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Biliary apparatus
The biliary apparatus includes passages that store and convey bile from the liver to the duodenum. It has two parts: the intrahepatic and extrahepatic parts. The intrahepatic part includes the duct system within the liver while the extrahepatic part includes the right and left hepatic ducts, common hepatic duct, cystic duct, bile duct, and gallbladder. The common hepatic duct joins the cystic duct near the first part of the duodenum to form the bile duct, which opens at the major duodenal papilla. The gallbladder stores and concentrates bile before releasing it through the cystic duct into the common hepatic duct on contraction.
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Biliary apparatus
- 1. Biliary Apparatus • Passagesthat store bile & convey it to 2nd part of duodenum • 2 PARTS : Intrahepatic & Extahepatic INTRAHEPATIC PART : Duct system within the liver Hepatocytes -> Bile canaliculi -> Canals of Hering Bile ductules -> Rt & Lt Hepatic ducts
- 2. Extrahepatic • Rt andleft hepatic ducts • Common hepatic duct • Cystic duct • Bile duct • Gall bladder
- 3. Rt and lefthepatic ducts – Emerge through Porta hepatis – Relations : at Porta hepatis Ducts - Arteries - Veins (Ant to post) - Unite & form Common hepatic duct Anterior Porta hepatis
- 4. Common Hepatic duct PV •Loc : In Rt free margin of Lsr Omentum – In front of Portal vn & to the Rt of Hepatic A • Length : 4cm, Diameter : 4mm • Joins cystic duct 1cm above 1st part of duodenum (variable) Posterior
- 5. CYSTIC DUCT : •Connects Neck of GB with CH Duct • Joins CH Duct on the Rt, at an acute angle • Length : 2 - 3cm, Diameter : 2-3mm • Relations : Cystic Artery CHD Rt HD Lt HD B D
- 6. CYSTIC DUCT :Cont’d • 5 -12 crescentic valves in lumen : Spiral valves of Heister • Hartmann’s pouch : CHD Spiral valves
- 7. CALOT’S TRIANGLE BOUNDARIES : –Inf surface of liver (Above & laterally) – Cystic duct (Below & Lat) – Common Hepatic Duct (Medially) – Contents : Cystic artery with its variable dispositions Cystic Lymph Node APPLIED : Identification of Cystic artery - a prerequisite in cholecyctectomy.
- 8. BILE DUCT : Formation: CHD + Cystic duct – Length : 8cm, Diameter : 8mm Course : – Passes down, back & to the Rt – Joins Pancreatic duct- – Forms Ampulla of Vater & opens in Major duodenal papilla 4 Parts : – Supra, Retro, Infra (Para) & Intra duodenal parts : S R I I
- 9. Blood supply • FromBrs of Cystic, Hepatic and GD arteries - Ligation of cystic duct - away from Bile duct
- 10. BILE DUCT :APPLIEDANATOMY – Supra duodenal part : Most accessible part for surgery Eg : Choledochotomy, Insertion of drainage tube – Infra (Para) duodenal : Obstructed in Carcinoma Hd of pancreas (Jaundice) – Intra duodenal part : Ampullary carcinoma (Recurrent – obstructive - jaundice)
- 11. GALL BLADDER • Pearshaped fibro-muscular hollow viscus • Slate blue in colour • Size : 7-10 x 3 cm, 30-50 ml • Location : Gall bladder fossa on visceral surf of Rt lobe of liver, near quadrate lobe G B Quadrate lobe
- 12. GALL BLADDER Parts :Fundus, Body & Neck • Fundus - In lower bdr of liver Gall bladder
- 13. SURFACE MARKING -Fundus of GB • Transpyloric plane crosses costal margin at lat bdr of Rt Rectus sheath • At tip of Rt 9th costal cartilage • Area of tenderness in GB disease
- 14. GALL BLADDER- cont’d Functions: •Concentration & storage of bile •Reduces alkalinity •Regulates ductal pressure
- 15. GALL BLADDER cont’d •Arterial supply : Cystic A (Rt br of Hepatic A) •Occassionally from Lt Br of HA/ HA / GDA •Small vessels from hepatic bed of GB • Venous : Cystic vn (multiple) •Do not accompany Cystic Artery •Drain into Intra hepatic part of portal vein • Lymphatics : Hepatic nodes
- 16. GALL BLADDER- cont’d •Nerve supply : •Parasymp : Hepatic Br of Ant Vagal trunk –Contraction of GB, Relaxation of Sphincters •Hormonal : CCK •Symp : C Ganglion- From T 7-9 •Refd pain : C3- 4 (Phrenic) / T 7-9 –Pain at tip of shoulder, –Rt Hypochondrium, Epigastrium, Infrascapular region
- 17. GALL BLADDER :APPLIEDANAT CongAnomalies : Agenisis, Septate, Double, Floating, Intrahepatic, Phrygian cap
- 18. GALL BLADDER :APPLIEDANAT • Cholecystitis, • Cholangitis • Cholelithiasis, • White bile • Biliary colic • Cholecystectomy • Cholidocotomy : incision of bile duct (upper part) for removal of Gall stones
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- 21. Percutaneous Transhepatic cholangiography(PTC) • Detect obstructions • A thin needle is inserted into liver to deliver dye to the bile ducts • Movement of dye tracked using a fluoroscope (specialized X-ray machine)
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