARY+PANCREATIC OBSTRUCTION).d. diminishing intrahepatic ducts on the cholangiogram
17 Questions2. The gall bladder is connected to the common bile duct by the:a. Hepatic Ductb. Cystic Ductc. Pancreatic duct
18 Questions3. Clinical manifestation of primary sclerosing cholangitis may include: a. Pruritis b. Jaundice c. Abdominal Pain d. Portal Hypertension e. All of the above
19 Questions4. Progression of disease in a patient with primary sclerosing cholangitis has been listed to include the following:a. Progressive stricture formationb. Cirrhosisc. Cholangiocarcinomad. All of the above