1. Anatomy of biliary tree
Physiology of bile
and the bile circulation.
Hassan Alqarni
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2. Gallbladder
• pear-shaped sac, about 7–10 cm long
• lying on the visceral surface of the right lobe of the
liver in a fossa between the right and quadrate lobes
Divided into four anatomic areas:
– fundus
– the corpus (body)
– the infundibulum
– the neck
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3. • Relations
– Anteriorly: The anterior abdominal wall and the
inferior surface of the liver
– Posteriorly: The transverse colon and the first and
second parts of the duodenum
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5. • Blood supply :
– cystic artery
• usually a branch of the right hepatic artery (>90% of the
time).
• always is found within the hepatocystic triangle, the area
bound by the cystic duct, common hepatic duct, and the
liver margin (triangle of Calot).
• When the cystic artery reaches the neck of the
gallbladder, it divides into anterior and posterior divisions.
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7. • Venous drainage:
– either through:
• small veins that enter directly into the liver
• large cystic vein that carries blood back to the
portal vein (rarely)
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8. • lymphatic drainage
– nodes at the neck of the gallbladder.
– Frequently, a visible lymph node overlies the
insertion of the cystic artery into the gallbladder wall.
• Nerve supply:
– vagus
– sympathetic branches that pass through the celiac
plexus
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10. Bile ducts
Intrahepatic Extrahepatic
• formed from the larger bile • right and left hepatic ducts
canaliculi which come • the common hepatic duct
together to form segmental • cystic duct
ducts. • common bile duct or
choledochus.
• fuse close to the porta • The common bile duct
hepatis into right and left enters the second portion
hepatic ducts. of the duodenum through a
muscular structure, the
sphincter of Oddi
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12. common hepatic duct
• 1 to 4 cm in length and
• approximately 4 m of diameter
• lies in :
• front of the portal vein
• to the right of the hepatic
artery.
• The common hepatic duct is joined
at an acute angle by the cystic duct
to form the common bile duct.
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13. cystic duct
• length is quite variable
• Variations of the cystic duct and its point of
union with the common hepatic duct are
surgically important.
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14. A. Low junction between the cystic duct B. Cystic duct adherent to the common
and common hepatic duct hepatic duct
C. High junction between the cystic and
D. Cystic duct drains into right hepatic duct.
the common hepatic duct Benign Biliary Conditions - -
15. E. Long cystic duct that joins common
hepatic duct behind the duodenum F. Absence of cystic duct.
G. Cystic duct crosses posterior to common H. Cystic duct courses anterior to common
hepatic duct and joins it posteriorly
hepatic duct and joins it anteriorly. Benign Biliary Conditions - -
16. common bile duct CBD
• about 7 to 11 cm in length
• 5 to 10 mm in diameter.
• The upper third (supraduodenal)
• The middle third (retroduodenal)
• The lower third (pancreatic)
• Runs obliquely downward within the
wall of the duodenum for 1 to 2 cm
before opening on a papilla of
mucous membrane (ampulla of
Vater).
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17. The common bile duct enters the second portion of the duodenum through a
muscular structure, the sphincter of Oddi
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18. union of the common bile duct and
the main pancreatic duct
• The follows one of three configurations:
- In about 70%
- unite outside the duodenal wall and traverse the duodenal wall
as a single duct.
- In about 20%,
- they join within the duodenal wall and have a short or no
common duct, but open through the same opening into the
duodenum.
- In about 10%,
- they exit via separate openings into the duodenum.
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19. • The extrahepatic bile ducts are lined by
– a columnar mucosa with numerous mucous
glands in the common bile duct.
• The arterial supply to the bile ducts is
– derived from the gastroduodenal
– the right hepatic arteries, with major trunks
running along the medial and lateral walls of the
common duct.
• The nerve supply to the common bile duct
and the sphincter of Oddi is
– the same as for the gallbladder
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21. Bile Function
1. Aid in the digestion and absorption of lipids
and lipid soluble vitamins
2. Eliminate waste products (bilirubin and
cholesterol) through secretion into bile and
elimination in feces.
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22. Bile Formation and Composition
• The liver produces bile continuously and
excretes it into the bile canaliculi.
• Normally liver produce 500–1000 mL of bile a
day.
• Bile is mainly composed of water, electrolytes,
bile salts, proteins, lipids, and bile pigments.
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23. • The primary bile salts, cholate and
chenodeoxycholate, are synthesized in the liver from
cholesterol.
• They are conjugated there with taurine and glycine
• Bile salts are excreted into the bile by the hepatocyte
and aid in the digestion and absorption of fats in the
intestines.
– About 95 percent of the bile acid pool is reabsorbed and
returned via the portal venous system to the liver, the so-
called enterohepatic circulation.
– Five percent is excreted in the stool, leaving the relatively
small amount of bile acids to have maximum effect.
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25. • Absorption and Secretion
– In the fasting state, approximately 80 percent of the
bile secreted by the liver is stored in the gallbladder
• Motor Activity
– after meal ,cholecystokinin (CCK) is released from the
duodenal mucosa in response to a meal.
– gallbladder empties 50–70 percent of its contents
within 30–40 min.
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