Surgical anatomy of the biliary tract (BDT). Gallbladder

Right and left hepatic ducts, leaving the same lobes of the liver, form the common hepatic duct. The width of the hepatic duct ranges from 0.4 to 1 cm and averages about 0.5 cm. The length of the bile duct is about 2.5-3.5 cm. The common hepatic duct, connecting with the cystic duct, forms the common bile duct. The length of the common bile duct is 6-8 cm, width 0.5-1 cm.

The common bile duct has four sections: supraduodenal, located above the duodenum, retroduodenal, passing behind the upper horizontal branch of the duodenum, retropancreatic (behind the head of the pancreas) and intramural, located in the wall of the vertical branch of the duodenum (Fig. 153). The distal portion of the common bile duct forms the major duodenal papilla (papilla of Vater), located in the submucosal layer of the duodenum. The large duodenal papilla has an autonomous muscular system consisting of longitudinal, circular and oblique fibers - the sphincter of Oddi, independent of the muscles of the duodenum. The pancreatic duct approaches the large duodenal papilla, forming, together with the terminal section of the common bile duct, the ampulla of the duodenal papilla. Various options for the relationship between the bile and pancreatic ducts should always be taken into account when performing surgery on the major duodenal papilla.

Rice. 153. Structure of the biliary tract (diagram).

1 - left hepatic duct; 2 - right hepatic duct; 3 - common hepatic duct; 4 - gallbladder; 5 - cystic duct; b _ common bile duct; 7 - duodenum; 8 - accessory duct of the pancreas (duct of Santorini); 9 - major duodenal papilla; 10 - pancreatic duct (duct of Wirsung).

The gallbladder is located on the lower surface of the liver in a small depression. Most of its surface is covered by peritoneum, with the exception of the area adjacent to the liver. The capacity of the gallbladder is about 50-70 ml. The shape and size of the gallbladder can undergo changes due to inflammatory and cicatricial changes. The bottom, body and neck of the gallbladder, which passes into the cystic duct, are distinguished. Often a bay-shaped protrusion forms at the neck of the gallbladder - Hartmann's pouch. The cystic duct often flows into the right semicircle of the common bile duct at an acute angle. Other options for the confluence of the cystic duct: into the right hepatic duct, into the left semicircle of the common hepatic duct, high and low confluence of the duct, when the cystic duct accompanies the common hepatic duct for a long distance. The wall of the gallbladder consists of three membranes: mucous, muscular and fibrous. The mucous membrane of the bladder forms numerous folds. In the area of the bladder neck and the initial part of the cystic duct, they are called Heister valves, which in the more distal parts of the cystic duct, together with bundles of smooth muscle fibers, form the Lütkens sphincter. The mucous membrane forms multiple protrusions located between the muscle bundles - the Rokitansky-Aschoff sinuses. In the fibrous membrane, often in the area of the bladder bed, there are aberrant hepatic tubules that do not communicate with the lumen of the gallbladder. Crypts and aberrant tubules can be a site of microflora retention, which causes inflammation of the entire thickness of the gallbladder wall.

Blood supply to the gallbladder carried out through the cystic artery, coming to it from the neck of the gallbladder with one or two trunks from the proper hepatic artery or its right branch. There are other options for the origin of the cystic artery.

Lymphatic drainage occurs in the lymph nodes of the portal of the liver and the lymphatic system of the liver itself.

Innervation of the gallbladder carried out from the hepatic plexus, formed by branches of the celiac plexus, the left vagus nerve and the right phrenic nerve.

Bile, produced in the liver and entering the extrahepatic bile ducts, consists of water (97%), bile salts (1-2%), pigments, cholesterol and fatty acids (about 1%). The average flow rate of bile secretion by the liver is 40 ml/min. During the interdigestive period, the sphincter of Oddi is in a state of contraction. When a certain level of pressure in the common bile duct is reached, the Lütkens sphincter opens and bile from the hepatic ducts enters the gallbladder. The concentration of bile occurs in the gallbladder due to the absorption of water and electrolytes. In this case, the concentration of the main components of bile (bile acids, pigments, cholesterol, calcium) increases 5-10 times from their initial content in hepatic bile. Food, acidic gastric juice, fats, entering the duodenal mucosa, cause the release of intestinal hormones into the blood - cholecystokinin, secretin, which cause contraction of the gallbladder and simultaneous relaxation of the sphincter of Oddi. When food leaves the duodenum and the contents of the duodenum become alkaline again, the release of hormones into the blood stops and the sphincter of Oddi contracts, preventing further flow of bile into the intestine. About 1 liter of bile enters the intestines per day.

Surgical diseases. Kuzin M.I., Shkrob O.S. et al., 1986

The bile ducts are a complex transport route for liver secretions. They go from the reservoir (gallbladder) into the intestinal cavity.

The bile ducts are an important transport route for liver secretions, ensuring its outflow from the gallbladder and liver to the duodenum. They have their own special structure and physiology. Diseases can affect not only the gallbladder itself, but also the bile ducts. There are many disorders that impair their functioning, but modern monitoring methods make it possible to diagnose diseases and treat them.

The bile duct is a collection of tubular tubules through which bile is evacuated into the duodenum from the gallbladder. Regulation of the work of muscle fibers in the walls of the ducts occurs under the influence of impulses from the nerve plexus located in the liver area (right hypochondrium). The physiology of excitation of the bile ducts is simple: when the receptors of the duodenum are irritated by food masses, nerve cells send signals to the nerve fibers. From them, a contraction impulse is sent to the muscle cells, and the muscles of the bile ducts relax.

The movement of secretions in the bile ducts occurs under the influence of pressure exerted by the lobes of the liver - this is facilitated by the function of the sphincters, called motor, GB and tonic tension of the vascular walls. The large hepatic artery feeds the tissues of the bile ducts, and the outflow of oxygen-poor blood occurs into the portal vein system.

Anatomy of the bile ducts

The anatomy of the biliary tract is quite confusing, because these tubular formations are small in size, but gradually they merge, forming large canals. Depending on how the bile capillaries are located, they are divided into extrahepatic (hepatic, common bile and cystic duct) and intrahepatic.

The beginning of the cystic duct is located at the base of the gallbladder, which, like a reservoir, stores excess secretions, then merges with the hepatic duct, forming a common channel. The cystic duct emerging from the gallbladder is divided into four sections: supraduodenal, retropancreatic, retroduodenal and intramural canals. Coming out at the base of the papilla of Vater of the duodenum, a section of a large bile vessel forms an orifice, where the channels of the liver and pancreas are transformed into the hepatic-pancreatic ampulla, from which a mixed secretion is released.

The hepatic duct is formed by the fusion of two side branches that transport bile from each part of the liver. The cystic and hepatic tubules will flow into one large vessel - the common bile duct (choledochus).

Major duodenal papilla

Speaking about the structure of the biliary tract, one cannot help but recall the small structure into which they flow. The major duodenal papilla (DC) or papilla of Vater is a hemispherical flattened elevation located on the edge of the fold of the mucous layer in the lower part of the DP, 10–14 cm above it there is a large gastric sphincter - the pylorus.

The dimensions of the Vater nipple range from 2 mm to 1.8–1.9 cm in height and 2–3 cm in width. This structure is formed when the biliary and pancreatic excretory ducts merge (in 20% of cases they may not connect and the ducts leaving the pancreas open a little higher).

An important element of the major duodenal papilla is, which regulates the flow of mixed secretions from bile and pancreatic juice into the intestinal cavity, and it also prevents intestinal contents from entering the biliary tract or pancreatic canals.

Pathologies of the bile ducts

There are many disorders of the functioning of the biliary tract; they can occur separately or the disease will affect the gallbladder and its ducts. The main violations include the following:

blockage of bile ducts (cholelithiasis);
dyskinesia;
cholangitis;
cholecystitis;
neoplasms (cholangiocarcinoma).

The hepatocyte secretes bile, which consists of water, dissolved bile acids, and some metabolic waste products. If this secretion is removed from the reservoir in a timely manner, everything functions normally. If there is stagnation or too rapid secretion, bile acids begin to interact with minerals, bilirubin, creating deposits - stones. This problem is typical for the bladder and bile ducts. Large stones clog the lumen of the bile vessels, damaging them, which causes inflammation and severe pain.

Dyskinesia is a dysfunction of the motor fibers of the bile ducts, in which there is an abrupt change in the pressure of secretions on the walls of blood vessels and the gallbladder. This condition can be an independent disease (of neurotic or anatomical origin) or accompanies other disorders, such as inflammation. Dyskinesia is characterized by the appearance of pain in the right hypochondrium several hours after eating, nausea, and sometimes vomiting.

– inflammation of the walls of the biliary tract, may be a separate disorder or a symptom of other disorders, for example, cholecystitis. The patient manifests itself as an inflammatory process with fever, chills, profuse secretion of sweat, pain in the right hypochondrium, lack of appetite, and nausea.

- an inflammatory process involving the bladder and bile duct. The pathology is of infectious origin. The disease occurs in an acute form, and if the patient does not receive timely and high-quality therapy, it becomes chronic. Sometimes, with permanent cholecystitis, it is necessary to remove the gallbladder and part of its ducts, because the pathology prevents the patient from living a normal life.

Neoplasms in the gallbladder and bile ducts (most often they occur in the common bile duct area) are a dangerous problem, especially when it comes to malignant tumors. Drug treatment is rarely carried out; the main therapy is surgery.

Methods for studying the bile ducts

Methods for diagnostic examination of the biliary tract help to detect functional disorders, as well as track the appearance of neoplasms on the walls of blood vessels. The main diagnostic methods include the following:

duodenal intubation;
intraoperative choledo- or cholangioscopy.

An ultrasound examination can detect deposits in the gallbladder and ducts, and also indicates neoplasms in their walls.

– a method for diagnosing the composition of bile, in which the patient is parenterally administered an irritant that stimulates contraction of the gallbladder. The method allows you to detect deviations in the composition of liver secretions, as well as the presence of infectious agents in it.

The structure of the ducts depends on the location of the liver lobes; the general plan resembles the branched crown of a tree, since many small ones flow into large vessels.

The bile ducts are the transport route for liver secretions from its reservoir (gallbladder) into the intestinal cavity.

There are a lot of diseases that disrupt the functioning of the biliary tract, but modern research methods make it possible to detect the problem and cure it.

Bile ducts are a system of channels designed to drain bile into the duodenum from the gallbladder and liver. The innervation of the bile ducts is carried out using branches of the nerve plexus located in the liver area. Blood comes from the hepatic artery, the blood outflows into the portal vein. Lymph flows to the lymph nodes that are located in the area of the portal vein.

The movement of bile in the biliary tract occurs due to the secretory pressure exerted by the liver, as well as due to the motor function of the sphincters, the gallbladder and due to the tone of the walls of the bile ducts themselves.

The structure of the bile ducts

Depending on their location, the ducts are divided into extrahepatic (this includes the left and right hepatic ducts, the common hepatic duct, the common bile duct and the cystic duct) and intrahepatic. The hepatic bile duct is formed due to the fusion of two lateral (left and right) hepatic ducts, which drain bile from each hepatic lobe.

The cystic duct, in turn, originates from the gallbladder, then, merging with the common hepatic duct, forms the common bile duct. The latter consists of 4 parts: supraduodenal, retropancreatic, retroduodenal, intramural. Opening on the papilla of Vater of the duodenum, the intramural part of the common bile duct forms an orifice where the pancreatic and bile ducts unite into the so-called hepatopancreatic ampulla.

Bile duct diseases

The biliary tract is susceptible to various diseases, the most common of which are described below:

Cholelithiasis. Characteristic not only of the gallbladder, but also of the ducts. A pathological condition that most often affects people who are prone to obesity. It consists of the formation of stones in the bile ducts and bladder due to stagnation of bile and metabolic disorders of certain substances. The composition of stones is very diverse: it is a mixture of bile acids, bilirubin, cholesterol and other elements. Often, stones in the bile ducts do not cause significant discomfort to the patient, which is why their carriage can last for years. In other situations, the stone can clog the bile ducts and damage their walls, which leads to inflammation in the bile ducts, which is accompanied by hepatic colic. The pain is localized in the area in the right hypochondrium and radiates to the back. Often accompanied by vomiting, nausea, and high fever. Treatment of bile ducts with the formation of stones often includes a diet based on eating foods rich in vitamins A, K, D, low in calories and excluding foods rich in animal fats;
Dyskinesia. A common disease in which the motor function of the biliary tract is impaired. Characterized by changes in bile pressure in various parts of the gallbladder and ducts. Dyskinesias can be either independent diseases or accompany pathological conditions of the biliary tract. Symptoms of dyskinesia are a feeling of heaviness and pain in the upper right area of the abdomen, which occurs 2 hours after eating. Nausea and vomiting may also occur. Treatment of bile ducts with dyskinesia caused by neurotization is carried out using drugs aimed at treating neuroses (primarily valerian root);
Cholangitis or inflammation in the bile ducts. In most cases, it is observed in acute cholecystitis, but it can also be an independent disease. It manifests itself as pain in the right hypochondrium, fever, profuse sweating, and is often accompanied by attacks of nausea and vomiting. Jaundice often occurs against the background of cholangitis;
Acute cholecystitis. Inflammation in the bile ducts and gallbladder due to infection. Just like colic, it is accompanied by pain in the right hypochondrium and increased temperature (from low-grade to high). In addition, there is an increase in the size of the gallbladder. As a rule, it occurs after eating a lot of fatty foods or drinking alcohol;
Cholangiocarcinoma or bile duct cancer. Intrahepatic, distal bile ducts, as well as those located in the area of the hepatic gate are susceptible to cancer. As a rule, the risk of developing cancer increases with the chronic course of a number of diseases, including biliary tract cysts, stones in the bile ducts, cholangitis, etc. Symptoms of the disease are very varied and can manifest themselves in the form of jaundice, itching in the duct area, fever, vomiting and/or nausea and others. Treatment is carried out by removing the bile ducts (if the size of the tumor is limited to the internal lumen of the ducts), or if the tumor has spread outside the liver, it is recommended to remove the bile ducts from the affected part of the liver. In this case, a donor liver transplant is possible.

Methods for studying the bile ducts

Diagnosis of biliary tract diseases is carried out using modern methods, descriptions of which are presented below:

intraoperative chaledo- or cholangioscopy. Methods appropriate for determining choledochotomy;
Ultrasound diagnostics with a high degree of accuracy reveals the presence of stones in the bile ducts. The method also helps to diagnose the condition of the walls of the bile ducts, their size, the presence of stones, etc.;
duodenal intubation is a method that is used not only for diagnostic purposes, but also for therapeutic purposes. It consists of introducing irritants (usually parenterally) that stimulate contractions of the gallbladder and relax the sphincter of the bile duct. Advancement of the probe along the digestive tract causes the release of secretions and bile. Assessment of their quality, along with bacteriological analysis, gives an idea of the presence or absence of a particular disease. Thus, this method allows you to study the motor function of the biliary tract, as well as identify blockage of the biliary tract with a stone.

Liver secretions necessary for digestion move through the gallbladder to the intestinal cavity along the bile ducts. Various diseases provoke changes in the functioning of the bile ducts. Interruptions in the functioning of these pathways affect the performance of the entire organism. The bile ducts differ in their structural and physiological features.

Interruptions in the functioning of the bile ducts affect the performance of the entire body

What is the gallbladder for?

The liver is responsible for the secretion of bile in the body, and what function does the gallbladder perform in the body? The biliary system is formed by the gallbladder and its ducts. The development of pathological processes in it threatens with serious complications and affects the normal functioning of a person.

The functions of the gallbladder in the human body are:

accumulation of bile fluid in the organ cavity;
thickening and preservation of liver secretions;
excretion through the bile ducts into the small intestine;
protecting the body from irritating components.

Bile production is carried out by liver cells and does not stop day or night. Why does a person need a gallbladder and why can’t we do without this connecting link when transporting liver fluid?

The secretion of bile occurs constantly, but the processing of food mass with bile is required only during the process of digestion, which is limited in duration. Therefore, the role of the gallbladder in the human body is to accumulate and store liver secretions until the right time.

The production of bile in the body is an uninterrupted process and it is produced many times more than the volume of the pear-shaped organ can accommodate. Therefore, bile is split inside the cavity, water and some substances necessary for other physiological processes are removed. Thus, it becomes more concentrated and its volume is significantly reduced.

The amount that the bladder will release does not depend on how much it is produced by the largest gland - the liver, which is responsible for the production of bile. What matters in this case is the amount of food consumed and its nutritional composition. The passage of food into the esophagus serves as a signal to begin work. To digest fatty and heavy foods, a larger amount of secretion will be required, so the organ will contract more strongly. If the amount of bile in the bladder is insufficient, then the liver is directly involved in the process, where the secretion of bile never stops.

The accumulation and excretion of bile is carried out as follows:

Therefore, the role of the gallbladder in the human body is to accumulate and store liver secretions until the right time.
the common hepatic duct transfers the secretion to the biliary organ, where it accumulates and is stored until the right moment;
the bubble begins to contract rhythmically;
the bladder valve opens;
the opening of the intracanal valves is provoked, the sphincter of the major duodendral papilla relaxes;

In cases where the bladder is removed, the biliary system does not cease to function. All the work falls on the bile ducts. The gallbladder is innervated or connected to the central nervous system through the hepatic plexus.

Gallbladder dysfunction affects your health and can cause weakness, nausea, vomiting, itching and other unpleasant symptoms. In Chinese medicine, it is customary to consider the gallbladder not as a separate organ, but as a component of one system with the liver, which is responsible for the timely release of bile.

The gallbladder meridian is considered Yangsky, i.e. paired and runs throughout the body from head to toes. The liver meridian, which belongs to the Yin organs, and the bile meridian are closely related. It is important to understand how it spreads in the human body so that treatment of organ pathologies using Chinese medicine is effective. There are two channel paths:

external, passing from the corner of the eye through the temporal region, forehead and back of the head, then descending to the armpit and lower along the front of the thigh to the ring toe;
internal, starting at the shoulders and going through the diaphragm, stomach and liver, ending with a branch in the bladder.

Stimulating points on the meridian of the biliary organ helps not only improve digestion and improve its functioning. Impact on the points of the head relieves:

migraines;
arthritis;
diseases of the visual organs.

Also, through the points of the body, you can improve cardiac activity, and with help. Areas on the legs - muscle activity.

The structure of the gallbladder and biliary tract

The gallbladder meridian affects many organs, which suggests that the normal functioning of the biliary system is extremely important for the functioning of the entire body. The anatomy of the gallbladder and biliary tract is a complex system of channels that ensure the movement of bile within the human body. Its anatomy helps to understand how the gallbladder works.

What is the gallbladder, what is its structure and functions? This organ has the shape of a sac, which is located on the surface of the liver, more precisely, in its lower part.

In some cases, during intrauterine development the organ does not come to the surface of the liver. The intrahepatic location of the bladder increases the risk of developing cholelithiasis and other diseases.

The shape of the gallbladder has a pear-shaped outline, a narrowed top and an expansion at the bottom of the organ. There are three parts in the structure of the gallbladder:

a narrow neck where bile enters through the common hepatic duct;
body, widest part;
the bottom, which is easily determined by ultrasound.

The organ has a small volume and is capable of holding about 50 ml of fluid. Excess bile is excreted through the small duct.

The walls of the bubble have the following structure:

Serous outer layer.
Epithelial layer.
Mucous membrane.

The mucous membrane of the gallbladder is designed in such a way that incoming bile is very quickly absorbed and processed. The folded surface contains many mucous glands, the intensive work of which concentrates the incoming fluid and reduces its volume.

The anatomy of the gallbladder and biliary tract is a complex system of channels that ensure the movement of bile within the human body

The anatomy of the biliary tract includes two types of ducts: extrahepatic and intrahepatic bile ducts.

The structure of the bile ducts outside the liver consists of several channels:

Cystic duct connecting the liver with the bladder.
The common bile duct (CBD or common bile duct), starting at the place where the hepatic and cystic ducts connect and going to the duodenum.

The anatomy of the bile ducts distinguishes the sections of the common bile duct. First, bile from the bladder passes through the supraduodendral section, passes into the retroduodendral section, then through the pancreatic section it enters the duodendral section. Only along this path can bile pass from the organ cavity to the duodenum.

How does the gallbladder work?

The process of moving bile in the body is started by small intrahepatic tubules, which unite at the outlet and form the left and right hepatic ducts. Then they form into an even larger common hepatic duct, from where the secretion enters the gallbladder.

How does the gallbladder work, and what factors influence its activity? During periods when digestion of food is not required, the bladder is in a relaxed state. The job of the gallbladder at this time is to accumulate secretions. Eating food triggers many reflexes. The pear-shaped organ is also included in the process, which makes it mobile due to the contractions that begin. At this point, it already contains processed bile.

The required amount of bile is released into the common bile duct. Through this channel, liquid enters the intestine and promotes digestion. Its function is to break down fats through the acids it contains. In addition, processing food with bile leads to the activation of enzymes required for digestion. These include:

lipase;
aminolase;
trypsin.

Bile appears in the liver. Passing through the choleretic channel, it changes its color, structure and decreases in quantity. Those. bile is formed in the bladder, which is different from the liver secretion.

Concentration of incoming bile from the liver occurs by removing water and electrolytes from it.

The principle of operation of the gallbladder is described by the following points:

Collection of bile, which is produced by the liver.
Thickening and storage of secretions.
The direction of fluid through the duct into the intestine, where food is processed and broken down.

The organ begins to work, and its valves open only after the person receives nutrition. The gallbladder meridian, on the contrary, is activated only in the late evening from eleven to one in the morning.

Diagnosis of bile ducts

Failure in the functioning of the biliary system most often occurs due to the formation of some kind of obstacle in the canals. The reason for this may be:

cholelithiasis
tumors;
inflammation of the bladder or bile ducts;
strictures and scars that may affect the common bile duct.

Diseases are identified through a medical examination of the patient and palpation of the area of the right hypochondrium, which makes it possible to establish deviations from the norm in the size of the gallbladder, laboratory tests of blood and feces, as well as using hardware diagnostics:

Ultrasonography shows the presence of stones and how many of them have formed in the ducts.

X-ray. Not able to give specifics about the pathology, but helps confirm the presence of a suspected pathology.
Ultrasound. Ultrasonography shows the presence of stones and how many of them have formed in the ducts.
ERCP (endoscopic retrograde cholangiopancreatography). It combines x-ray and endoscopic examination and is the most effective method for studying diseases of the biliary system.
CT. In case of cholelithiasis, this study helps to clarify some details that cannot be determined with ultrasound.
MRI. A method similar to CT.

In addition to these studies, a minimally invasive method for detecting blockage of the choleretic ducts can be used - laparoscopy.

Causes of bile duct diseases

Disturbances in the functioning of the bladder have various causes and can be caused by:

Any pathological changes in the ducts disrupt the normal outflow of bile. Expansion and narrowing of the bile ducts, thickening of the walls of the common bile duct, and the appearance of various formations in the canals indicate the development of diseases.

The narrowing of the lumen of the bile ducts disrupts the return flow of secretions to the duodenum. The causes of the disease in this case may be:

mechanical trauma caused during surgery;
obesity;
inflammatory processes;
the appearance of cancerous tumors and metastases in the liver.

Strictures that form in the bile ducts provoke cholestasis, pain in the right hypochondrium, jaundice, intoxication, and fever. The narrowing of the bile ducts leads to the fact that the walls of the canals begin to thicken, and the area above begins to expand.

Blockage of the ducts leads to stagnation of bile. It becomes thicker, creating ideal conditions for the development of infections, so the appearance of strictures often precedes the development of additional diseases.

Dilation of the intrahepatic bile ducts occurs due to:

Dilatation of the intrahepatic bile ducts occurs due to the formation of stones

Changes in the bile ducts accompany the symptoms:
nausea;
gagging;
soreness on the right side of the abdomen;
fever;
jaundice;
rumbling in the gall bladder;

flatulence.

All this indicates that the biliary system is not working properly. There are several most common diseases:
Housing and communal services The formation of stones is possible not only in the bladder, but also in the ducts. In many cases, the patient does not experience any discomfort for a long time. Therefore, stones may remain undetected for several years and continue to grow. If stones block the bile ducts or injure the walls of the canal, then the developing inflammatory process is difficult to ignore. Pain, high fever, nausea and vomiting will not allow you to do this.
Dyskinesia. This disease is characterized by a decrease in the motor function of the bile ducts. Disruption of bile flow occurs due to changes in pressure in different areas of the channels. This disease can develop independently, as well as accompany other pathologies of the gallbladder and its ducts. A similar process causes pain in the right hypochondrium and heaviness that occurs a couple of hours after eating.
Acute cholecystitis. The inflammation is infectious in nature and occurs with pain and fever. At the same time, the size of the gallbladder increases, and deterioration of the condition occurs after consuming fatty, heavy meals and alcoholic beverages.
Cancerous tumors of the canals. The disease most often affects the intrahepatic bile ducts or pathways at the porta hepatis. With cholangiocarcinoma, yellowing of the skin, itching in the liver area, fever, nausea and other symptoms appear.

In addition to acquired diseases, congenital developmental anomalies, such as aplasia or hypoplasia of the gallbladder, can complicate the functioning of the gallbladder.

Anomalies of the bile

An anomaly in the development of the gallbladder ducts is diagnosed in almost 20% of people. Much less common is the complete absence of channels intended for the removal of bile. Congenital defects entail disruption of the biliary system and digestive processes. Most congenital defects do not pose a serious threat and can be treated; severe forms of pathologies are extremely rare.

Duct anomalies include the following pathologies:

the appearance of diverticula on the walls of the canals;
cystic lesions of the ducts;
the presence of kinks and partitions in the channels;
hypoplasia and atresia of the biliary tract.

Anomalies of the bubble itself, according to their characteristics, are conventionally divided into groups depending on:

localization of the bile;
changes in organ structure;
deviations in shape;
quantities.

An organ can be formed, but have a different location from the normal one and be located:

in the right place, but across;
inside the liver;
under the left hepatic lobe;
in the left hypochondrium.

The pathology is accompanied by disturbances in bladder contractions. The organ is more susceptible to inflammatory processes and the formation of stones.

A “wandering” bubble can occupy various positions:

inside the abdominal region, but almost not in contact with the liver and covered by abdominal tissues;
completely separated from the liver and communicating with it through a long mesentery;
with a complete lack of fixation, which increases the likelihood of kinks and torsion (lack of surgical intervention leads to the death of the patient).

It is extremely rare for doctors to diagnose a newborn with a congenital absence of the gallbladder. Gallbladder agenesis can take several forms:

Complete absence of the organ and extrahepatic bile ducts.
Aplasia, in which, due to underdevelopment of the organ, there is only a small process that is not capable of functioning and full-fledged ducts.
Bladder hypoplasia. The diagnosis indicates that the organ is present and capable of functioning, but some of its tissues or areas are not fully formed in the child in the prenatal period.

Functional excesses go away on their own, but true ones require medical intervention

Agenesis in almost half of cases leads to the formation of stones and dilation of the large bile duct.

An abnormal, non-pear-shaped shape of the gallbladder appears due to constrictions, kinks in the neck or body of the organ. If the bubble, which should be pear-shaped, resembles a snail, then there has been a bend that has disrupted the longitudinal axis. The gallbladder collapses towards the duodenum, and adhesions form at the point of contact. Functional excesses go away on their own, but true ones require medical intervention.

If the pear-shaped shape changes due to constrictions, then the vesical body narrows in places or completely. With such deviations, stagnation of bile occurs, causing the appearance of stones and accompanied by severe pain.

In addition to these shapes, the pouch can resemble a Latin S, a ball or a boomerang.

The biliary bile weakens the organ and leads to dropsy, stones and tissue inflammation. The gallbladder may be:

multi-chamber, in which the bottom of the organ is partially or completely separated from its body;
bilobed, when two separate lobules are attached to one bladder neck;
ductular, two bladders with their ducts function simultaneously;
triplicative, three organs united by a serous membrane.

How are bile ducts treated?

When treating blocked ducts, two methods are used:

conservative;
operational.

The main thing in this case is surgical intervention, and conservative agents are used as auxiliaries.

Sometimes, a calculus or mucous clot can leave the duct on its own, but this does not mean complete relief from the problem. The disease will return without treatment, so it is necessary to combat the cause of such stagnation.

In severe cases, the patient is not operated on, but his condition is stabilized and only after that the day of surgery is set. To stabilize the condition, patients are prescribed:

starvation;
installation of a nasogastric tube;
antibacterial drugs in the form of antibiotics with a wide spectrum of action;
droppers with electrolytes, protein drugs, fresh frozen plasma and others, mainly for detoxifying the body;
antispasmodic drugs;
vitamin products.

To speed up the flow of bile, non-invasive methods are used:

extraction of stones using a probe followed by drainage of the canals;
percutaneous puncture of the bladder;
cholecystostomy;
choledochostomy;
percutaneous hepatic drainage.

Normalization of the patient's condition allows the use of surgical treatment methods: laparotomy, when the abdominal cavity is completely opened, or laparoscopy performed using an endoscope.

In the presence of strictures, treatment with the endoscopic method allows you to expand the narrowed ducts, insert a stent and guarantee that the channels are provided with normal lumen of the ducts. The operation also allows you to remove cysts and cancerous tumors that usually affect the common hepatic duct. This method is less traumatic and even allows for cholecystectomy. Opening the abdominal cavity is resorted to only in cases where laparoscopy does not allow the necessary manipulations to be performed.

Congenital malformations, as a rule, do not require treatment, but if the gallbladder is deformed or prolapsed due to some injury, what should you do? Displacement of an organ while maintaining its functionality will not worsen health, but if pain and other symptoms appear, it is necessary:

maintain bed rest;
drink enough liquid (preferably without gas);
adhere to the diet and foods approved by the doctor, cook correctly;
take antibiotics, antispasmodics and analgesics, as well as vitamin supplements and choleretic drugs;
attend physiotherapy, do physical therapy and massage to relieve the condition.

Despite the fact that the organs of the biliary system are relatively small, they do a tremendous job. Therefore, it is necessary to monitor their condition and consult a doctor when the first symptoms of disease appear, especially in the presence of any congenital anomalies.

Video

What to do if a stone appears in the gall bladder.

The bile ducts are a tubular system in the body that often requires treatment. The common hepatic duct is the most painful place in the biliary system. Even a person leading a healthy lifestyle is not immune from health problems (especially the digestive system). Therefore, you need to know what problems lie in wait and how therapy is carried out. If you start a therapeutic course of any disease on time, it will go away faster and bring fewer problems.

The bile ducts are a system of channels that are designed to drain bile into the duodenum from the liver and gallbladder.

general characteristics

Bile is an auxiliary enzyme, it is secreted in the human liver to improve digestion. In humans, the bile ducts are a system of channels through which bile is discharged into the intestine. The bile ducts of the liver open into the duodenum, which leads to the stomach. The system of pathways and bile ducts vaguely resembles the image of a tree: the crown of the tree is the small channels located in the liver, the trunk is the common hepatic duct connecting the duodenum with the liver. The movement of bile is carried out using pressure, it is created by the liver.

Biliary tract: structure

The structure of the canal is not very complicated. All small ducts originate in the liver. The fusion of the left and right canals (both located in the liver) forms the common hepatic canal. The channels carry the burn formed by the hepatic lobes. The bile duct is formed in the bladder, then it connects with the common hepatic duct and forms the common bile duct. A bend in the gallbladder may indicate abnormalities in its development. Strictures of the common hepatic duct are not normal. Occurs due to strong blows to the liver area.

Congenital pathologies and developmental anomalies of the biliary tract

Congenital tract anomalies are a defect from which no one is immune. Anomalies should be detected in the maternity hospital or in the first year of the child’s life. Otherwise, it can lead to death or worsening health problems in older age. There is no universally accepted classification of anomalies of this organ yet. Scientists also do not agree on whether the pathologies are hereditary. Most often, they appear if during pregnancy a woman led an unhealthy lifestyle or took illegal drugs. There are the following types of congenital abnormalities:

tract atresia;
hypoplasia of interlobular intrahepatic bile ducts;
common duct cysts.

Biliary atresia

Atresia is an obstruction of the lumen of several or all extrahepatic bile ducts. The main symptom is rapidly developing jaundice in newborns. If it is physiological, then you should not be afraid. It will go away in 2-3 weeks after the baby is born.

Apart from the icteric color, the child does not experience any discomfort, feces and urine are normal, but the amount of bilirubin in the blood is increased. It is worth making sure that its level does not increase too rapidly. To speed up its elimination, you need to place the baby on a well-lit surface under indirect sunlight.

But, if the feces and urine are of an unnatural yellow color, the child diarrhea and vomits, and feels constant anxiety, then this is not obstructive jaundice, but tract atresia. It appears 2-3 days after birth. The pathways are not able to remove bile, this leads to an increase in the size of the liver and its compaction, and the angle becomes sharper. Doctors advise taking x-rays after 4, 6 and 24 hours for an accurate diagnosis. Atresia can lead to acute liver failure at 4-6 months and death of the child at 8-12 months. It can only be treated surgically.

Hypoplasia of interlobular intrahepatic bile ducts

This disease is due to the fact that the intrahepatic ducts are not able to remove bile. The main symptoms of the disease are similar to atresia, but they are not as pronounced. The disease sometimes goes away without symptoms. Sometimes itchy skin appears at the age of 4 months, the itching does not stop. The disease can be an addition to other diseases, for example, the cardiovascular system. The treatment is difficult. Sometimes leads to cirrhosis of the liver.

Common bile duct cysts

Common gallbladder cyst.

This disease manifests itself in children 3−5 years old. Children experience sharp attacks of pain, especially during pressing; in older age, nausea and vomiting occur. The skin has an uncharacteristic icteric tint, feces and urine have an uncharacteristic yellowish color. Fever is common. Ruptures and peritonitis, malignant cyst tumors are possible. It is treated by removing cysts from the affected organ.

Damage to the bile ducts

Canal ruptures can be seen very rarely. They can be provoked by a strong blow to the right side. Damage of this type quickly leads to peritonitis. It is worth noting that with ruptures of other organs it is very difficult to diagnose damage to the ducts. In addition, in the first hours there are no signs other than painful sensations. In addition, if there is an infection, the situation can be greatly aggravated by a sharp increase in temperature. It can only be treated with urgent surgery, sometimes the inflammation ends in death.

Bile duct diseases

Diseases of the bile ducts are characterized by changes in skin color (it turns yellow), itching, and pain in the right side. It can be constant with frequent worsening and vomiting, then the pain is referred to as hepatic colic. The pain increases after intense physical activity, long driving and eating spicy, salty foods. The pain increases when pressing on the right side.

The main symptom of chronic cholecystitis is acute pain in the right side.

Chronic cholecystitis is a disease caused by a virus. Due to inflammation of the gallbladder, it enlarges. This entails painful sensations in the right side. The pain doesn't stop. If the diet is violated or if there is a strong shake, the pain increases. Proper treatment is prescribed by a gastroenterologist. Following a simple diet is important for health.

Biliary tract cholangitis

Cholangitis is an inflammation of the bile ducts. The disease is caused by pathogenic bacteria. The cause is inflammation of the gallbladder. Sometimes it is purulent in nature. With this disease, the excretion of bile worsens due to blockage of the channels. The patient experiences severe pain on the right side, bitterness in the mouth, nausea and vomiting, and loss of strength. This disease is characterized by the fact that in the early stages it can be effectively treated with folk remedies, but in later stages only by surgery.

Biliary dyskinesia

Dyskenisia is a violation of the tone or motility of the biliary tract. It develops against the background of psychosomatic diseases or allergies. The disease is accompanied by mild pain in the hypochondrium, bad mood, and depression. Constant fatigue and irritability also become constant companions of the patient. Men and women report problems in their intimate lives.

Cholelithiasis

Scheme of localization of stones in the gall bladder.

Cholangiolithiasis is the formation of stones in the bile ducts. Large amounts of cholesterol and salt can lead to this disease. At the moment of the formation of sand (the precursor of stones), the patient does not experience any discomfort, but as the grains of sand grow and pass through the bile ducts, the patient begins to notice severe pain in the hypochondrium area, which radiates to the shoulder blade and arm. The pain is accompanied by nausea and vomiting. To speed up the process of stone passage, you can increase your physical activity (the best way is to walk up the stairs).

Biliary tract cholestasis

Cholestasis is a disease in which the flow of bile into the intestines decreases. Symptoms of the disease: itching of the skin, darkening of the color of urine and yellowing of stool. Yellowness of the skin is noted. The disease sometimes entails dilation of bile capillaries and the formation of blood clots. May be accompanied by anorexia, fever, vomiting and flank pain. There are the following causes of the disease:

alcoholism;
cirrhosis of the liver;
tuberculosis;
infectious diseases;
cholestasis during pregnancy and others.

Bile duct blockage

Blockage of the canals can be a consequence of other diseases of the digestive system. Most often it is a consequence of gallstone disease. This tandem occurs in 20% of humanity, and women suffer from this disease 3 times more often than men. In the first stages, the disease does not make itself felt. But after suffering an infectious disease, the digestive system begins to progress rapidly. The patient's temperature rises, the skin begins to itch, feces and urine take on an unnatural color. A person is rapidly losing weight and suffers from pain in his right side.