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BILIARY
APPARATUS
DR Sana Yaseen
Anatomy department.
INTRODUCTION
• Collects bile from liver, stores in gall bladder and
transmits it into 2nd part of duodenum
• Consist of
 Interlobular tributaries/ ducts
 R&L hepatic duct
 Common hepatic duct
 Cystic duct
 Gall bladder
 Bile duct
Biliary apparatus
Biliary apparatus
GALL BLADDER
• Small pear shaped sac attach to the visceral
surface of the liver (R-lobe).
• Length: 7-10ml
• Width: 3cm
• Capasity: 30-50ml
• Bile formation: 1L/day
• Functions:
1. Storage and concentration of bile
2. Selectively absorbes bile salts
3. excretes cholesterol and emulsification of fats
4. Secretes mucous
Parts of gall bladder
• Neck : on the right of porta hepatis, posteromedial
wall of the neck is dilated outward to form a pouch
known as Hartmann’s pouch.
• Body: lies within the visceral surface of the liver.
Superiorly is devoid of peritoneum. Inferiorly related
to colona and second part of the duodenum.
• Fundus: tounded and projects downward below
inferior margin of liver. It comes into contact with
anterior abdominal wall and tip of 9th costal cartilage.
Lies anterior to transverse colon.
Biliary apparatus
RELATION OF GALL BLADDER
4cm/
1.5inch
3-4cm
Dia: 1-3cm
8cm/ 3 inch
Dia: 6mm
Biliary apparatus
Biliary apparatus
RELATIONS OF CBD
PARTS OF CBD
1. Supra duodenal part
ant: liver
post: portal vein + epiploic foramen
left: hepatic artery
2. Retroduodenal part
ant: duodenum 1st part
post: IVC
left gastroduodenal artery
3. Infra duodenal part
ant: groove inhead of post surface of pancreas
post: IVC
4. Intraduodenal part
BLOOD SUPPLY
• ARTERIAL SUPPLY:
– Gall bladder: cystic artery, branch of Right hepatic
artery.
– CBD: cystic artery, pancreatico duodenal artery.
Middle segment by anastomosis of variety of vessels
present.
• VENOUS DRAINAGE: cystic vein drains into portal vein.
Biliary apparatus
INNERVATION
• Sympathetic & para sympathetic from
vagal fibers form the celiac plexus.
• It contracts in response to CCK release by
mucous membrane of duodenum in
response to fatty meal.
LYMPHATIC DRAINAGE
• Cystic node located near the neck of
bladder. Then into hepatic nodes and to
celiac nodes.
• FUNCTIONS OF GALL BLADDER:
COMPLICATIONS
• Biliary colic
• Cholecystitis
• Acute and chronic
• Mucocele of GB
• Empyema of GB
• Gangrene of GB
• Perforation
• Cholelithiasis
• Obstruction of biliary
duct
• Choledocholithiasis
• gallstone ileus (rare)
• Acute pancreatitis
• Intestinal obstruction
• Acute hepatitis
• Courvoisier`s law
Biliary apparatus
Distended gallbladder with bile sludge (white arrow) and increased wall thickening (black arrow)
Biliary apparatus
• LAPAROSCOPIC
CHOLECYSTECTO
MY WITH FUNDUS
FIRST TECHNIQUE
FOR
GANGRENOUS
AND INFECTED
GALLBLADDER
WHERE THE
CYSTIC DUCT
ANATOMY IS
DIFFICULT AND
UNCLEAR
Biliary apparatus
Biliary apparatus
Treatment
Surgical approach
• Open cholecystectomy
• Laproscopic cholecystectomy
Biliary apparatus
Biliary apparatus
Biliary apparatus
STEPS IN
CHOLECYSTECTOMY
Biliary apparatus
Biliary apparatus
• ERCP: endoscopic retrograde
cholangiopancreticography
• MRCP: magnetic resonance
cholangiopancreaticography
Biliary apparatus
Biliary apparatus
Biliary apparatus
Biliary apparatus
Biliary apparatus

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Biliary apparatus

  • 2. INTRODUCTION • Collects bile from liver, stores in gall bladder and transmits it into 2nd part of duodenum • Consist of  Interlobular tributaries/ ducts  R&L hepatic duct  Common hepatic duct  Cystic duct  Gall bladder  Bile duct
  • 5. GALL BLADDER • Small pear shaped sac attach to the visceral surface of the liver (R-lobe). • Length: 7-10ml • Width: 3cm • Capasity: 30-50ml • Bile formation: 1L/day • Functions: 1. Storage and concentration of bile 2. Selectively absorbes bile salts 3. excretes cholesterol and emulsification of fats 4. Secretes mucous
  • 6. Parts of gall bladder • Neck : on the right of porta hepatis, posteromedial wall of the neck is dilated outward to form a pouch known as Hartmann’s pouch. • Body: lies within the visceral surface of the liver. Superiorly is devoid of peritoneum. Inferiorly related to colona and second part of the duodenum. • Fundus: tounded and projects downward below inferior margin of liver. It comes into contact with anterior abdominal wall and tip of 9th costal cartilage. Lies anterior to transverse colon.
  • 13. PARTS OF CBD 1. Supra duodenal part ant: liver post: portal vein + epiploic foramen left: hepatic artery 2. Retroduodenal part ant: duodenum 1st part post: IVC left gastroduodenal artery 3. Infra duodenal part ant: groove inhead of post surface of pancreas post: IVC 4. Intraduodenal part
  • 14. BLOOD SUPPLY • ARTERIAL SUPPLY: – Gall bladder: cystic artery, branch of Right hepatic artery. – CBD: cystic artery, pancreatico duodenal artery. Middle segment by anastomosis of variety of vessels present. • VENOUS DRAINAGE: cystic vein drains into portal vein.
  • 16. INNERVATION • Sympathetic & para sympathetic from vagal fibers form the celiac plexus. • It contracts in response to CCK release by mucous membrane of duodenum in response to fatty meal.
  • 17. LYMPHATIC DRAINAGE • Cystic node located near the neck of bladder. Then into hepatic nodes and to celiac nodes. • FUNCTIONS OF GALL BLADDER:
  • 18. COMPLICATIONS • Biliary colic • Cholecystitis • Acute and chronic • Mucocele of GB • Empyema of GB • Gangrene of GB • Perforation • Cholelithiasis • Obstruction of biliary duct • Choledocholithiasis • gallstone ileus (rare) • Acute pancreatitis • Intestinal obstruction • Acute hepatitis • Courvoisier`s law
  • 20. Distended gallbladder with bile sludge (white arrow) and increased wall thickening (black arrow)
  • 22. • LAPAROSCOPIC CHOLECYSTECTO MY WITH FUNDUS FIRST TECHNIQUE FOR GANGRENOUS AND INFECTED GALLBLADDER WHERE THE CYSTIC DUCT ANATOMY IS DIFFICULT AND UNCLEAR
  • 25. Treatment Surgical approach • Open cholecystectomy • Laproscopic cholecystectomy
  • 32. • ERCP: endoscopic retrograde cholangiopancreticography • MRCP: magnetic resonance cholangiopancreaticography