The document summarizes the anatomy of the biliary tree. It describes how bile is produced in the liver and stored in the gallbladder before being released into the duodenum during digestion. It outlines the structures that make up the biliary tree, including the hepatic ducts, cystic duct, common bile duct, and sphincter of Oddi. It also discusses important anatomical landmarks surgeons must be aware of when performing cholecystectomies, such as Calot's triangle, the cystic lymph node of Lund, Hartmann's pouch, and Rouviere's sulcus.

1. The Biliary Tree
By Ashtar Alhamad
Under the Professor Süphan Ertürk’s supervision
Cerrahpaşa medical school
General Surgery department.

2. Bile or Gall
It’s a dark green to yellowish brown fluid, produced
by the liver of most vertebrates, it aids the digestion
of lipids in the small intestine.
O In humans, bile is produced continuously by the
liver (liver bile), and stored and concentrated in the
gallbladder. After eating, this stored bile is
discharged into the duodenum.

3. O The composition of gallbladder bile is
water, bile salts, bilirubin, fats (cholesterol,
fatty acids, and lecithin), and inorganic
salts.

4. O The hepatocytes secrete bile into the bile canaliculi
formed between them. The canaliculi drain into the small
interlobular biliary ducts and then into large
collecting bile ducts of the intrahepatic portal triad,
which merge to form the hepatic ducts. The right and
left hepatic ducts drain the right and left parts of the
liver, respectively.
O Shortly after leaving the porta hepatis, these hepatic
ducts unite to form the common hepatic duct, which is
joined on the right side by the cystic duct to form the
bile duct.

7. The Gallbladder
O it lies in the fossa for the gallbladder on
the visceral surface of the liver
The gallbladder has three parts
• Fundus, Body, and Neck.

9. O The bile duct (formerly called the common bile duct) forms by
the union of the cystic duct and common hepatic duct
O On the left side of the descending part of the duodenum, the
bile duct comes into contact with the main pancreatic duct.
These ducts run obliquely
through the wall of this part of the duodenum, where they
unite, forming a dilation, the hepatopancreatic ampulla(Ampulla
of Vater) The distal end of the ampulla opens into the
duodenum through the major duodenal papilla
O The circular muscle around the distal end of the bile duct is
thickened to form the sphincter of the bile duct

11. Blood Supply
O Cystic artery( a branch of right hepatic
artery)-gall bladder,cystic
duct,hepatic ducts,and upper part of bile
duct.
• Posterior superior pancreaticoduodenal
artery-lower part of bile duct.
• Right hepatic artery –minor source of
middle part of bile duct.

13. Venous drainage
O Superior surface of
GB drains into
hepatic
veins.
• Rest of GB is
drained by one or two
cystic veins which
enter into right branch
of portal vein.
• Lower part of bile
duct drains into portal
vein.

15. Anatomical Land Marks
O In surgery and especially in cholecystectomy
operation there are 5 important land marks
that any surgeon must be aware of:
O 1. Calot’s triangle
O 2. Cystic node of Lund (Mascagni's lymph node)
O 3. Hartmann’s pouch
O 4. Cystic artery and right hepatic artery
O 5. Rouviere’s sulcus

16. Calot’s triangle
O Also called cystohepatic triangle
O It’s bounded on the upper border by inferior
surface of liver and on the other two sides by
cystic duct and common hepatic duct. Its
contents include right hepatic artery, cystic artery,
cystic lymph node of Lund.
O Its importance:
O Dissection of its contents without damaging the
bile duct is the most challenging step of
laparoscopic cholecystectomy,
O In addition, this space may be obscured and
shrunken by inflammatory process and adhesion
as a result of cholecystitis.

18. Lund Lymph node
O It is a guide to the place where cystic duct
joins the hepatic duct and is an important
structure which needs identification during
laparoscopic cholecystectomy.

20. Hartmann pouch
O is an out-pouching of the wall of the
gallbladder, at the junction of the
neck of the gallbladder and the
cystic duct.
O It may be a site where gall stone
impacts, which leads to mucocele of
gallbladder. So its identification is
useful in delineating biliary anatomy
while performing a cholecystectomy.

22. Rouviere’s sulcus
O It is a fissure on the inferior surface of the liver
between the right lobe and caudate process
and is clearly seen during posterior dissection
during laparoscopic cholecystectomy
O Its importance:
O The surgeon must draw an imaginary line of
safety between this sulcus and the hilar plate,
and must avoid any dissection below it.

25. O Thank You 