Cystic duct. Possible pathologies of the bile and hepatic ducts. How are bile ducts treated?

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 biliary mucosa 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 volume.

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, when the ducts are obstructed, 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 useful:

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

common bile duct has a length of 5 to 15 cm (usually 8-10 cm). It, like the common hepatic duct, is located along the free edge of the hepatoduodenal ligament. To the left and somewhat anteriorly is the hepatic artery. The portal vein runs behind the hepatic artery, being closer to it. than to the common bile duct. The common bile duct passes behind the initial part of the duodenum, then continuing down and to the right. It runs along a groove or tunnel formed by the head of the pancreas and the beginning of the descending part of the duodenum. The common bile duct enters the wall of the duodenum and joins with the pancreatic duct to form a common duct that opens into the duodenum with the major duodenal papilla.

common bile duct can be divided into four segments:
1. Supraduodenal, usually 20 mm long. This segment is most easily accessible during surgical operations. Together with the common hepatic duct, it provides good access for choledochotomy and revision of the biliary tract.
2. Retroduodenal segment 15-20 mm long.
3. Infraduodenal extra-pancreatic segment 20-30 mm long. It follows the descending duodenum in a notch or tunnel along the head of the pancreas. The pancreas and the common bile duct are not fused with each other, so the tissue separating them is well defined, except in cases of chronic pancreatitis in the head of the pancreas. In such cases, it is almost impossible to separate the common bile duct and pancreas. Fibrotissue infiltration and thickening of the pancreas can lead to obstruction of the common bile duct. If there is no fusion of the common bile duct with the pancreas, a retropancreatic choledochotomy can be performed to remove an impacted calculus that cannot be removed by supraduodenal or transduodenal sphincterotomy.
4. Intraduodenal, or intramural, segment. As soon as the common bile duct crosses the wall of the duodenum, its caliber decreases significantly, and the walls become thicker. This must be remembered when interpreting the cholangiogram. It should also be borne in mind that the radiopaque substance that enters the duodenum during intraoperative cholangiography can cause shadows that hide a clear picture of the intramural segment of the common bile duct. In these cases, the radiograph should be repeated and a clear image of the terminal common bile duct should be achieved. The length of the intramural section of the common bile duct is very variable, but always greater than the thickness of the wall of the duodenum. This is due to its oblique trajectory when crossing the wall of the duodenum. The length of the transduodenal section of the common bile duct is 14-16 mm.

There are three main ways common bile junctions and pancreatic ducts:
1. Most commonly, the common bile duct and pancreatic duct join shortly after penetration through the duodenal wall, forming a short common tract.
2. Both ducts run in parallel, but do not connect and empty separately into the major duodenal papilla. Sometimes the pancreatic duct can fall 5-15 mm below the papilla.
3. Pancreatic duct and common bile duct join at a higher level, before entering the wall of the duodenum, forming a longer common canal. In rare cases, a type 1 or 3 compound forms an extension called an ampulla.

Vater's papilla and its study

Abraham Vater in 1720 (491 lectured at the university Wittenberg(Germany), entitled "Novus bills diverticulum", in which he described a diverticulum located at the distal end of the common bile duct. Vater thus described the diverticulum of the common bile duct, the rarest example of choledochocele. Subsequently, he failed to find a second such case. He never mentioned the duodenal papilla; the ampulla was also not described by him. Nevertheless, in the medical literature, the major duodenal papilla and ampulla bear his name. The formation, called the ampulla of Vater, is a duct formed by the connection of the common bile and pancreatic ducts as they pass through the wall of the descending part of the duodenum to the place where it flows into the major duodenal papilla. It is usually a short segment shaped like a duct rather than an ampulla. Sometimes it can be longer. This duct can expand if the duodenal papilla is blocked as a result of an inflammatory process or infringement of a calculus. Probably, it can reach a larger diameter without obstruction due to post-mortem autolysis of the common bile and pancreatic ducts. Like other authors, we believe that the term "ampoule" should not be used. The formation considered is a duct, not an ampulla. The eponym "Vater" should also not be used, since Vater never mentioned her (10). Some authors believe that the error in the name of the ampoule came from Claude Bernard, who in 1856 in his book, quoting Vater, said: "Ampoule commune nomme ampoule de Water," - and wrote "Vater" with W instead of V.

Vater never did not mention the duodenal papilla that bears his name. The major duodenal papilla was first described by Francis Glisson in England in 1654 (151 in the first edition of his book Anaromie Heparis, the second edition of which was published in 1681. Some authors believe that the major duodenal papilla was first described by Gottfried Bidloo of Hague in 1685 Others attribute this to Giovanni Domenico Santorini (42) in 1724, so some texts call the duct the papilla of Santorini Santorini gave an excellent description of the duodenal papilla of the dog, sheep, and bull, but was not the first to do so and did not add anything new to his description. .

Sphincter of Oddi, along with with duodenal papilla, also first described by Francis Glisson in 1654. Glisson described the annular muscle fibers of the terminal common bile duct, claiming that they serve to close the common bile duct to avoid reflux of duodenal contents. In 1887 (36), Ruggiero Oddi also described the terminal sphincter of the common bile duct and related it to bile physiology. Thus we have found that the papilla described by Glisson is called Oddi. The ampulla named Fater has not been described by anyone, there are serious doubts that it exists at all in the norm, and yet it is still called the ampulla of Vater.

In 1898 Hendrickson (17) in the USA studied the sphincter at the end common bile duct. He added details unknown at the time. In 1937, Schwegler and Boyden studied the sphincter of Oddi, and Boyden later added much to our knowledge of the sphincter of Oddi.

To avoid confusion in terminology, in what follows we will consider Vater terms papilla, Santorini papilla, Bedloo papilla, duodenal papilla and major duodenal papilla (major duodenal papilla) as synonyms.

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 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:

Expansion of the intrahepatic bile ducts occurs due to the formation of stones

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 violates 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.

One of the main places in the biliary tract system is occupied by the gallbladder - an unpaired organ that serves as a kind of "accumulator" of bile secreted by the liver. Subsequently, this bile is transported to the small intestine. This process occurs under the influence of the hormone cholecystokinin - it provokes contraction and subsequent emptying of the gallbladder.

What is the human gallbladder made of?

The human gallbladder in the biliary tract system is an unpaired hollow pear-shaped organ, approximately 7-10 x 2-3 cm in size, with a capacity of 40-70 ml. However, it is easily stretched and can freely, without damage, contain up to 200 ml of liquid.

The gallbladder has a characteristic dark green color and is located on the inner surface of the liver in the fossa of the gallbladder. it depends on the gender, age and physique of the person. In men, it is located on a line drawn from the right nipple to the navel; in women, it is determined by the line connecting the right shoulder to the navel. In some cases, the gallbladder can be partially or completely located inside the liver tissue (intrahepatic location) or, conversely, be completely suspended on its mesentery, which sometimes causes it to twist around the mesentery.

Rare congenital anomalies include the absence of the gallbladder, as well as its partial or complete doubling.

Below you will learn what the gallbladder consists of and how its transport systems are arranged.

The structure of the gallbladder includes 3 parts - the bottom, body and neck:

• Bottom goes to the lower part of the liver and protrudes from under it, being the part visible from the front, which can be examined using ultrasound diagnostic methods.
• Body is the longest and most extended part. At the point of transition of the body to its neck (the narrowest part), a bend is usually formed, so the neck is at an angle to the body of the gallbladder and goes to the gates of the liver.
• Neck continues into the cystic duct, the lumen of which is on average 3 mm, and the length is from 3 to 7 cm. The cystic and hepatic ducts form a common bile duct, which has a lumen of 6 mm and a length of up to 8 cm. When the mouth is blocked, the lumen of the common bile duct may increase up to 2 cm in diameter without any pathology.

A feature of the structure of the gallbladder is that the common bile duct unites with the main duct of the pancreas and through the sphincter of Oddi opens into the duodenum in the Vater (large) papilla.

Look at the photo of the structure of the gallbladder to better understand what parts it consists of:

Walls and membranes of the gallbladder

The wall of the gallbladder consists of mucous, muscular and connective tissue membranes, and the lower surface is covered with a serous membrane:

• mucous membrane It is represented by a loose network of elastic fibers and contains mucus-forming glands, which are mainly located in the cervical region of the gallbladder. On the mucous membrane there are numerous small folds, giving it a velvety appearance. In the region of the neck 1-2, the transverse folds are of considerable height and, together with the folds in the cystic duct, form a valve system called the Heister valve.
• Muscular membrane The gallbladder is made up of bundles of smooth muscle and elastic fibers. In the neck region, muscle fibers are located mainly circularly (in a circle), forming a kind of pulp - the sphincter of Lutkens, which regulates the flow of bile from the gallbladder into the cystic bile duct and vice versa. Between the bundles of muscle fibers in the wall of the gallbladder there are multiple gaps - Aschoff's passages. Poorly drained, they can be a place of stagnation of bile, formation of stones, foci of chronic infection.
• Connective tissue sheath consists of elastic and collagen fibers. In the body of the gallbladder, the muscular and connective tissue membranes do not have a clear distinction. Sometimes, having passed to the serous membrane, the fibers form narrow tubular passages with blindly ending ends - Lushka's passages, which play a role in the occurrence of microabscesses in the gallbladder wall.

Changes in the walls and transport systems of the gallbladder

An overdistended gallbladder with a pathologically altered wall often has a pocket of Hartmann, in which gallstones tend to accumulate. Sometimes, when the walls of the gallbladder change, this pocket reaches a sufficiently large size, which greatly complicates the detection of the confluence of the cystic duct into the common hepatic duct.

Transport systems of the gallbladder:

• The gallbladder is supplied by the cystic artery, which arises from the right hepatic artery. Venous flows from the gallbladder along several venous trunks through the main tissue of the liver into the portal vein and partially into the right branch of the portal vein through the extrahepatic vessels.
• The outflow of lymph occurs both in the liver and in the extrahepatic lymphatic vessels.
• Innervation (supply of organs and tissues with nerves, which ensures their connection with the central nervous system) of the gallbladder is carried out through the solar plexus, the vagus nerve and the right-sided phrenic nerve bundle. These nerve endings regulate the contraction of the gallbladder, relaxation of the corresponding sphincters and provoke pain in diseases.

Thanks to muscle fibers, the gallbladder is able to contract together with the biliary tract, throwing bile into the duodenum under a pressure of 200-300 mm of water column!

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The bile duct is a tubular system in the body that often requires treatment. The common hepatic duct is the most painful place in the biliary system. Even a person who leads a healthy lifestyle is not immune to health problems (especially the digestive system). Therefore, you need to know what problems lie in wait and how therapy is carried out. If you start a therapeutic course of any disease on time, it will pass faster and bring fewer problems.

general characteristics

Bile is an auxiliary enzyme, it is secreted in the human liver to improve digestion. In humans, the bile ducts are a system of channels, bile is excreted through them into the intestine. The bile ducts of the liver open into the duodenum, which leads to the stomach. The system of pathways and bile ducts remotely resemble the image of a tree: the crown of the tree is the crayons of the channels located in the liver, the trunk is the common hepatic duct connecting the duodenum with the liver. The movement of bile is carried out with the help of pressure, it is created by the liver.

Bile ducts: structure

The structure of the channel is not very complicated. All small ducts originate in the liver. The fusion of the left and right canals (both located in the liver) forms the common hepatic canal. The channels carry the burn formed by the hepatic lobes. The bile duct is formed in the bladder, then it connects to the common hepatic canal and forms the common bile duct. The inflection of the gallbladder may indicate anomalies in its development. Strictures of the common hepatic duct are not normal. They occur as a result of strong blows to the liver area.

Congenital pathologies and anomalies in the development of the biliary tract

Congenital anomalies of the pathways are a defect from which no one is immune. Anomalies should be detected even in the hospital or in the first year of a child's life. Otherwise, it can lead to death or aggravation of health problems at an older age. So far, there is no universally recognized classification of anomalies of this organ. Scientists also do not agree on whether pathologies are hereditary in nature. Most often, they appear if during pregnancy a woman led an unhealthy lifestyle or took illegal drugs. There are such types of congenital abnormalities:

• tract atresia;
• hypoplasia of interlobular intrahepatic bile ducts;
• common duct cysts.

Biliary atresia

Atresia is an obstruction of the lumen of some or all of the extrahepatic bile ducts. The main symptom is rapidly developing jaundice in newborns. If it is physiological, then you should not be afraid. It will pass in 2-3 weeks, after the birth of the child.

In addition to the icteric color, the child does not experience any discomfort, feces and urine are normal, but the amount of bilirubin in the blood is increased. It is worth making sure that its level does not rise too rapidly. To speed up its removal, you need to spread the child on a well-lit surface under indirect sunlight.

But, if the feces and urine are of an unnatural yellow color, the child swears and vomits, feels constant anxiety, then this is not obstructive jaundice, but atresia of the pathways. It appears 2-3 days after birth. The paths are not able to remove bile, this leads to an increase in the size of the liver and its compaction, in addition, the angle is sharpened. Doctors advise taking x-rays at 4, 6, and 24 hours for an accurate diagnosis. Atresia can lead to acute liver failure in 4-6 months and the death of a child in 8-12 months. It is treated only by surgery.

Hypoplasia of interlobular intrahepatic bile ducts

This disease is due to the fact that the intrahepatic ducts are not able to remove bile. The main symptoms of the disease are similar to atresia, but they are not so pronounced. The disease sometimes goes away and is asymptomatic. Sometimes itching appears at the age of 4 months, the itching does not stop. The disease is an addition to other diseases, for example, the cardiovascular system. The treatment is hard. Sometimes leads to cirrhosis of the liver.

Common bile duct cysts

This disease manifests itself in children 3-5 years old. Children experience sharp bouts of pain, especially during pressure, at an older age there is nausea and vomiting. The skin has an uncharacteristic icteric hue, feces and urine of an uncharacteristic yellowish color. Temperature rise is common. Ruptures and peritonitis, malignant tumors of the cyst are possible. It is treated by extracting cysts from the affected organ.

Bile duct injury

Canal breaks are very rare. They are able to provoke a strong blow to the right side. Damage of this kind quickly leads to peritonitis. It is worth noting that with ruptures of other organs, it is very difficult to diagnose damage to the ducts. In addition, in the first hours there are no signs, except for painful sensations. In addition, in the presence of infection, the situation can be greatly aggravated by a sharp increase in temperature. It is treated only with urgent surgical intervention, sometimes the inflammation ends in death.

Diseases of the bile ducts

Diseases of the bile ducts are characterized by a change in skin color (it turns yellow), itching, pain in the right side. It is constant with frequent amplifications and vomiting, then the pain is referred to as hepatic colic. The pain increases after intense physical exertion, long driving and eating spicy, salty foods. The pain increases when pressing on the right side.

Chronic cholecystitis is a disease caused by a virus. Due to inflammation of the gallbladder, it increases. This entails pain in the right side. The pain doesn't stop. If the diet is violated or a strong shake-up, the pain increases. Proper treatment is prescribed by a gastroenterologist. Eating a simple diet is important for health.

Cholangitis of the biliary tract

Cholangitis is inflammation of the bile ducts. The disease is caused by pathogenic bacteria. The cause is inflammation of the gallbladder. Sometimes it is purulent. With this disease, the excretion of bile from clogging of the channels worsens. The patient experiences severe pain on the right, bitterness in the mouth, nausea and vomiting, loss of strength. This disease is characterized by the fact that in the early stages it is effectively treated with folk remedies, but at later stages only by surgery.

Biliary dyskinesia

Dyskenesia is a violation of the tone or motility of the biliary tract. It develops against the background of psychosomatic diseases or allergies. The disease is accompanied by mild pain in the hypochondrium, bad mood, depression. Constant fatigue and irritability also become constant companions of the patient. Men and women note problems in intimate life.

Cholelithiasis

Cholangiolithiasis is the formation of stones in the bile ducts. A large amount of cholesterol and salt can lead to this disease. At the time of the inception of sand (the precursor of stones), the patient does not experience any discomfort, but as the grains of sand grow and pass through the biliary tract, the patient begins to notice severe pain in the hypochondrium, which is given to the shoulder blade and arm. Pain is accompanied by nausea and vomiting. To speed up the process of passing stones, you can increase physical activity (the best way is to walk up the stairs).

Cholestasis of the biliary tract

Cholestasis is a disease in which the flow of bile into the intestine decreases. Symptoms of the disease: skin itching, darkening of the color of urine and yellowing of feces. Yellowness of the skin is noted. The disease sometimes entails the expansion of the bile capillaries, the formation of blood clots. May be accompanied by anorexia, fever, vomiting and pain in the side. There are such causes of the disease:

• alcoholism;
• cirrhosis of the liver;
• tuberculosis;
• infectious diseases;
• cholestasis during pregnancy and others.

Blockage of the bile ducts

Blockage of the channels is the result of other diseases of the digestive system. Most often it is a consequence of gallstone disease. Such a tandem occurs in 20% of humanity, and women suffer from this disease 3 times more often than men. In the early stages, the disease does not make itself felt. But after the transfer of an infectious disease of the digestive system, it begins to progress rapidly. The patient's temperature rises, itching of the skin begins, feces and urine acquire an unnatural color. The person is rapidly losing weight and suffers from pain in the right side.