BILE TRACT ANATOMY.ppt

Anatomy and Physiology of Biliary Tree

1. BILE TRACT ANATOMY
SEVVANTHEE AIYALU
TEAM B CME

2. OUTLINE
1)DEVELOPMENTOF LIVER AND BILIARY TRACT
2) ANATOMY OF BILE TRACT AND ITS PECULIARITIES

3. DEVELOPMENT OF LIVER AND BILIARY TRACT
•LIVER IS LARGEST INTERNAL ORGAN WITH DIVERSE CELLS AND
FUNCTION INCL ENDOCRINE, EXOCRINE AND ESSENTIAL METABOLIC
FUNCTIONS
PRINCIPAL CELLS :
•FROM ENDODERM :HEPATOCYTES 70%
CHOLANGIOCYTES
•FROM MESODERM: OTHER CELLS SUCH AS KUPPFER CELLS,
STROMAL, STELLATE

4. •DEVELOPMENT STARTS AT 3
RD
WEEK
•LIVER PRIMORDIUM AS OUTGROWTH OF VENTRAL FOREGUT
ENDODERM
•PROLIFERATION OF EPITHELIAL CELLS IN THIS LIVER BUD GIVES RISE
TO LIVER AND INTRAHEPATIC BILIARY TREE
•AS IT TRAVERSES THE SEPTUM TRANSVERSUM, THE CONNECTION
PERSISTS BTW THE BRANCHING EPITHELIUM AND FOREGUT 
DEVELOPS INTO EXTRAHEPATIC BILE DUCTS AND GB
•BIPOTENTIAL HEPATOBLASTS EVENTUALLY DIFFERENTIATE INTO
HEPATOCYTE AND CHOLANGIOCYTE
•FINAL STRUCTURE CONTINUES TO DEVELOP THRU POSTNATAL
PERIOD

6. •HEPATOBLASTS NEAR PORTAL VEIN DIFFERENTIATE INTO BILIARY
EPITHELIAL CELLS FORM INTRAHEPATIC BILIARY DUCT
•REMAINING BECOME HEPATOCYTES
•IN MATURE SYSTEM–HEPATOCYTE PRODUCE BILE
SECRETE INTO CANALICULI
INTRAHEPATIC BILE DUCT
EXTRAHEPATIC BILE DUCT

7. PORTAL TRIAD

8. ANATOMY OF BILIARY SYSTEM

11. BLOOD SUPPLY OF BILE DUCT
•FROM HEPATIC A. ONLY
ABERRANTLY FROM SMA, PHRENIC A, CYSTIC A
•3 ELEMENTS :
-BRANCH FROM HEPATIC A.
-LONGITUDINAL A. MOVING PARALLEL TO DUCT
-ARTERIAL PLEXUS FROM MARGINAL A. = EPICHOLEDOCHAL PLEXUS
AT 3 AND 9 O’CLOCK POSITION ON CBD/CHD
*MAINTAIN SUPPLY TO LIVER IF ONE ARTERY OCCLUDED
*IF CBD TRANSECTED ISCHAEMIC DT LOSS OF BLOOD SUPPLY FROM BELOW
CAUSE OF FAILURE OF CHOLEDOCHO-CHOLEDOCHOTOMY IN BILIARY
RECONSTRUCTION
TO AVOID THIS –TRIM BILE DUCT TO 1CM FROM CONFLUENCE AND FASHION
HEPATICO-JEJUNOSTOMY

12. •CAUDATE LOBE
SUPPLY FROM BOTH LEFT AND RIGHT HEPATIC A.
BILE DRAINS TO BOTH RIGHT AND LEFT BD
VENOUS DRAINAGE BY SHORT CAUDATE V. TO IVC DIRECTLY

13. RIGHT HEPATIC DUCT
-IS EXTRAHEPATIC ABT 1CM
•IMPORTANT ANOMALIES ON RIGHT SIDE :
1.RIGHT SECTIONAL DUCT INSERT INTO LEFT H.DUCT
-POST SECTIONAL = 20%
-ANT SECTIONAL = 6%
*IN LEFT HEPATECTOMY –LIGATE CLOSE TO UMBILICAL FISSURE
2.RIGHT HEPATIC DUCT INSERTS LOWER THAN CONFLUENCE/AT CYSTIC DUCT/DIRECT TO
GB/ABSENT CHD –BOTH RIGHT AND LEFT H.DUCT DRAINS INTO GB
3.HJORTSJO’S CROOK : RIGHT POST SECTIONAL DUCT HOOKS OVER RIGHT ANT
SECTIONAL DUCT

16. LEFT HEPATIC DUCT
–EXTRAHEPATIC PORTION ABT 2-3CM
*SITE FOR HIGH BILIARY-ENTERIC ANASTOMOSIS

18. GALLBLADDER
•CONSISTS OF FUNDUS, BODY, NECK, HARTMANN’S POUCH
•BLOOD SUPPLY : CYSTIC A., DIRECT A. FROM LIVER BED
*BLEED DURING DISSECTION
•VENOUS DRAIN : DIRECT TO LIVER BED
•LYMPH DRAINAGE : TO CYSTIC LN OF LUND COELIAC NODE
•NERVE :
-SYMP : T7-9 FROM COELIAC PLEXUS
-PARASYMP : HEPATIC BR OF ANTERIOR VAGUS
-SENSORY : RIGHT PHRENIC 3-5
-HAS MUCOUS MEMBRANE WITH MICROVILLI –ABSORB WATER AND
INORGANIC SALTS

20. CYSTIC DUCT
•USUALLY ABT 1-2CM LONG, 2-3MM DIAMETRE
•JOINS CHD ABT 4CM ABOVE THE DUODENUM
•3 TYPES OF UNION OF CD TO CHD
-ANGULAR : 75%
-PARALLEL : 20%
-SPIRAL : 5%
•PRONE TO INJURY
•LUMEN HAS A SPIRAL MUCOSAL VALVE :
VALVE OF HEISTER

22. DUCTS OF LUSCHKA
•SMALL SUBMILIMETRE DUCTS
•PENETRATE THE HEPATOCYSTIC TRANGLE TO ENTER GB
*CAUSE OF BILEOMA

23. CYSTIC ARTERY
•ABT 1-2CM LONG BEFORE REACHING THE GB, SUPERIOR TO CYSTIC
DUCT
•1MM DIAMETRE
•ARISES FROM RIGHT HEPATIC ARTERY AT THE HEPATOCYSTIC
TRIANGLE
•ON SURFACE OF GB, DIVIDES INTO
-ANTERIOR BR
-POSTERIOR BR

24. ANOMALIES
•AGENESIS = 1/8000
•DOUBLE GB
•CYSTIC DUCT VARIATIONS
•CYSTIC ARTERY VARIATIONS

25. THANK YOU