七年制胆道疾病英文.ppt

THE BILIARY SYSTEM Anatomy Bile Duct Intrahepatic bile ducts Glisson’s system Extrahepatic bile ducts Left and right hepatic ducts common hepatic ducts common bile ducts Gallbladder Anatomy The shape of the gallbladder is approximately that of a pear. It’s about 8cm long and holds 40 to 60ml of bile. The gallbladder is divided into four sections: fundus, body, neck and cystic duct. The corpus nestles into the substance of the liver. The neck of the gallbladder is lax, because it is not bound to the liver by peritoneum. The distal portion of the gallbladder has the appearance of a diverticulum, which is called Hartmann’s pouch. Anatomy The cystic duct is 2 to 4 cm long and contains the spiral valves of Heister, which allow easy entry of bile into gallbladder but offer resistance to its outflow. The neck tapers and connects to the biliary tree via the cystic duct, which then joins the common hepatic duct to become the common bile duct. The extrahepatic bile ducts lie within the hepatoduodenal ligament. Anatomy –  Common bile duct CBD: length 4-8cm; diameter:0.6-0.8;Divided into four segments. The CBD courses through the pancreas and the wall of the duodenum to form the papilla of Vater on the medial wall of the duodenum. Its distal end is enveloped by the sphincter of Oddi, which regulates the flow of bile from the liver into the duodenum. Anatomy The triangle of Calot, a surgical landmark used to identify important structures during cholecystectomy, is bounded by the cystic duct , the common hepatic duct, and the inferior border of the liver. The right hepatic and cystic arteries are located within it, and anomalous structures often pass through it. Functions of Gallbladder Concentration and preservation of the bile. Secretion Contraction and empty Methods of Diagnosis X- ray Ultrasonography, EUS CT MRI, MRCP(Magnetic resonance cholangiopancreatography) PTC, PTBD ERCP Scintigraphy Choledochoscopy Cholangiography Congenital Cystic Dilatation of B