Gallbladder and Biliary System

Slides:



Advertisements
Similar presentations
Meechai Srisai M.D.,Ph.D. Nigun Worapunpong M.D. Department of Anatomy Faculty of Medicine Chulalongkorn University August 2010 Liver, Gallbladder, Biliary.
Advertisements

Chapter 14/22 Gallbladder and Biliary Ducts. The Liver Largest ___________organ in the body Has ____________ Manufactures bile and sends it to the ______________( ml.
IVC What is this contrast containing structure posterior to the liver? The right, middle and left hepatic veins What are these contrast containing.
Lecture 22 Digestive System II.
Marilyn Rose. Largest organ of abdomen Rt hypochondriac/ and epigastric regions Borders: Superior/lateral and anterior= Rt diaph Medial= sto/duodenum,
Liver, Pancreas & Spleen
Liver, Pancreas, Spleen and Gall bladder anatomy
RADIOGRAPHS AND IMAGES:
Biliary System Bile, required for the digestion of food, is excreted by the liver into passages that carry bile toward the hepatic duct, which joins with.
Endoscopic retrograde cholangiopancreatography (ERCP)
Pancreas & Biliary System
Pancreas & Biliary System
BIO 335: Cross Sectional Anatomy
PTA 106 Unit 2 Lecture Digestive Functions Ingestion intake of food Digestion breakdown of molecules Absorption uptake nutrients into blood/lymph.
Liver: anatomy & functions Pavle Peić Tukuljac Mentor: A. Žmegač Horvat.
Pamela Youde Nethersole Eastern Hospital
THE GALLBLADDER. I. Introduction/General Information A. Location: 1. Epigastric region 2. Right hypochondriac region 3. On inferior surface of liver 4.
Prefinal topic.  is pear-shaped sac, composed of three-parts – fundus, body and neck.  7 – 10 cm long, 3 cm wide and normally holds 30 to 40cc’s of.
Biliary System Dr. Zeenat & Dr. Vohra.
Figure 24-18a The Pancreas. Common bile duct Pancreatic duct Lobules
Gallstone Disease.
Biliary Imaging.
Biliary System and Liver Liver Largest gland of body 2nd largest organ What is the 1 st ? Skin How much does it weigh? Approx. 3 lbs.
Biliary System Heartland Society of Gastroenterology Nurses and Associates Mary Ganley RN CGRN BSHA.
Radiography of the Biliary System
Pages and  Teeth – mechanical digestion through mastication  Salivary glands – parotid, submandibular, sublingual ◦ Secrete saliva,
Ducts of Pancreas No striated ducts Intercalated ducts = intralobular ducts Intercalated ducts drain directly into interlobular ducts – simple squamous.
Diagnostic studies Blood Tests Imaging Modalities Reference: Schwartz’s Principles of Surgery 8 th Edition.
Chapter 12/15/19 Gallbladder and Biliary Ducts. The Liver Largest ___________ organ in the body Has many functions Manufactures ______ and sends it to.
DIGESTIVE SYSTEM Chapter 3. Digestion is the mechanical and chemical breaking down of food into smaller components, to a form that can be absorbed, for.
Biliary System and Liver Biliary System and Liver 8/21/2015.
In the name of Allah. Pancreas Grayish – pink cm Situation - - Epigastric - - Lt hypochondriac - - Umbilical.
Abdominal Region II PA 544 Clinical Anatomy Tony Serino, Ph.D.
Anatomy and Physiology Part 1: Liver, Gallbladder, and Bile
ANATOMY OF LIVER. Lesson Overview  The liver  The gall bladder  Bile  The relationship with other intra-abdominal structures.
No Liver 2. Gallbladder and Biliary Ducts 3. Pancreas.
The Duodenum It is the first and widest part of the small intestine.
Gall Bladder and Biliary System Procedures Manal AlOsaimi.
 Cephalic phase  sight, smell, taste or thought of food  vagus nerve stimulates gastric secretion and motility  Gastric phase  activated.
BY Prof. ANSARI Wednesday, April 26, 2017.
The Liver and Gall bladder. Liver The liver is the largest gland in the body and, after the skin, the largest single organ It occupies almost all of the.
GALL BLADDER AND BILIARY SYSTEM PROCEDURES MEAAD AL-MUSINED.
Hepatobiliary system structure
LIVER AND BILIARY PASSAGES
ANATOMY OF LIVER. The Liver Largest gland in the body (1.5 Kg) Under the diaphragm, within the rib cage in the upper right quadrant of the abdomen.
Anatomy of liver and gall bladder
Biliary Imaging Ian Scharrer, MIV. Clinical Scenario A 46 year old woman presents to the clinic complaining of epigastric pain that she experiences after.
The Liver Anatomy Largest gland in the body (1.5 kg) Under the diaphragm, within the rib cage in the upper right quadrant of the abdomen Only human organ.
Digestive system Diagnostic imaging department of xuzhou medical college of xuzhou medical college.
Pages and  Teeth – mechanical digestion through mastication  Salivary glands – parotid, submandibular, sublingual ◦ Secrete saliva,
Learning Objectives Describe the location , external features, relations, lobes, segments & applied anatomy of Liver. Describe parts, relations, & clinical.
WELCOME!!!.
Health Sciences Department, Rogers State University 1 GastroIntestinal System Revision of anatomy and physiology.
CH 23 Anatomy of the Liver James F. Thompson, Ph.D.
Pancreas & Biliary System
Accessory Glands of Digestive System
Histology of The Liver.
Clinical Anatomy Tony Serino, Ph.D.
Embryology and Histology of the Pancreas
Extrahepatic biliary apparatus
Digestive System Anatomy
Digestive System: Outcome: I can describe the structure and functions of the accessory organs of the digestive system Drill: What are the three regions.
Gall Bladder.
THE STOMACH By: MUTHANNA AL-LAMI.
Lower GI Anatomy, Pathology, and Radiography of the Lower GI Tract & Accessory Organs All images copyright Mosby Inc., an affiliate of Elsevier Inc.
The peritoneum lining the walls is the parietal peritoneum; the peritoneum covering the viscera is the visceral peritoneum Transverse section of the abdomen.
Pancreas & Biliary System
Objectives At the end of the lecture, students should be able to:
The Digestive System and Body Metabolism
Presentation transcript:

Gallbladder and Biliary System Anatomy and Positioning

Liver and GB Liver is the largest solid organ of the body weighing about about 3-4 lbs. It is located on in the RUQ. It is convex, the superior border conforms to the inferior surface of the right hemidiaphragm.

Liver The Liver has 4 lobes Faliciform Ligament Right lobe Left lobe Quadrant lobe Caudate lobe Faliciform Ligament Which divides the right lobe from the left The Liver produces about 800-1000 ml or 1 qt of bile each day.

Right and left hepatic ducts Bile Route Right and left hepatic ducts ▼ Common hepatic duct Common bile duct Pancreatic duct Duodenum 4

Gallbladder Gallbladder is located on the posterior, inferior wall of the liver. It is made up of three main parts Fundus: broad distal aspect Body Neck: proximal end

GB function Store bile produced by the liver Bile is formed by small lobules in the liver. It then travels to into the right/left hepatic ducts which unite to form the common hepatic duct From the common hepatic duct travels to the common bile duct. The common hepatic duct meets with the GB through the cystic duct. The cystic duct is 3-4 cm long. It contains spiral-shaped membranous folds called the spiral valve. It purpose is to prevent distention or collapse of the cyst duct. Bile is stored in the GB until needed for use in the digestion of fat.

Function of the GB When bile is needed to emulsify or break down dietary fat the GB contracts. Bile flows from the GB to the Common bile duct to the junction of the pancreatic duct (duct of Wirsung) It then travels through the Ampulla of Vater (hepatopancreatic ampulla) and through the sphincter of Oddi (hepatopancreatic sphincter) into the papilla of Vater (duodunal papilla) into the duodenum.

Distal Common Bile Duct

Gall Bladder The word ampulla means a rounded sac-like dilation of a duct or canal. In Latin it means flask. The word papilla means small nipple-shaped projection.

Anatomic Relationships PA to reduce OID Supine for gallbladder drainage

Main functions of the GB Storage of bile Concentration of bile: concentration (bile consistency) is monitored by hydrolysis – removal of water. If too much water is removed; cholesterol in the bile becomes too concentrated and form choleliths (stones). Contraction and release of bile for digestion.

Position of the GB The GB position in the abdomen is determined by body habitus. Hypersthenic – GB is high and more lateral. Sthenic/ Hyposthenic – GB is midway between the xiphoid and the lower lateral rib margin. Asthenic – GB is lower (at the crest) and midline

Radiographic Anatomy Cystic duct Neck Body Fundus

Radiographic anatomy Right hepatic duct Left hepatic duct Common hepatic duct Common bile duct Duodenum

GB and Biliary duct terminology Chole – bile, also used for GB Cysto – sac or bladder Angio – vessel or duct Graphy – write or study Gram – picture or film (image) Cholecystography – study of the GB Choleangiography – study of the biliary system (ducts) Cholecystocholangiogram – study of the GB and biliary system Cholecystectomy – removal of the GB

GB procedures OCG – Oral cholecystogram Operative Cholangiogram Laparoscopic Cholangiogram T-tube Cholangiogram (done post-op to either a operative or laparoscopic cholangiogram PTC Percutaneous Transhepatic Cholangiogram ERCP Endoscopic Retrograde Cholangiopancreatography

OCG Purpose is to study the anatomy and function of the GB. Ability of the liver to remove contrast media from the bloodstream Patency (openness) and condition of the biliary ducts Concentration and contracting ability of the GB Not done anymore!

Sonography Sonography has eliminated the need for OCG. Advantages Non-invasive Can detect small calculi in the ducts that are radiolucent No need for contrast media Less time consuming.

Operative exams Operative cholangiogram – done in conjunction with a cholecystectomy Used to visualize choleliths undetected during surgery Demonstrates the patency or openness of the ducts. Demonstrates the function of the hepatopancreatic ampulla (ampulla of vater) Visualize possible small lesions or strictures in the biliary ducts

Laparoscopic Cholecystectomy The GB is suctioned out via an endoscopic tube, the remnant cystic duct is cauterized. If stones are suspected, a T-tube maybe placed into the common bile duct. T-tube is placed in the duct and extended to outside the body for access. Contrast media can then be injected and checked by imaging at various times. If residual stones are detected they can be removed by a basket catheter.

Postoperative (T-tube or delayed) Cholangiogram Performed in radiology department T-tube placed in common bile duct during surgery and extending outside body clamped off Contrast media injected into T-tube catheter Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

ERCP (endoscopic retrograde cholangiopancreatography) Procedure: endoscopic inspection, cannulation, and injection of the biliary ducts with the use of a duodenoscope Endoscope Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

PTC Percutaneous Transhepatic Cholangiogram Transhepatic means through the liver A special “skinny” or Chiba needle is placed through the liver and into one of the biliary ducts (guidance is done through fluoroscopy) PTC has some risks: Liver hemorrhage Pneumothorax Bile escaping into the peritoneal (bile is corrosive and will irritate the periotoneal tissue causing peritonitis)