Biliary apparatus

Biliary apparatus

1. Biliary Apparatus
•Passages that store bile & convey it to 2
nd
part of
duodenum
•2 PARTS :
Intrahepatic & Extahepatic
INTRAHEPATIC PART : Duct system within the liver
Hepatocytes-> Bile canaliculi -> Canals of Hering
Bile ductules -> Rt & Lt Hepatic ducts

2. Extrahepatic
•Rt and left hepatic ducts
•Common hepatic duct
•Cystic duct
•Bile duct
•Gall bladder

3. Rt and left hepatic ducts
–Emerge through Porta hepatis
–Relations :at Porta hepatis
Ducts -Arteries -Veins (Ant to post)
-Unite & form Common hepatic
duct
Anterior
Porta hepatis

4. Common Hepatic duct
PV
•Loc : In Rt free margin of Lsr Omentum
–In front of Portal vn & to the Rt of Hepatic A
•Length : 4cm, Diameter : 4mm
•Joins cystic duct 1cm above 1
st
part of
duodenum(variable)
Posterior

5. CYSTIC DUCT :
•Connects Neck of GB with CH Duct
•Joins CH Duct on the Rt, at an acute angle
•Length : 2 -3cm, Diameter : 2-3mm
•Relations:
Cystic Artery
CHD
Rt HDLt HD
B D

6. CYSTIC DUCT : Cont’d
•5 -12 crescentic valves in lumen :
Spiral valves of Heister
•Hartmann’s pouch :
CHD
Spiral valves

7. CALOT’S TRIANGLE
BOUNDARIES :
–Inf surface of liver (Above & laterally)
–Cystic duct (Below & Lat)
–Common Hepatic Duct (Medially)
–Contents: Cystic artery with its variable dispositions
Cystic Lymph Node
APPLIED: Identification of Cystic artery -a prerequisite
in cholecyctectomy.

8. BILE DUCT :
Formation : CHD + Cystic duct
–Length : 8cm, Diameter : 8mm
Course:
–Passes down, back & to the Rt
–Joins Pancreatic duct-
–Forms Ampulla of Vater &
opens in Major duodenal papilla
4 Parts :
–Supra,Retro, Infra (Para) &
Intra duodenal parts :
S
R
I
I

9. Blood supply
•From Brs of Cystic, Hepatic and GD arteries
-Ligation of cystic duct -away from Bile duct

10. BILE DUCT : APPLIED ANATOMY
–Supra duodenal part : Most accessible part for surgery
Eg : Choledochotomy, Insertion of drainage tube
–Infra (Para) duodenal :
Obstructed in Carcinoma Hd of pancreas (Jaundice)
–Intra duodenal part :
Ampullary carcinoma (Recurrent –obstructive -
jaundice)

11. GALL BLADDER
•Pear shaped fibro-muscular hollow viscus
•Slate blue in colour
•Size : 7-10 x 3 cm, 30-50 ml
•Location :
Gall bladder fossa on visceral surf of Rt lobe of liver,
near quadrate lobe
G B
Quadrate lobe

12. GALL BLADDER
Parts : Fundus, Body & Neck
•Fundus -In lower bdr of liver
Gall bladder

13. SURFACE MARKING -Fundus of GB
•Transpyloric plane crosses costal margin at lat bdr of Rt
Rectus sheath
•At tip of Rt 9
th
costal cartilage
•Area of tenderness in GB disease

14. GALL BLADDER -cont’d
Functions:
•Concentration & storage of bile
•Reduces alkalinity
•Regulates ductal pressure

15. GALL BLADDER cont’d
•Arterial supply : Cystic A (Rt br of Hepatic A)
•Occassionally from Lt Br of HA/ HA / GDA
•Small vessels from hepatic bed of GB
•Venous: Cystic vn (multiple)
•Do not accompany Cystic Artery
•Drain into Intra hepatic part of portal vein
•Lymphatics: Hepatic nodes

16. GALL BLADDER -cont’d
•Nerve supply :
•Parasymp: Hepatic Br of Ant Vagal trunk
–Contraction of GB, Relaxation of Sphincters
•Hormonal : CCK
•Symp: C Ganglion-From T 7-9
•Refd pain: C3-4 (Phrenic) / T 7-9
–Pain at tip of shoulder,
–Rt Hypochondrium, Epigastrium, Infrascapular
region

17. GALL BLADDER : APPLIED ANAT
Cong Anomalies :
Agenisis, Septate, Double, Floating, Intrahepatic,
Phrygian cap

18. GALL BLADDER : APPLIED ANAT
•Cholecystitis,
•Cholangitis
•Cholelithiasis,
•White bile
•Biliary colic
•Cholecystectomy
•Cholidocotomy : incision of bile duct (upper part) for
removal of Gall stones

20. Oral/
Intravenous

21. Percutaneous Transhepatic cholangiography (PTC)
•Detect obstructions
•A thin needle is inserted into liver
to deliver dye to the bile ducts
•Movement of dye tracked using a fluoroscope
(specialized X-ray machine)

22. ?