Physiology of the Human Biliary System
Wenguang Li in Biliary Tract and Gallbladder Biomechanical Modelling with Physiological and Clinical Elements, 2021
Physiology of the human biliary system and its common diseases, especially gallstone and acalculous biliary pain, are described. Clinical aspects and critical factors relating to the diseases such as gallbladder (GB) motor function, cystic duct geometry and bile rheology are explained and discussed in terms of biomechanical point of view. Research profiles in fluid and solid mechanics of the biliary system are summarised. It turns out that fluid mechanics of GB and biliary tract in gallstone-bile two-phase flow conditions needs to be investigated to provide insights into clinical physiology of gallstone formation in future. Solid mechanics of intact GBs and GB wall tissue should be expanded in soft bio-tissue context, especially viscoelasticity. Modelling of GB in active state is a new challenge. The relationships between GB wall tissue biomechanical property and disease condition are on demand to improve clinical diagnosis.
Bile Duct Cancer
Dongyou Liu in Tumors and Cancers, 2017
The bile ducts are thin tubes of 10-12.5 cm in length that connect the liver, gallbladder, and small intestine. The bile ducts are divided into two sections: intrahepatic and extrahepatic. The intrahepatic bile ducts are small ducts located within the liver. The extrahepatic bile ducts include part of the right and left hepatic ducts outside the liver. The main function of the bile ducts is to collect bile produced in the liver and to carry the bile via the cystic duct to the gallbladder for storage and via the distal extrahepatic bile duct and through the pancreas to the small intestine. Tumors of the intrahepatic bile ducts arise from the biliary epithelium of small intrahepatic ductules or large intrahepatic ducts near the bifurcation of the right and left hepatic ducts. Tumors of the extrahepatic bile ducts occur in the common bile duct located between the point where the cystic duct joins the common hepatic duct and the ampulla of Vater.
Case 57: Upper abdominal pain
Eamon Shamil, Praful Ravi, Dipak Mistry in 100 Cases in Emergency Medicine and Critical Care, 2018
This chapter presents a case study of a 43-year-old overweight male who is presented with an 8-hour history of worsening upper abdominal pain that radiates to his back. This patient has acute cholecystitis. He has a probable history of gallstones and is now febrile and Murphy's sign positive on examination. Most patients with gallstones are asymptomatic. However, complications of gallstones range from biliary colic, whereby gallstones irritate or temporarily block the biliary tract, to acute cholecystitis, which is an infection of the gallbladder sometimes due to obstruction of the cystic duct. Patients with epigastric or right upper quadrant (RUQ) pain require a full blood count, renal and electrolyte screening, liver function tests (LFT), serum calcium and amylase/lipase level to rule out pancreatitis. The patient should be referred to a general surgeon on an outpatient basis for consideration of a laparoscopic cholecystectomy.
Clinical Evaluation of a Low Junction of the Cystic Duct
Published in Scandinavian Journal of Gastroenterology, 1993
S. Uetsuji, Y. Okuda, H. Komada, M. Yamamura, Y. Kamiyama
The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and by gross intraoperative examinations in 468 surgical patients with biliary diseases. The cystic duct entered the hepatic duct at a very low position and was consequently long in 39 patients. The clinical significance of this abnormally low junction of the cystic duct was studied in comparison with 358 patients with gallstones with a normal cystic duct-hepatic duct junction. In the low-junction group with a short common bile duct several complications, including gallstone pancreatitis (7 patients), the Mirizzi syndrome (7), confluence stones (2), gallbladder cancer (3), and congenital dilation of the cystic duct (1), were demonstrated preoperatively. The anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct, producing a choledochopancreatic ductal junction and posing difficulties at surgery.
Adverse consequences of cystic duct closure by clips
Published in Minimally Invasive Therapy, 1994
Summary Laparoscopic cholecystectomy (LC) is now established as the standard alternative to open cholecystectomy. It is safe with a reported complication rate ranging from 0.5 to 5%. The majority of surgeons performing LC employ metal and, less frequently, absorbable polydioxanone clips to secure the medial end of the cystic duct. Only a small minority ligate the cystic duct in continuity or by the use of an endoloop. Bile duct leakage from the cystic duct Is the most common technical complication after LC with a reported range of 0–7% and a median prevalence of 2%. Instances of metal clip migration and internalization into the common duct, although rare, have also been reported. Both these complications can be prevented by the routine practice of ligature of the medial end of the cystic duct by an external slip knot of the Roeder type using dry catgut.
The use of the Veress needle in operative cholangiography
Published in Minimally Invasive Therapy & Allied Technologies, 1999
A. Chaudhuri, F. Bridgewater, G. S. M. Robertson
Summary This paper examines the percutaneous use of the Veress needle as a safe and convenient adjunct to peroperative cholangiography during laparoscopic cholecystectomy. Peroperative cholangiograms were performed in 31 patients undergoing laparoscopic cholecystectomy. The cystic duct was cannulated with a 4 F ureteric catheter, threaded through a Veress needle introduced percutaneously. Peroperative cholangiography was performed using this method with no complications. The cystic duct was easily cannulated. Air bubbles were not observed in any film. The Veress needle is a useful tool for performing peroperative cholangiograms during laparoscopic cholecystectomy. It provides a simple, readily-available aid to cannulating the cystic duct.