Anatomy of the extrahepatic bile ducts. What is the human bile duct system and how does it work? Diagnosis and treatment of cholangitis

Anatomy

What is dangerous blockage of the ducts

Diagnosis of diseases

Features of treatment

Therapeutic diet

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Dear readers, the bile ducts (bile ducts) have one important function - they conduct bile to the intestines, which plays a key role in digestion. If for some reason it periodically does not reach the duodenum, there is a direct threat to the pancreas. After all, bile in our body eliminates the properties of pepsin that are dangerous for this organ. It also emulsifies fats. Cholesterol and bilirubin are excreted through bile, because they cannot be filtered out by the kidneys in full.

If the gallbladder ducts are blocked, the entire digestive tract suffers. Acute blockage causes colic, which can result in peritonitis and an urgent operation, partial obstruction disrupts the functionality of the liver, pancreas and other significant organs.

Let's talk about what is especially in the bile ducts of the liver and gallbladder, why they begin to conduct bile poorly and what needs to be done to avoid the adverse effects of such blockage.

The anatomy of the bile ducts is quite complex. But it is important to understand it in order to understand how the biliary tract functions. The bile ducts are intrahepatic and extrahepatic. From the inside, they have several epithelial layers, the glands of which secrete mucus. The bile duct has a biliary microbiota - a separate layer that forms a community of microbes that prevent the spread of infection in the organs of the biliary system.

The intrahepatic bile ducts have a tree structure. The capillaries pass into the segmental bile ducts, and those, in turn, flow into the lobar ducts, which, outside the liver, form the common hepatic duct. It enters the cystic duct, which drains bile from the gallbladder and forms the common bile duct (choledochus).

Before entering the duodenum, the common bile duct passes into the pancreatic excretory duct, where they combine to form the hepatopancreatic ampulla, which is separated by the sphincter of Oddi from the duodenum.

Diseases that cause obstruction of the bile ducts

Diseases of the liver and gallbladder in one way or another affect the state of the entire biliary system and cause blockage of the bile ducts or their pathological expansion as a result of a chronic inflammatory process and stagnation of bile. Provoke obstruction such diseases as cholelithiasis, cholecystitis, excesses of the gallbladder, the presence of structures and scars. In this condition, the patient needs urgent medical attention.

Blockage of the bile ducts is caused by the following diseases:

• bile duct cysts;
• cholangitis, cholecystitis;
• benign and malignant tumors of the pancreas and organs of the hepatobiliary system;
• scars and strictures of the ducts;
• cholelithiasis;
• pancreatitis;
• hepatitis and cirrhosis of the liver;
• helminthic invasions;
• enlarged lymph nodes of the hepatic gate;
• surgical interventions on the biliary tract.

Most diseases of the biliary system cause chronic inflammation of the biliary tract. It leads to thickening of the walls of the mucosa and narrowing of the lumen of the ductal system. If, against the background of such changes, the stone enters the gallbladder duct, the calculus partially or completely blocks the lumen.

Bile stagnates in the bile ducts, causing them to expand and exacerbate the symptoms of the inflammatory process. This can lead to empyema or dropsy of the gallbladder. For a long time, a person suffers minor symptoms of blockage, but eventually irreversible changes in the mucosa of the biliary tract will begin to occur.

Why is it dangerous

If the bile ducts are clogged, it is necessary to consult a specialist as soon as possible. Otherwise, there will be an almost complete loss of the liver from participation in detoxification and digestive processes. If the patency of the extrahepatic or intrahepatic bile ducts is not restored in time, liver failure may occur, which is accompanied by damage to the central nervous system, intoxication and goes into a severe coma.

Blockage of the bile ducts can occur immediately after an attack of biliary colic https://site/zhelchnaya-kolika against the background of the movement of stones. Sometimes obstruction occurs without any prior symptoms. A chronic inflammatory process, which inevitably occurs with biliary dyskinesia, cholelithiasis, cholecystitis, leads to pathological changes in the structure and functionality of the entire biliary system.

At the same time, the bile ducts are dilated, they may contain small stones. Bile stops flowing into the duodenum at the right time and in the required amount.

The emulsification of fats slows down, metabolism is disturbed, the enzymatic activity of the pancreas decreases, food begins to rot and ferment. Stagnation of bile in the intrahepatic ducts causes the death of hepatocytes - liver cells. Bile acids and direct active bilirubin begin to enter the bloodstream, which provokes damage to internal organs. The absorption of fat-soluble vitamins against the background of insufficient intake of bile into the intestine worsens, and this leads to hypovitaminosis, a violation of the functions of the blood coagulation system.

If a large stone gets stuck in the bile duct, it immediately closes its lumen. There are acute symptoms that signal the severe consequences of obstruction of the biliary tract.

How does blockage of the ducts manifest?

Many of you probably believe that if the bile ducts are clogged, the symptoms will immediately be so acute that they cannot be tolerated. In fact, the clinical manifestations of blockage can increase gradually. Many of us have experienced discomfort in the right hypochondrium, which sometimes even lasts for several days. But we are not in a hurry with these symptoms to specialists. And such aching pain may indicate that the bile ducts are inflamed or even clogged with stones.

As the ductal patency worsens, additional symptoms appear:

• acute girdle pain in the right hypochondrium and abdomen;
• yellowing of the skin, the appearance of obstructive jaundice;
• discoloration of feces due to a lack of bile acids in the intestine;
• itching of the skin;
• darkening of the urine due to the active excretion of direct bilirubin through the kidney filter;
• severe physical weakness, increased fatigue.

Pay attention to symptoms of obstruction of the bile ducts and diseases of the biliary system. If you undergo diagnostics at the initial stage, change the nature of nutrition, you can avoid dangerous complications and preserve the functionality of the liver and pancreas.

Diseases of the biliary system are treated by gastroenterologists or hepatologists. You should contact these specialists if you have complaints of pain in the right hypochondrium and other characteristic symptoms. The main method for diagnosing diseases of the bile ducts is ultrasound. It is recommended to look at the pancreas, liver, gallbladder and ducts.

If the specialist detects strictures, tumors, expansion of the choledochus and ductal system, the following studies will be additionally assigned:

• MRI of the bile ducts and the entire biliary system;
• biopsy of suspicious areas and neoplasms;
• feces on the coprogram (detect a low content of bile acids);
• blood biochemistry (increased direct bilirubin, alkaline phosphatase, lipase, amylase and transaminases).

Blood and urine tests are prescribed in any case. In addition to the characteristic changes in the biochemical study, with duct obstruction, prothrombin time is prolonged, leukocytosis is observed with a shift to the left, and the number of platelets and erythrocytes decreases.

Features of treatment

The tactics of treating pathologies of the bile ducts depends on concomitant diseases and the degree of blockage of the lumen of the ductal system. In the acute period, antibiotics are prescribed, detoxification is carried out. In this state, serious surgical interventions are contraindicated. Specialists try to limit themselves to minimally invasive methods of treatment.

These include the following:

• choledocholithotomy - an operation to partially excise the common bile duct in order to free it from stones;
• bile duct stenting (installation of a metal stent that restores ductal patency);
• drainage of the bile ducts by inserting a catheter into the bile ducts under the control of an endoscope.

After the duct system is restored, specialists can plan more serious surgical interventions. Sometimes the blockage is provoked by benign and malignant neoplasms that have to be removed, often along with the gallbladder (with calculous cholecystitis).

Total resection is performed using microsurgical instruments, under the control of the endoscope. Doctors remove the gallbladder through small punctures, so the operation is not accompanied by heavy blood loss and a long rehabilitation period.

During cholecystectomy, the surgeon must assess the patency of the ductal system. If stones or strictures remain in the bile ducts after removal of the bladder, severe pain and emergencies may occur in the postoperative period.

Removal of a stone-filled bladder in a certain way saves other organs from destruction. And the streams too.

Do not refuse the operation if it is necessary and threatens the entire biliary system. From the stagnation of bile, inflammation, reproduction of infectious pathogens, the entire digestive tract and the immune system suffer.

Often a person against the background of diseases of the ducts begins to lose weight dramatically, feel bad. He is forced to limit his activity, give up his favorite work, because constant pain attacks and health problems do not allow him to live a full life. And the operation in this case prevents the dangerous consequences of chronic inflammation and stagnation of bile, including malignant tumors.

Therapeutic diet

For any diseases of the bile ducts, diet No. 5 is prescribed. This involves the exclusion of fatty, fried foods, alcohol, carbonated drinks, foods that provoke gas formation. The main goal of such nutrition is to reduce the increased load on the biliary system and prevent a sharp course of bile.

In the absence of severe pain, you can eat as usual, but only if you have not abused prohibited foods before. Try to completely abandon trans fats, fried foods, spices, smoked meats, convenience foods. But at the same time, nutrition should be complete and varied. It is important to eat often, but in small portions.

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It is necessary to resort to treatment with folk remedies when the bile ducts are clogged with extreme caution. Many herbal recipes have a strong choleretic effect. Using such methods, you risk your own health. Since it is impossible to clean the bile ducts with herbal preparations without the risk of developing colic, you should not experiment with herbs at home.

First, make sure that there are no large stones that can cause blockage of the ductal system. If you use choleretic herbs, give preference to those that have a mild effect: chamomile, rosehip, flax seeds, immortelle. Beforehand, nevertheless, consult a doctor and conduct an ultrasound. You should not joke with choleretic compounds if there is a high risk of blockage of the bile ducts.

Articles you may find helpful:

This video describes a gentle cleansing of the gallbladder and ducts that can be used at home.

Guy de Chauliac(1300-13681, a famous surgeon from Avignon, France), stated: "A good operation cannot be performed without knowledge of anatomy." Knowledge of anatomy is very important in biliary surgery. Surgeons operating on the biliary tract are faced with countless anatomical variations that occur in the hilum of the liver and extrahepatic biliary structures.The surgeon must be familiar with the normal anatomy and the most common abnormalities.Before ligation or dissection, each anatomical structure must be carefully identified to avoid fatal consequences.

gallbladder located on the lower surface of the liver and is held in its bed by the peritoneum. The line separating the right and left lobes of the liver passes through the gallbladder bed. The gallbladder has the shape of a pear-shaped sac 8-12 cm long and up to 4-5 cm in diameter, its capacity is from 30 to 50 ml. When the bubble is stretched, its capacity can increase to 200 ml. The gallbladder receives and concentrates bile. Normally, it is bluish in color, which is formed by a combination of translucent walls and the bile it contains. With inflammation, the walls become cloudy and translucency is lost.

gallbladder divided into three segments that do not have an exact distinction: bottom, body and funnel.
1. The bottom of the gallbladder- this is the part that is projected beyond the anterior border of the liver and is completely covered by the peritoneum. The bottom is palpable. when the gallbladder is swollen. The bottom is projected onto the anterior abdominal wall at the intersection of the ninth costal cartilage with the outer edge of the right rectus abdominis muscle, however, there are numerous deviations.

2. Body of the gallbladder located posteriorly, and with distance from the bottom, its diameter progressively decreases. The body is not completely covered by the peritoneum; it connects it with the lower surface of the liver. Thus, the lower surface of the gallbladder is covered by the peritoneum, while the upper part is in contact with the lower surface of the liver, from which it is separated by a layer of loose connective tissue. Blood and lymphatic vessels, nerve fibers, and sometimes additional hepatic ducts pass through it. In cholecystectomy, the surgeon needs to separate this loose connective tissue, which will allow you to operate with minimal blood loss. In various pathological processes, the space between the liver and bladder is obliterated. In this case, the liver parenchyma is often injured, which leads to bleeding. 3. The funnel is the third part of the gallbladder that follows the body. Its diameter gradually decreases. This segment of the bladder is completely covered by the peritoneum.

It is within hepatoduodenal ligament and usually protrudes anteriorly. The funnel is sometimes called the pocket of Hartmann (Hartmann (. But we believe that the pocket of Hartmann is the result of a pathological process caused by the infringement of the calculus in the lower part of the funnel or in the neck of the gallbladder. This leads to the expansion of the mouth and the formation of the pocket of Hartmann, which, in turn , contributes to the formation of adhesions with the cystic and common bile ducts and makes cholecystectomy difficult.Hartmann's pocket should be considered as a pathological change, since the normal infundibulum does not have the shape of a pocket.

gallbladder consists of a layer of high cylindrical epithelial cells, a fibromuscular layer consisting of longitudinal, circular and oblique muscle fibers, and fibrous tissue covering the mucous membrane. The gallbladder does not have submucosal and muscular-mucous membranes. It does not contain mucous glands (sometimes there may be single mucous glands, the number of which increases somewhat with inflammation; these mucous glands are located almost exclusively in the neck). The fibromuscular layer is covered with a layer of loose connective tissue through which blood, lymphatic vessels and nerves penetrate. To perform a subserous cholecystectomy. it is necessary to find this loose layer, which is a continuation of the tissue that separates the gallbladder from the liver in the liver bed. The funnel passes into the neck 15-20 mm long, forming an acute angle, open upwards.

Cystic duct connects the gallbladder to the hepatic duct. When it merges with the common hepatic duct, the common bile duct is formed. The length of the cystic duct is 4-6 cm, sometimes it can reach 10-12 cm. The duct can be short or completely absent. Its proximal diameter is usually 2-2.5 mm, which is slightly less than its distal diameter, which is about 3 mm. Outwardly, it appears uneven and twisted, especially in the proximal half and two thirds, due to the presence of Heister valves within the duct. The Geister valves are crescent-shaped and arranged in an alternating sequence, giving the impression of a continuous spiral. In fact, the valves are separated from each other. The Geister valves regulate the flow of bile between the gallbladder and the bile ducts. The cystic duct usually joins the hepatic duct at an acute angle in the upper half of the hepatoduodenal ligament, more often along the right edge of the hepatic duct, forming the vesicohepatic angle.

Cystic duct may enter the common bile duct perpendicularly. Sometimes it runs parallel with the hepatic duct and joins with it behind the initial part of the duodenum, in the region of the pancreas, and even in the major duodenal papilla near it, forming a parallel connection. Sometimes it connects with the hepatic duct in front of the plp behind it, enters the duct along the left edge of the plp on its anterior wall. This rotation with respect to the hepatic duct has been termed spiral fusion. This fusion can cause hepatic Mirizzi syndrome. Occasionally, the cystic duct drains into the right or left hepatic duct.

Surgical anatomy of the hepatic duct

bile ducts originate in the liver in the form of bile ducts, which receive bile secreted by the liver cells. Connecting with each other, they form ducts of increasing diameter, forming the right and left hepatic ducts, coming, respectively, from the right and left lobes of the liver. Normally, as they exit the liver, the ducts join to form the common hepatic duct. The right hepatic duct is usually located more inside the liver than the left. The length of the common hepatic duct is very variable and depends on the level of connection of the left and right hepatic ducts, as well as on the level of its connection with the cystic duct to form the common bile duct. The length of the common hepatic duct is usually 2–4 cm, although 8 cm is not uncommon. The diameter of the common hepatic and common bile ducts is most often 6-8 mm. The normal diameter can reach 12mm. Some authors show that ducts of normal diameter may contain calculi. Obviously, there is a partial coincidence of the size and diameter of normal and pathologically altered bile ducts.

In patients who have undergone cholecystectomy, as well as in the elderly, the diameter of the common bile duct may increase. The hepatic duct over its own plate containing the mucous glands is covered with a high cylindrical epithelium. The mucous membrane is covered with a layer of fibroelastic tissue containing a certain amount of muscle fibers. Mirizzi described the sphincter in the distal hepatic duct. Since no muscle cells were found, he called it the functional sphincter of the common hepatic duct (27, 28, 29, 32). Hang (23), Geneser (39), Guy Albot (39), Chikiar (10, 11), Hollinshed et al. (19) have demonstrated the presence of muscular filaments in the hepatic duct. To identify these muscle fibers, after obtaining the sample, it is necessary to immediately proceed to tissue fixation, since autolysis quickly occurs in the bile and pancreatic ducts. With these precautions in mind, together with Dr. Zuckerberg, we confirmed the presence of muscle fibers in the hepatic duct.

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

BELARUSIAN STATE MEDICAL UNIVERSITY

DEPARTMENT OF OPERATIONAL SURGERY AND TOPOGRAPHIC ANATOMY

V. F. VARTANYAN, P. V. MARKAUTSAN

OPERATIONS ON THE GALL BLADDER AND BILID DUCTS

Teaching aid

UDC 616.361/.366-089(075.8) BBK 54.13 i 73

Approved by the Scientific and Methodological Council of the University as a teaching aid on June 14, 2006, Protocol No. 7

Reviewers: Assoc. S. N. Tikhon, prof. A. V. Prokhorov

Vartanyan, V. F.

In 18 Operations on the gallbladder and bile ducts: textbook.-method. allowance / V. F. Vartanyan, P. V. Markautsan. - Minsk: BSMU, 2007 - 16 p.

ISBN 978-985-462-763-2.

The issues of anatomy are considered, as well as the general principles of surgical treatment of diseases of the gallbladder and extrahepatic bile ducts used in clinical practice.

Designed for senior students of all faculties.

Anatomy of the gallbladder

Holotopia. The gallbladder (GB) and ducts are projected into the right hypochondrium and proper epigastric region.

Skeletotopia. The bottom of the gallbladder is most often projected in the corner formed by the outer edge of the right rectus abdominis muscle and the costal arch, at the level of the anterior end of the IX costal cartilage (at the place where the cartilage of the X rib merges with it). The GB can also be projected at the place where the costal arch is crossed by a line connecting the top of the right axillary cavity with the navel.

Syntopia. Above and in front of the gallbladder is the liver, on the left is the pylorus, on the right is the hepatic flexure of the colon, the transverse colon (or the initial section of the duodenum 12). The bottom of the gallbladder usually comes out from under the anterior-lower edge of the liver by 2–3 cm and adjoins the anterior abdominal wall.

The gallbladder ( vesica fellea) has a pear-shaped shape (Fig. 1), is located on the visceral surface of the liver in the corresponding hole (fossa vesicae felleae), separating the anterior section of the right lobe of the liver from the square. The gallbladder is covered by the peritoneum, usually on three sides (mesoperitoneally). Much less often, intrahepatic (extraperitoneal) and intraperitoneal (maybe mesentery) its location takes place. Anatomically, the bottom is distinguished in the gallbladder (fundus vesicae felleae), the wide part is the body (corpus vesicae felleae) and the narrow part is the neck (collum vesicae felleae). The length of the gallbladder varies from 8 to 14 cm, the width is 3–5 cm, and the capacity reaches 60–100 ml. In the gallbladder, before it passes into the cystic duct, there is a kind of protrusion of the wall in the form of a pocket (Hartmann's pocket), which is located below the rest of the bladder cavity.

Rice. 1. Scheme of the gallbladder:

1 - bottom; 2 - body; 3 - neck; 4 - common bile duct; 5 - cystic duct; 6 - Hartmann pocket

The wall of the gallbladder consists of a mucous membrane (tunica mucosa vesicae felleae),

muscular (tunica muscularis vesicae felleae), subserous (tela subserosa vesicae felleae) and serous (tunica serosa vesicae felleae) layers.

The mucous membrane is represented by a large number of spiral folds, lined with a single-layer prismatic border epithelium and has a good resorption capacity. It is quite sensitive to various extreme events in the body, which is morphologically manifested by its swelling and desquamation.

The muscle layer consists of bundles of muscle fibers running in the longitudinal and circular directions. There may be gaps between them, through which the mucous membrane can directly fuse with the serous one (Rokitansky-Ashoff sinuses). These sinuses play an important role in the pathogenesis of the development of biliary peritonitis without perforation of the gallbladder: when the gallbladder is overstretched, bile leaks through the mucous and serous membranes directly into the abdominal cavity.

Luschke's burrows may be located on the upper surface of the GB (Fig. 2). They start from the small intrahepatic ducts of the liver and reach the mucous membrane. During cholecystectomy, these passages gape and cause the outflow of bile into the free abdominal cavity, which, as a rule, necessitates drainage of this cavity and the bed of the gallbladder.

Rice. 2. The structure of the HP:

1 - Luschke's moves; 2 - intrahepatic duct; 3 - muscle layer of the gallbladder; 4 - sine of Rokitansky–Ashoff

The blood supply to the gallbladder (Fig. 3) is carried out by the cystic artery (a. systica), which departs from the right branch of the hepatic artery and, approaching the neck of the bladder, is divided into two branches going to the upper and lower surfaces. To find it, one can distinguish the so-called Kahlo triangle, the walls of which are the cystic and common hepatic ducts, and the base is the cystic artery.

The lymphatic network of the gallbladder vessels has its own characteristics. Lymph through two collectors enters the lymph nodes, one of which is located on the left side of the bladder neck, the second - directly at the edge

12 duodenal ulcer. These nodes in the inflammatory process in the gallbladder can increase in size and compress the common bile duct.

Rice. 3. Blood supply to the gallbladder:

1 - Kahlo's triangle; 2 - cystic artery; 3 - cystic duct; 4 - common hepatic duct; 5 - common bile duct

Innervation of the gallbladder, ducts, sphincters is carried out from the celiac, lower diaphragmatic plexuses, as well as from the anterior trunk of the vagus nerve. Therefore, often diseases of the stomach and duodenum, as well as irritation of the vagus nerve with a sliding hernia of the esophageal opening of the diaphragm lead to dysfunction of the sphincter of Oddi and inflammatory changes in the gallbladder, and vice versa.

Anatomy of the extrahepatic bile ducts

The neck of the gallbladder passes into the cystic duct (ductus cysticus), which usually connects at an acute angle to the common hepatic duct (ductus hepaticus communis), resulting in the formation of the common bile duct (ductus choledochus). The folds of the mucous membrane in the cystic duct are located along the bile flow, which makes it difficult for it to move retrogradely (like a valve).

The diameter of the ductus cysticus is 3 mm, ductus hepaticus communis -

4–5 mm and ductus choledochus 6–8 mm. The common bile duct is on average 6–8 cm long. It runs along the right edge of the hepatoduodenal ligament. Next to it is the hepatic artery, and between them and behind it is the portal vein. Ductus choledochus (Fig. 4) consists of four sections: pars supraduodenalis (from the beginning to the duodenum 12), pars retroduodenalis (behind the horizontal part of the intestine), pars pancreatica (in the thickness of the pancreas), pars duodenalis (in the intestinal wall). common bile

Before talking about the development of the disease and surgery, it is important to understand the anatomical features of the most important bone junction, on the health of which, one might say, the fate of a person depends. After all, the failure of the TBS negatively affects the biomechanics of not only the legs, but the entire locomotor apparatus, which often leads to disability.

The joints are securely hidden behind the tendons, they are correctly called "joint bags".

The hip joint is the largest joint in the body. It is formed by two articulating bones - the thigh bone and the acetabulum of the pelvis. The femoral head is located in the cup-shaped recess of the pelvic bone, where it moves freely in various directions. Thanks to this interaction of two bone elements, it is ensured:

• flexion and extension;
• adduction and abduction;
• hip rotation.

Back part.

The surfaces of interacting bones are covered with a special elastic layer called hyaline cartilage. A special elastic coating allows the head to glide smoothly and unhindered, so that a person moves freely and does not experience problems at the time of physical activity. In addition, cartilage performs the functions of stabilizing the hip joint and cushioning every movement.

The structure of the joint is placed in a strong case - the joint capsule. Inside the capsule is a synovial membrane that produces a specific fluid. It lubricates the cartilaginous surfaces of the articular bones, moisturizes and enriches with nutrients, which maintains the cartilage structures in excellent condition.

Outside the capsule lies the supra-articular group of the femoral and pelvic muscles, thanks to which, in fact, the joint is set in motion. In addition, the largest joint covers a fan of various ligaments that perform a regulatory function, preventing excessive movement of the hip, more than the physiological norm.

The main part of the load falls on the TBS, therefore it is easily injured and prone to rapid wear in the event of adverse factors. This explains the fact of the high prevalence of the disease. Unfortunately, many patients turn to doctors at a late stage of arthrotic disorders, when the functionality has irreversibly dried up.

Under the influence of negative phenomena, the synthesis of synovial fluid is disrupted. It is produced in catastrophically low quantities, its composition changes. Thus, cartilaginous tissues are constantly deprived of nutrition, dehydrated. The cartilage gradually loses its former strength and elasticity, exfoliates and decreases in volume, which makes it impossible to smoothly and smoothly glide.

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The liver secret necessary for digestion moves through the gallbladder to the intestinal cavity through the bile ducts. Various diseases provoke changes in the functioning of the bile ducts. Interruptions in the work of these pathways affect the performance of the whole organism. The bile ducts differ in their structural and physiological features.

Interruptions in the work of the bile ducts affect the performance of the whole organism

What is the gallbladder for?

The liver is responsible for the secretion of bile in the body, and what function does the gallbladder perform in the body? The biliary system is formed by the gallbladder and its ducts. The development of pathological processes in it threatens with serious complications and affects the normal life of a person.

The functions of the gallbladder in the human body are:

• accumulation of bile fluid in the cavity of the organ;
• thickening and preservation of hepatic secretions;
• excretion through the bile ducts into the small intestine;
• protecting the body from irritants.

The production of bile is carried out by the cells of the liver and does not stop day or night. Why does a person need a gallbladder and why is it impossible to do without this link when transporting hepatic fluid?

The excretion of bile occurs constantly, but the processing of the food mass with bile is required only in the process of digestion, which is limited in duration. Therefore, the role of the gallbladder in the human body is to accumulate and store the secret of the liver until the right time. The production of bile in the body is an uninterrupted process and it is formed many times more than the volume of the pear-shaped organ allows. Therefore, bile splitting occurs inside the cavity, the removal of water and some substances necessary in other physiological processes. Thus, it becomes more concentrated, and its volume is significantly reduced.

The amount that the bubble will throw out does not depend on how much it produces the largest gland - the liver, which is responsible for the production of bile. The value in this case is played by the amount of food consumed and its nutritional composition. The passage of food through the esophagus serves as a signal to start work. To digest fatty and heavy foods, more secretions will be required, so the organ will contract more strongly. If the amount of bile in the bladder is insufficient, then the liver is directly involved in the process, where the secretion of bile never stops.

The accumulation and excretion of bile is carried out as follows:

Therefore, the role of the gallbladder in the human body is to accumulate and store the secret of the liver until the right time.

• the common hepatic duct passes the secret to the bile duct, where it accumulates and is stored until the right moment;
• the bubble begins to contract rhythmically;
• the bladder valve opens;
• the opening of the intracanal valves is provoked, the sphincter of the major duodenal papilla relaxes;
• bile goes to the intestines through the common bile duct.

In cases where the bubble is removed, the biliary system does not cease to function. All work falls on the bile ducts. The innervation of the gallbladder or its connection with the central nervous system occurs through the hepatic plexus.

Gallbladder dysfunction affects the well-being and can cause weakness, nausea, vomiting, itchy skin and other unpleasant symptoms. In Chinese medicine, it is customary to consider the gallbladder not as a separate organ, but as a component of one system with the liver, which is responsible for the timely release of bile.

The meridian of the gallbladder is considered Jansky, i.e. paired and runs throughout the body from head to toes. The meridian of the liver, which belongs to the Yin organs, and the gallbladder are closely related. It is important to understand how it spreads in the human body so that the treatment of organ pathologies with the help of Chinese medicine is effective. There are two channel paths:

• external, passing from the corner of the eye through the temporal region, forehead and back of the head, then descending to the armpit and lower along the front of the thigh to the ring toe;
• internal, starting in the area of ​​​​the shoulders and going through the diaphragm, stomach and liver, ending with a branch in the bladder.

Stimulation of points on the meridian of the biliary organ helps not only to improve digestion and improve its work. Impact on the points of the head eliminates:

• migraines;
• arthritis;
• diseases of the visual organs.

Also, through the points of the body, you can improve cardiac activity, but with help. Areas on the legs - muscle activity.

The structure of the gallbladder and biliary tract

The gallbladder meridian affects many organs, which indicates that the normal functioning of the biliary system is extremely important for the functioning of the whole organism. The anatomy of the gallbladder and biliary tract is a complex system of channels that ensure the movement of bile inside the human body. To understand how the gallbladder works, its anatomy helps.

What is the gallbladder, what is its structure and functions? This organ has the shape of a sac, which is located on the surface of the liver, more precisely, in its lower part.

In some cases, during fetal development, the organ does not come to the surface of the liver. The intrahepatic location of the bladder increases the risk of developing cholelithiasis and other diseases.

The shape of the gallbladder has a pear-shaped outline, a narrowed top and an expansion at the bottom of the organ. There are three parts in the structure of the gallbladder:

• narrow neck, where bile enters through the common hepatic duct;
• body, widest part;
• the bottom, which is easily determined by ultrasound.

The organ has a small volume and is able to hold about 50 ml of fluid. Excess bile is excreted through the small duct.

The walls of the bubble have the following structure:

1. Serous outer layer.
2. epithelial layer.
3. Mucous membrane.

The mucous membrane of the gallbladder is designed in such a way that the incoming bile is very quickly absorbed and processed. In the folded surface there are many mucous glands, the intensive work of which concentrates the incoming fluid and reduces its volume.

The ducts perform a transport function and ensure the movement of bile from the liver through the bladder to the duodenum. Ducts run to the right and left of the liver and form into the common hepatic duct.

The anatomy of the gallbladder and biliary tract is a complex system of channels that ensure the movement of bile inside the human body.

The anatomy of the biliary tract includes two types of ducts: extrahepatic and intrahepatic bile ducts.

The structure of the biliary tract outside the liver consists of several channels:

1. Cystic duct that connects the liver to the bladder.
2. The common bile duct (CBD or common bile duct), which begins at the junction of the hepatic and cystic ducts and leads to the duodenum.

The anatomy of the biliary tract distinguishes between the sections of the common bile duct. First, bile from the bladder passes through the supraduodenal section, passes into the retroduodenal section, then enters the duodenal section through the pancreatic section. Only along this path can bile get from the organ cavity to the duodenum.

How the gallbladder works

The process of movement of bile in the body is triggered by small intrahepatic tubules, which unite at the exit and form the hepatic left and right ducts. Then they form into an even larger common hepatic duct, from where the secret enters the gallbladder.

How does the gallbladder work, and what factors affect its activity? During periods when digestion is not required, the bladder is in a relaxed state. The work of the gallbladder at this time is to accumulate a secret. Eating provokes the launch of many reflexes. The pear-shaped organ is also included in the process, which makes it mobile due to the beginning contractions. By this point, it already contains processed bile.

The required amount of bile is released into the common bile duct. Through this channel, the liquid enters the intestine and promotes digestion. Its function is to break down fats through its constituent acids. In addition, the processing of food with bile leads to the activation of enzymes required for digestion. These include:

• lipase;
• aminolase;
• trypsin.

Bile appears in the liver. Passing through the choleretic channel, it changes its color, structure and decreases in quantity. Those. bile is formed in the bladder, which is different from the liver secretion.

The concentration of incoming bile from the liver occurs by removing water and electrolytes from it.

The principle of the gallbladder is described in the following paragraphs:

1. Collection of bile produced by the liver.
2. Condensation and storage of a secret.
3. The direction of the liquid through the duct into the intestine, where food is processed and broken down.

The organ begins to work, and its valves open only after the person receives food. The gallbladder meridian, on the contrary, is activated only in the late evening from 11 am to 1 am.

Diagnostics of the bile ducts

Failure of the biliary system occurs most often due to the formation of any obstacle in the channels. The reason for this may be:

• cholelithiasis
• tumors;
• inflammation of the bladder or bile ducts;
• strictures and scars that can affect the common bile duct.

Identification of diseases occurs with the help of a medical examination of the patient and palpation of the right hypochondrium, which allows you to establish a deviation from the norm in the size of the gallbladder, laboratory tests of blood and feces, as well as using hardware diagnostics:

Ultrasonography shows the presence of stones and how many have formed in the ducts.

1. X-ray. Not able to give specifics about the pathology, but helps to confirm the presence of a suspected pathology.
2. ultrasound. Ultrasonography shows the presence of stones and how many have formed in the ducts.
3. ERCP (endoscopic retrograde cholangiopancreatography). It combines X-ray and endoscopic examination and is the most effective method for studying diseases of the biliary system.
4. CT. With cholelithiasis, this study helps to clarify some details that cannot be determined with ultrasound.
5. MRI. Similar to CT method.

In addition to these studies, a minimally invasive method for detecting blockage of the choleretic ducts, laparoscopy, can be used.

Causes of diseases of the bile ducts

Violations in the functioning of the bladder have various causes and can be triggered by:

Any pathological changes in the ducts disrupt the normal outflow of bile. Expansion, narrowing of the bile ducts, thickening of the walls of the common bile duct, the appearance of various formations in the canals indicates the development of diseases.

The narrowing of the lumen of the bile ducts disrupts the return flow of secretions to the duodenum. The causes of diseases in this case can be:

• mechanical trauma caused during surgery;
• obesity;
• inflammatory processes;
• the appearance of cancerous tumors and liver metastases.

Strictures formed in the bile ducts provoke cholestasis, pain in the right hypochondrium, jaundice, intoxication, and fever. The narrowing of the bile ducts leads to the fact that the walls of the channels begin to thicken, and the area above - to expand. Blockage of the ducts leads to stagnation of bile. It becomes thicker, creating ideal conditions for the development of infections, so the appearance of strictures often precedes the development of additional diseases.

The expansion of the intrahepatic bile ducts occurs due to:

Changes in the bile ducts accompany the symptoms:

• nausea;
• gagging;
• soreness of the right side of the abdomen;
• fever;
• jaundice;
• rumbling in the gallbladder;
• flatulence.

All this indicates that the biliary system is not working properly. There are some of the most common diseases:

1. ZhKB. The formation of stones is possible not only in the bladder, but also in the ducts. In many cases, the patient does not experience any discomfort for a long time. Therefore, stones may go unnoticed for several years and continue to grow. If the stones block the bile ducts or injure the walls of the canal, then the developing inflammatory process is difficult to ignore. Pain, high fever, nausea and vomiting will not allow this to be done.
2. Dyskinesia. This disease is characterized by a decrease in the motor function of the bile ducts. Violation of the flow of bile occurs due to changes in pressure in various areas of the channels. This disease can develop independently, as well as accompany other pathologies of the gallbladder and its ducts. A similar process causes pain in the right hypochondrium and heaviness that occurs a couple of hours after eating.
3. Cholangitis. It is usually caused by acute cholecystitis, but the inflammatory process can also occur on its own. Symptoms of cholangitis include: fever, excessive sweating, pain in the right side, nausea and vomiting, jaundice develops.
4. Acute cholecystitis. Inflammation is of an infectious nature and proceeds with pain and fever. At the same time, the size of the gallbladder increases, and deterioration occurs after eating fatty, heavy meals and alcoholic beverages.
5. Cancer tumors of channels. The disease often affects the intrahepatic bile ducts or pathways at the gates of the liver. With cholangiocarcinoma, yellowing of the skin, itching in the liver, fever, nausea, and other symptoms appear.

In addition to acquired diseases, congenital developmental anomalies, such as aplasia or hypoplasia of the gallbladder, can complicate the work of the bladder.

Anomalies of the gallbladder

Anomaly in the development of the gallbladder ducts is diagnosed in almost 20% of people. Much less often you can find a complete absence of channels designed to remove bile. Congenital malformations entail disruption of the biliary system and digestive processes. Most congenital malformations do not pose a serious threat and can be treated; severe forms of pathologies are extremely rare.

Anomalies of the ducts include the following pathologies:

• the appearance of diverticula on the walls of the channels;
• cystic lesions of the ducts;
• the presence of kinks and partitions in the channels;
• hypoplasia and atresia of the biliary tract.

According to their characteristics, anomalies of the bubble itself are conditionally divided into groups depending on:

• localization of the gall;
• changes in the structure of the body;
• deviations in form;
• quantities.

An organ may be formed but not in its normal position and placed:

• in the right place, but across;
• inside the liver;
• under the left hepatic lobe;
• in the left hypochondrium.

Pathology is accompanied by violations of bladder contractions. The organ is more susceptible to inflammatory processes and the formation of stones.

The "wandering" bubble can occupy various positions:

• inside the abdominal region, but almost not in contact with the liver and covered with abdominal tissues;
• completely separated from the liver and communicating with it through a long mesentery;
• with a complete lack of fixation, which increases the likelihood of kinks and twisting (lack of surgical intervention leads to the death of the patient).

It is extremely rare for doctors to diagnose a newborn with a congenital absence of the gallbladder. Gallbladder agenesis can take several forms:

1. Complete absence of the organ and extrahepatic bile ducts.
2. Aplasia, in which, as a result of underdevelopment of the organ, there is only a small, incapable of functioning process and full-fledged ducts.
3. Hypoplasia of the bladder. The diagnosis suggests that the organ is present and able to function, but some of its tissues or areas are not fully formed in the child in the prenatal period.

Functional kinks go away on their own, while true ones require medical intervention.

Agenesis in almost half of the cases leads to the formation of stones and the expansion of the large bile duct.

An abnormal, non-pear-shaped form of the gallbladder appears due to constrictions, kinks in the neck or body of the organ. If the bubble, which should be pear-shaped, resembles a snail, then a kink has occurred that violated the longitudinal axis. The gallbladder collapses to the duodenum, and adhesions form at the point of contact. Functional excesses pass on their own, and the true ones require medical intervention.

If the pear-shaped shape changes due to constrictions, then the vesical body narrows in places or completely. With such deviations, stagnation of bile occurs, provoking the appearance of stones and accompanied by severe pain.

In addition to these shapes, the pouch may resemble the Latin S, a ball, or a boomerang.

A bifurcation of the gallbladder weakens the organ and leads to dropsy, calculi and inflammation of the tissues. The gallbladder may be:

• multi-chamber, while the bottom of the organ is partially or completely separated from its body;
• bilobed, when two separate lobules join one bladder neck;
• ductular, two bladders with their ducts function simultaneously;
• triplication, three organs united by a serous membrane.

How are bile ducts treated?

In the treatment of blockage of the ducts, two methods are used:

• conservative;
• operational.

The main in this case is surgical intervention, and conservative means are used as auxiliary.

Sometimes, a calculus or a mucous clot can leave the duct on its own, but this does not mean that the problem is completely eliminated. The disease in the absence of treatment will return, so it is necessary to deal with the cause of the appearance of such stagnation.

In severe cases, the patient is not operated on, but his condition is stabilized, and only after that the day of the operation is appointed. To stabilize the condition, patients are prescribed:

• starvation;
• installation of a nasogastric tube;
• antibacterial drugs in the form of antibiotics with a wide spectrum of action;
• droppers with electrolytes, protein preparations, fresh frozen plasma and others, mainly for detoxification of the body;
• antispasmodic drugs;
• vitamin remedies.

To accelerate the outflow of bile, non-invasive methods are resorted to:

• extraction of calculi with a probe, followed by drainage of channels;
• percutaneous puncture of the bladder;
• cholecystostomy;
• choledochostomy;
• percutaneous hepatic drainage.

Normalization of the patient's condition allows the use of surgical methods of treatment: laparotomy, when the abdominal cavity is fully opened or laparoscopy performed using an endoscope.

In the presence of strictures, endoscopic treatment allows you to expand the narrowed ducts, insert a stent and ensure that the channels are provided with a normal lumen of the ducts. Also, the operation allows you to remove cysts and cancerous tumors that usually affect the common hepatic duct. This method is less traumatic and allows even cholecystectomy. Opening the abdominal cavity is resorted to only in cases where laparoscopy does not allow for the necessary manipulations.

Congenital malformations, as a rule, do not require treatment, but if the gallbladder is deformed or omitted due to some kind of injury, what should I do? Displacement of the organ while maintaining its performance does not worsen health, but with the appearance of pain and other symptoms, it is necessary:

• observe bed rest;
• drink enough liquid (preferably without gas);
• adhere to a diet and foods approved by the doctor, cook correctly;
• take antibiotics, antispasmodics and analgesics, as well as vitamin supplements and choleretic drugs;
• attend physiotherapy, do physiotherapy exercises and massage to relieve the condition.

Despite the fact that the organs of the biliary system are relatively small, they do a great job. Therefore, it is necessary to monitor their condition and consult a doctor when the first symptoms of diseases appear, especially if there are any congenital anomalies.

Video

What to do if a stone appears in the gallbladder.

Source: liver.org

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