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Hepatobiliary and pancreatic emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Bile drains from the liver via the left and right hepatic ducts, which unite to form the common hepatic duct. The cystic duct then joins the common hepatic duct to form the common bile duct (CBD). The CBD enters the head of the pancreas and unites with the main pancreatic duct to form the ampulla of Vater, a short duct that opens into the second part of the duodenum. This opening is known as the major duodenal papilla and is surrounded by a ring of smooth muscle called the sphincter of Oddi. When the sphincter is open bile can drain freely into the duodenum, when it is closed bile backs up and enters the gallbladder where it is stored until it is required.
Metorchis
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Mariya Y. Pakharukova, Viatcheslav A. Mordvinov
The pathogenesis of infection with opisthorchiid liver flukes is associated with the living activities of the parasites in the bile ducts of the liver and pancreas. Note that the organs of the duodeno-choledocho-pancreatic zone are tightly interconnected. Consequently, although the helminths are localized to the bile ducts of the liver and sometimes pancreas, characteristic of the liver fluke infections is various pathologies of the remaining organs in this zone. The main pathologies are chronic proliferative cholangitis and pancreatic canaliculitis accompanied by fibrosis of various degrees. Of importance in the pathogenesis of the diffuse cholangiectasia and retention canalicular ectasia in the pancreas are the hyperplasia and inflammatory sclerotic processes in the ampule wall of the major duodenal papilla and opening of the major pancreatic duct. Development of the strictures in the terminal region of the common bile duct and cystic duct is also typical.58,59
Abdomen
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
Bile duct - about 8 cm long and 8 mm in diameter, it lies in the right margin of the lesser omentum, where it lies anterior to the portal vein, with the hepatic artery on the duct’s left side. Correct identification of the bile duct and adjacent structures is vital to the understanding of diseases of, and operations on, the stomach, duodenum, pancreas, liver and biliary tract. The bile duct then passes posterior to the first part of the duodenum to reach the second part, where it enters the posteromedial part of the wall to join the pancreatic duct at the hepatopancreatic ampulla (of Vater), which opens at the major duodenal papilla (about 10 cm distal to the pylorus).
Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model
Published in Journal of Investigative Surgery, 2022
José Marcus Raso Eulálio, Manoel Luiz Ferreira, Paulo César Silva, Juan Miguel Renteria, Andrei Ferreira Costa Nicolau, Thales Penna de Carvalho, Adrielle Rodas Fernandes, Julia Radicetti de Siqueira Paiva e Silva, Alberto Schanaider, José Eduardo Ferreira Manso
In summary, the pancreas of the rat has the following relevant anatomical landmarks:Considering its limits, the duodenum on the right, the stomach anteriorly, the spleen on the left, and the colon attached to the anterior face of the mesoduodenum.Considering its parenchyma, an intraperitoneal layer inside the omental pouch, with mobility from the spleen, duodenum and stomach.Considering its vascularization, the superior mesenteric vein and the superior mesenteric artery crosses the parenchyma posteriorly at the junction between the splenic and duodenal lobes receiving the arterial and venous tributaries. The splenic vessels follow the splenic lobe on its upper margin, from the hilum of the spleen to the root of the mesentery, where the splenic vein merges with the superior mesenteric vein to form the portal vein.Considering the ductal structure, the pancreatobiliary duct has its intrapancreatic path toward the second duodenal portion, directly receiving the lobular and lobar ducts. There is a major duodenal papilla, where the pancreatobiliary duct flows and several small ducts drains directly to the duodenum.
Establishment of a Canine Training Model for Digestive Tract Reconstruction after Pancreaticoduodenectomy
Published in Journal of Investigative Surgery, 2021
Jing-Rui Yang, Rui Xiao, Jiang Zhou, Lu Wang, Jia-Xing Wang, Qian Zhang, Jian-Xiang Niu, Ze-Feng Wang, Rui-Feng Yang, Jian-Jun Ren
In addition, we need to pay close attention to the canine’s minor duodenal papilla and the major duodenal papilla, which have pancreatic duct openings. In the partial resection of the pancreas, only they were ligated, making the animal model more similar to the PJ in human PD. The dog’s pancreas is divided into two left and right lobes, which is slightly different from the human pancreas. However, the size and texture of the dog pancreas do not affect the simulated human PJ. The PJ method we applied was a modified end-to-side dunking PJ. The advantage is that the jejunum tube is pushed to the pancreas and the suture is straightened when the posterior wall is sutured, which makes it hard to tear the pancreas, and can realize a seamless connection between the jejunum and the pancreas under direct observation. In healthy Europeans with a normally functioning gallbladder, the CBD diameter was 4–8 mm [11], and the diameter of the common bile duct in a canine is about 2 mm, which brings greater challenges to the canine’s BEA. Only a skilled technique and a suitable method can complete a high-quality BEA on a canine. This uses a modified technique of a BEA with a two-point interrupted eversion suture on the posterior wall. Its advantage is that the surgical field is clear, the suture is hard to entangle, and the knots are left outside the anastomosis. The anastomosis is elastically expanded during the procedure. No anastomotic stenosis and bile leakage occurred in the general specimen examination of the 6 experimental canines 30 days postoperatively.
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
The major duodenal papilla is a protuberance surrounded by a circular muscle (the sphincter of Oddi) that allows the flow of pancreatic enzymes and bile from the pancreatic duct and common bile duct into the second part of the duodenum [10]. Impaction of a stone at the duodenal papilla can obstruct biliopancreatic outflow [11] and thereby lead to acute pancreatitis, suppurative cholangitis, or acute exacerbation of chronic pancreatitis [12–15]. Persistent mechanical obstruction of biliary and pancreatic outflow by a calculus can be relieved by ERCP and endoscopic sphincterotomy [16], although other techniques such as endoscopic needle-knife precut papillotomy and endoscopic choledocho-duodenostomy have also been used [15,17].