Gallbladder and ducts anatomy. The structure of the gallbladder and biliary tract

The right and left hepatic ducts emerge from the liver and merge at the hilum into the common hepatic duct. As a result of its confluence with the cystic duct, the common bile duct is formed.

The common bile duct passes between the layers of the lesser omentum anterior to the portal vein and to the right of the hepatic artery. Located posterior to the first section of the duodenum in a groove on the posterior surface of the head of the pancreas, it enters the second section of the duodenum. The duct obliquely crosses the posteromedial wall of the intestine and usually joins with the main pancreatic duct, forming the hepato-pancreatic ampulla (ampulla of Vater). The ampulla forms a protrusion of the mucous membrane directed into the lumen of the intestine - the large papilla of the duodenum (papilla of Vater). Approximately 12-15% of the examined common bile duct and pancreatic duct open into the lumen of the duodenum separately.

The dimensions of the common bile duct, when determined by different methods, are not the same. The diameter of the duct, measured during operations, ranges from 0.5 to 1.5 cm. In endoscopic cholangiography, the diameter of the duct is usually less than 11 mm, and a diameter of more than 18 mm is considered pathological. In an ultrasound examination (ultrasound), it is normally even smaller and amounts to 2-7 mm; with a larger diameter, the common bile duct is considered dilated.

Part of the common bile duct, passing through the wall of the duodenum, is surrounded by a shaft of longitudinal and circular muscle fibers, which is called the sphincter of Oddi.

The gallbladder is a pear-shaped sac 9 cm long, capable of holding about 50 ml of fluid. It is always located above the transverse colon, adjacent to the duodenal bulb, projecting onto the shadow of the right kidney, but at the same time being located significantly in front of it.

Any decrease in the concentration function of the gallbladder is accompanied by a decrease in its elasticity. Its widest section is the bottom, which is located in front; it is he who can be palpated in the study of the abdomen. The body of the gallbladder passes into a narrow neck, which continues into the cystic duct. The spiral folds of the mucous membrane of the cystic duct and the neck of the gallbladder are called Heister's valve. The saccular dilation of the neck of the gallbladder, in which gallstones often form, is called Hartman's pouch.

The wall of the gallbladder consists of a network of muscle and elastic fibers with indistinctly distinguished layers. The muscle fibers of the neck and bottom of the gallbladder are especially well developed. The mucous membrane forms numerous delicate folds; glands are absent in it, however, there are depressions penetrating into the muscle layer, called Luschka's crypts. The mucosa does not have a submucosal layer and its own muscle fibers.

Rokitansky-Ashoff's sinuses are branched intussusceptions of the mucous membrane that penetrate through the entire thickness of the muscular layer of the gallbladder. They play an important role in the development of acute cholecystitis and gangrene of the bladder wall.

Blood supply. The gallbladder is supplied with blood from the cystic artery. This is a large, tortuous branch of the hepatic artery, which can have a different anatomical location. Smaller blood vessels exit the liver through the gallbladder fossa. Blood from the gallbladder drains through the cystic vein into the portal vein system.

The blood supply of the supraduodenal part of the bile duct is carried out mainly by the two arteries accompanying it. Blood in them comes from the gastroduodenal (bottom) and right hepatic (top) arteries, although their connection with other arteries is also possible. Strictures of the bile ducts after vascular injury can be explained by the peculiarities of the blood supply to the bile ducts.

Lymphatic system. In the mucous membrane of the gallbladder and under the peritoneum are numerous lymphatic vessels. They pass through the node at the neck of the gallbladder to the nodes located along the common bile duct, where they connect with the lymphatic vessels that drain lymph from the head of the pancreas.

Innervation. The gallbladder and bile ducts are abundantly innervated by parasympathetic and sympathetic fibers.

Development of the liver and bile ducts

The liver is laid in the form of a hollow protrusion of the endoderm of the anterior (duodenal) intestine at the 3rd week of intrauterine development. The protrusion is divided into two parts - hepatic and biliary. The hepatic part consists of bipotent progenitor cells, which then differentiate into hepatocytes and ductal cells, forming early primitive bile ducts - ductal plates. When cells differentiate, the type of cytokeratin in them changes. When the c-jun gene, which is part of the API gene activation complex, was removed in the experiment, liver development stopped. Normally, fast-growing cells of the hepatic part of the protrusion of the endoderm perforate the adjacent mesodermal tissue (transverse septum) and meet with the capillary plexuses growing in its direction, coming from the vitelline and umbilical veins. Sinusoids are subsequently formed from these plexuses. The biliary part of the protrusion of the endoderm, connecting with the proliferating cells of the hepatic part and with the foregut, forms the gallbladder and extrahepatic bile ducts. Bile begins to be secreted around the 12th week. From the mesodermal transverse septum, hematopoietic cells, Kupffer cells and connective tissue cells are formed. In the fetus, the liver mainly performs the function of hematopoiesis, which fades in the last 2 months of intrauterine life, and by the time of delivery, only a small number of hematopoietic cells remain in the liver.

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The liver secret necessary for digestion moves through the gallbladder to the intestinal cavity through the bile ducts. Various diseases provoke changes in the functioning of the bile ducts. Interruptions in the work of these pathways affect the performance of the whole organism. The bile ducts differ in their structural and physiological features.

Interruptions in the work of the bile ducts affect the performance of the whole organism

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 life of a person.

The functions of the gallbladder in the human body are:

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

The production of bile is carried out by the cells of the liver and does not stop day or night. Why does a person need a gallbladder and why is it impossible to do without this link when transporting hepatic fluid?

The excretion of bile occurs constantly, but the processing of the food mass with bile is required only in the process of digestion, which is limited in duration. Therefore, the role of the gallbladder in the human body is to accumulate and store the secret of the liver until the right time. The production of bile in the body is an uninterrupted process and it is formed many times more than the volume of the pear-shaped organ allows. Therefore, bile splitting occurs inside the cavity, the removal of water and some substances necessary in other physiological processes. Thus, it becomes more concentrated, and its volume is significantly reduced.

The amount that the bubble will throw out does not depend on how much it produces the largest gland - the liver, which is responsible for the production of bile. The value in this case is played by the amount of food consumed and its nutritional composition. The passage of food through the esophagus serves as a signal to start work. To digest fatty and heavy foods, more secretions 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 the secret of the liver until the right time.

the common hepatic duct passes the secret to the bile duct, 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 duodenal papilla relaxes;
bile goes to the intestines through the common bile duct.

In cases where the bubble is removed, the biliary system does not cease to function. All work falls on the bile ducts. The innervation of the gallbladder or its connection with the central nervous system occurs through the hepatic plexus.

Gallbladder dysfunction affects the well-being and can cause weakness, nausea, vomiting, itchy skin 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 meridian of the gallbladder is considered Jansky, i.e. paired and runs throughout the body from head to toes. The meridian of the liver, which belongs to the Yin organs, and the gallbladder are closely related. It is important to understand how it spreads in the human body so that the treatment of organ pathologies with the help of 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 in the area of the shoulders and going through the diaphragm, stomach and liver, ending with a branch in the bladder.

Stimulation of points on the meridian of the biliary organ helps not only to improve digestion and improve its work. Impact on the points of the head eliminates:

migraines;
arthritis;
diseases of the visual organs.

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

The structure of the gallbladder and biliary tract

The gallbladder meridian affects many organs, which indicates that the normal functioning of the biliary system is extremely important for the functioning of the whole organism. The anatomy of the gallbladder and biliary tract is a complex system of channels that ensure the movement of bile inside the human body. To understand how the gallbladder works, its anatomy helps.

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 fetal 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:

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 able to hold 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 the incoming bile is very quickly absorbed and processed. In the folded surface there are many mucous glands, the intensive work of which concentrates the incoming fluid and reduces its volume.

The ducts perform a transport function and ensure the movement of bile from the liver through the bladder to the duodenum. Ducts run to the right and left of the liver and form into the common hepatic duct.

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

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

The structure of the biliary tract outside the liver consists of several channels:

Cystic duct that connects the liver to the bladder.
The common bile duct (CBD or common bile duct), which begins at the junction of the hepatic and cystic ducts and leads to the duodenum.

The anatomy of the biliary tract distinguishes between the sections of the common bile duct. First, bile from the bladder passes through the supraduodenal section, passes into the retroduodenal section, then through the pancreatic section enters the duodenal section. Only along this path can bile get from the organ cavity to the duodenum.

How the gallbladder works

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

How does the gallbladder work, and what factors affect its activity? During periods when digestion is not required, the bladder is in a relaxed state. The work of the gallbladder at this time is to accumulate a secret. Eating provokes the launch of many reflexes. The pear-shaped organ is also included in the process, which makes it mobile due to the beginning contractions. By this point, it already contains processed bile.

The required amount of bile is released into the common bile duct. Through this channel, the liquid enters the intestine and promotes digestion. Its function is to break down fats through its constituent acids. In addition, the processing of 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.

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

The principle of the gallbladder is described in the following paragraphs:

Collection of bile produced by the liver.
Condensation and storage of a secret.
The direction of the liquid 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 food. The gallbladder meridian, on the contrary, is activated only in the late evening from 11 am to 1 am.

Diagnostics of the bile ducts

Failure of the biliary system occurs most often due to the formation of any obstacle in the channels. The reason for this may be:

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

Identification of diseases occurs with the help of a medical examination of the patient and palpation of the right hypochondrium, which allows you to establish a deviation 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 have formed in the ducts.

X-ray. Not able to give specifics about the pathology, but helps to confirm the presence of a suspected pathology.
ultrasound. Ultrasonography shows the presence of stones and how many 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. With cholelithiasis, this study helps to clarify some details that cannot be determined with ultrasound.
MRI. Similar to CT method.

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

Causes of diseases of the bile ducts

Violations in the functioning of the bladder have various causes and can be triggered by:

Any pathological changes in the ducts disrupt the normal outflow of bile. Expansion, narrowing of the bile ducts, thickening of the walls of the common bile duct, the appearance of various formations in the canals indicates 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 diseases in this case can be:

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

Strictures formed 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 channels begin to thicken, and the area above - 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.

The expansion of the intrahepatic bile ducts occurs due to:

Changes in the bile ducts accompany the symptoms:

nausea;
gagging;
soreness of the right side of the abdomen;
fever;
jaundice;
rumbling in the gallbladder;
flatulence.

All this indicates that the biliary system is not working properly. There are some of the most common diseases:

ZhKB. 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 go unnoticed for several years and continue to grow. If the 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 this to be done.
Dyskinesia. This disease is characterized by a decrease in the motor function of the bile ducts. Violation of the flow of bile occurs due to changes in pressure in various 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.
Cholangitis. It is usually caused by acute cholecystitis, but the inflammatory process can also occur on its own. Symptoms of cholangitis include: fever, excessive sweating, pain in the right side, nausea and vomiting, jaundice develops.
Acute cholecystitis. Inflammation is of an infectious nature and proceeds with pain and fever. At the same time, the size of the gallbladder increases, and deterioration occurs after eating fatty, heavy meals and alcoholic beverages.
Cancer tumors of channels. The disease often affects the intrahepatic bile ducts or pathways at the gates of the liver. With cholangiocarcinoma, yellowing of the skin, itching in the liver, 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 work of the bladder.

Anomalies of the gallbladder

Anomaly in the development of the gallbladder ducts is diagnosed in almost 20% of people. Much less often you can find a complete absence of channels designed to remove bile. Congenital malformations entail disruption of the biliary system and digestive processes. Most congenital malformations do not pose a serious threat and can be treated; severe forms of pathologies are extremely rare.

Anomalies of the ducts include the following pathologies:

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

According to their characteristics, anomalies of the bubble itself are conditionally divided into groups depending on:

localization of the gall;
changes in the structure of the body;
deviations in form;
quantities.

An organ may be formed but not in its normal position and placed:

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

Pathology is accompanied by violations of bladder contractions. The organ is more susceptible to inflammatory processes and the formation of stones.

The "wandering" bubble can occupy various positions:

inside the abdominal region, but almost not in contact with the liver and covered with 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 twisting (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, as a result of underdevelopment of the organ, there is only a small, incapable of functioning process and full-fledged ducts.
Hypoplasia of the bladder. The diagnosis suggests that the organ is present and able to function, but some of its tissues or areas are not fully formed in the child in the prenatal period.

Functional kinks go away on their own, while true ones require medical intervention.

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

An abnormal, non-pear-shaped form 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 a kink has occurred that violates the longitudinal axis. The gallbladder collapses to the duodenum, and adhesions form at the point of contact. Functional excesses pass on their own, and the 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, provoking the appearance of stones and accompanied by severe pain.

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

A bifurcation of the gallbladder weakens the organ and leads to dropsy, calculi and inflammation of the tissues. The gallbladder may be:

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

How are bile ducts treated?

In the treatment of blockage of the ducts, two methods are used:

conservative;
operational.

The main in this case is surgical intervention, and conservative means are used as auxiliary.

Sometimes, a calculus or a mucous clot can leave the duct on its own, but this does not mean that the problem is completely eliminated. The disease in the absence of treatment will return, so it is necessary to deal with the cause of the appearance of such stagnation.

In severe cases, the patient is not operated on, but his condition is stabilized, and only after that the day of the operation is appointed. 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 preparations, fresh frozen plasma and others, mainly for detoxification of the body;
antispasmodic drugs;
vitamin remedies.

To accelerate the outflow of bile, non-invasive methods are resorted to:

extraction of calculi with a probe, followed by drainage of channels;
percutaneous puncture of the bladder;
cholecystostomy;
choledochostomy;
percutaneous hepatic drainage.

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

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

Congenital malformations, as a rule, do not require treatment, but if the gallbladder is deformed or omitted due to some kind of injury, what should I do? Displacement of the organ while maintaining its performance does not worsen health, but with the appearance of pain and other symptoms, it is necessary:

observe bed rest;
drink enough liquid (preferably without gas);
adhere to a 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 physiotherapy exercises and massage to relieve the condition.

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

Video

What to do if a stone appears in the gallbladder.

Source: liver.org

Anatomy

What is dangerous blockage of the ducts

Diagnosis of diseases

Features of treatment

Therapeutic diet

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Dear readers, the bile ducts (bile ducts) have one important function - they conduct bile to the intestines, which plays a key role in digestion. If for some reason it periodically does not reach the duodenum, there is a direct threat to the pancreas. After all, bile in our body eliminates the properties of pepsin that are dangerous for this organ. It also emulsifies fats. Cholesterol and bilirubin are excreted through bile, because they cannot be filtered out by the kidneys in full.

If the gallbladder ducts are blocked, the entire digestive tract suffers. Acute blockage causes colic, which can result in peritonitis and an urgent operation, partial obstruction disrupts the functionality of the liver, pancreas and other significant organs.

Let's talk about what is especially in the bile ducts of the liver and gallbladder, why they begin to conduct bile poorly and what needs to be done to avoid the adverse effects of such blockage.

The anatomy of the bile ducts is quite complex. But it is important to understand it in order to understand how the biliary tract functions. The bile ducts are intrahepatic and extrahepatic. From the inside, they have several epithelial layers, the glands of which secrete mucus. The bile duct has a biliary microbiota - a separate layer that forms a community of microbes that prevent the spread of infection in the organs of the biliary system.

The intrahepatic bile ducts have a tree structure. The capillaries pass into the segmental bile ducts, and those, in turn, flow into the lobar ducts, which, outside the liver, form the common hepatic duct. It enters the cystic duct, which drains bile from the gallbladder and forms the common bile duct (choledochus).

Before entering the duodenum, the common bile duct passes into the pancreatic excretory duct, where they combine to form the hepatopancreatic ampulla, which is separated by the sphincter of Oddi from the duodenum.

Diseases that cause obstruction of the bile ducts

Diseases of the liver and gallbladder in one way or another affect the state of the entire biliary system and cause blockage of the bile ducts or their pathological expansion as a result of a chronic inflammatory process and stagnation of bile. Provoke obstruction such diseases as cholelithiasis, cholecystitis, excesses of the gallbladder, the presence of structures and scars. In this condition, the patient needs urgent medical attention.

Blockage of the bile ducts is caused by the following diseases:

bile duct cysts;
cholangitis, cholecystitis;
benign and malignant tumors of the pancreas and organs of the hepatobiliary system;
scars and strictures of the ducts;
cholelithiasis;
pancreatitis;
hepatitis and cirrhosis of the liver;
helminthic invasions;
enlarged lymph nodes of the hepatic gate;
surgical interventions on the biliary tract.

Most diseases of the biliary system cause chronic inflammation of the biliary tract. It leads to thickening of the walls of the mucosa and narrowing of the lumen of the ductal system. If, against the background of such changes, the stone enters the gallbladder duct, the calculus partially or completely blocks the lumen.

Bile stagnates in the bile ducts, causing them to expand and exacerbate the symptoms of the inflammatory process. This can lead to empyema or dropsy of the gallbladder. For a long time, a person suffers minor symptoms of blockage, but eventually irreversible changes in the biliary mucosa will begin to occur.

Why is it dangerous

If the bile ducts are clogged, it is necessary to consult a specialist as soon as possible. Otherwise, there will be an almost complete loss of the liver from participation in detoxification and digestive processes. If the patency of the extrahepatic or intrahepatic bile ducts is not restored in time, liver failure may occur, which is accompanied by damage to the central nervous system, intoxication and goes into a severe coma.

Blockage of the bile ducts can occur immediately after an attack of biliary colic https://site/zhelchnaya-kolika against the background of the movement of stones. Sometimes obstruction occurs without any prior symptoms. A chronic inflammatory process, which inevitably occurs with biliary dyskinesia, cholelithiasis, cholecystitis, leads to pathological changes in the structure and functionality of the entire biliary system.

At the same time, the bile ducts are dilated, they may contain small stones. Bile stops flowing into the duodenum at the right time and in the required volume.

The emulsification of fats slows down, metabolism is disturbed, the enzymatic activity of the pancreas decreases, food begins to rot and ferment. Stagnation of bile in the intrahepatic ducts causes the death of hepatocytes - liver cells. Bile acids and direct active bilirubin begin to enter the bloodstream, which provokes damage to internal organs. The absorption of fat-soluble vitamins against the background of insufficient intake of bile into the intestine worsens, and this leads to hypovitaminosis, a violation of the functions of the blood coagulation system.

If a large stone gets stuck in the bile duct, it immediately closes its lumen. There are acute symptoms that signal the severe consequences of obstruction of the biliary tract.

How does blockage of the ducts manifest?

Many of you probably believe that if the bile ducts are clogged, the symptoms will immediately be so acute that they cannot be tolerated. In fact, the clinical manifestations of blockage can increase gradually. Many of us have experienced discomfort in the right hypochondrium, which sometimes even lasts for several days. But we are not in a hurry with these symptoms to specialists. And such aching pain may indicate that the bile ducts are inflamed or even clogged with stones.

As the ductal patency worsens, additional symptoms appear:

acute girdle pain in the right hypochondrium and abdomen;
yellowing of the skin, the appearance of obstructive jaundice;
discoloration of feces due to a lack of bile acids in the intestine;
itching of the skin;
darkening of the urine due to the active excretion of direct bilirubin through the kidney filter;
severe physical weakness, increased fatigue.

Pay attention to symptoms of obstruction of the bile ducts and diseases of the biliary system. If you undergo diagnostics at the initial stage, change the nature of nutrition, you can avoid dangerous complications and preserve the functionality of the liver and pancreas.

Diseases of the biliary system are treated by gastroenterologists or hepatologists. You should contact these specialists if you have complaints of pain in the right hypochondrium and other characteristic symptoms. The main method for diagnosing diseases of the bile ducts is ultrasound. It is recommended to look at the pancreas, liver, gallbladder and ducts.

If the specialist detects strictures, tumors, expansion of the choledochus and ductal system, the following studies will be additionally assigned:

MRI of the bile ducts and the entire biliary system;
biopsy of suspicious areas and neoplasms;
feces on the coprogram (detect a low content of bile acids);
blood biochemistry (increased direct bilirubin, alkaline phosphatase, lipase, amylase and transaminases).

Blood and urine tests are prescribed in any case. In addition to the characteristic changes in the biochemical study, when the ducts are obstructed, prothrombin time is prolonged, leukocytosis is observed with a shift to the left, and the number of platelets and erythrocytes decreases.

Features of treatment

The tactics of treating pathologies of the bile ducts depends on concomitant diseases and the degree of blockage of the lumen of the ductal system. In the acute period, antibiotics are prescribed, detoxification is carried out. In this state, serious surgical interventions are contraindicated. Specialists try to limit themselves to minimally invasive methods of treatment.

These include the following:

choledocholithotomy - an operation to partially excise the common bile duct in order to free it from stones;
bile duct stenting (installation of a metal stent that restores ductal patency);
drainage of the bile ducts by inserting a catheter into the bile ducts under the control of an endoscope.

After the duct system is restored, specialists can plan more serious surgical interventions. Sometimes the blockage is provoked by benign and malignant neoplasms that have to be removed, often along with the gallbladder (with calculous cholecystitis).

Total resection is performed using microsurgical instruments, under the control of the endoscope. Doctors remove the gallbladder through small punctures, so the operation is not accompanied by heavy blood loss and a long rehabilitation period.

During cholecystectomy, the surgeon must assess the patency of the ductal system. If stones or strictures remain in the bile ducts after removal of the bladder, severe pain and emergencies may occur in the postoperative period.

Removal of a stone-filled bladder in a certain way saves other organs from destruction. And the streams too.

Do not refuse the operation if it is necessary and threatens the entire biliary system. From the stagnation of bile, inflammation, reproduction of infectious pathogens, the entire digestive tract and the immune system suffer.

Often a person against the background of diseases of the ducts begins to lose weight dramatically, feel bad. He is forced to limit his activity, give up his favorite work, because constant pain attacks and health problems do not allow him to live a full life. And the operation in this case prevents the dangerous consequences of chronic inflammation and stagnation of bile, including malignant tumors.

Therapeutic diet

For any diseases of the bile ducts, diet No. 5 is prescribed. This involves the exclusion of fatty, fried foods, alcohol, carbonated drinks, foods that provoke gas formation. The main goal of such nutrition is to reduce the increased load on the biliary system and prevent a sharp course of bile.

In the absence of severe pain, you can eat as usual, but only if you have not abused prohibited foods before. Try to completely abandon trans fats, fried foods, spices, smoked meats, convenience foods. But at the same time, nutrition should be complete and varied. It is important to eat often, but in small portions.

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It is necessary to resort to treatment with folk remedies when the bile ducts are clogged with extreme caution. Many herbal recipes have a strong choleretic effect. Using such methods, you risk your own health. Since it is impossible to clean the bile ducts with herbal preparations without the risk of developing colic, you should not experiment with herbs at home.

First, make sure that there are no large stones that can cause blockage of the ductal system. If you use choleretic herbs, give preference to those that have a mild effect: chamomile, rosehip, flax seeds, immortelle. Beforehand, nevertheless, consult a doctor and conduct an ultrasound. You should not joke with choleretic compounds if there is a high risk of blockage of the bile ducts.

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This video describes a gentle cleansing of the gallbladder and ducts that can be used at home.

Chapter 1. Anatomy and Physiology

The hepatic tissue consists of many lobules, separated by layers of connective tissue, in which the bile ducts, branches of the portal vein, hepatic artery and nerves, braiding the lobules with a dense mesh, pass. Hepatocytes in the lobules are located so that one pole of them faces the blood vessels, and the other - to the bile ducts,

Secreted bile is secreted from hepatocytes into the bile ducts - gaps 1-2 microns in diameter between adjacent hepatocytes. Through the tubules, bile moves in the direction from the centro-lobular cells to the interlobular portal triads and enters the bile ducts. The latter, merging, form larger ducts, and those, in turn, are bile ducts lined with sinusoidal epithelial cells (A. L. Tones et al., 1980).

The intrahepatic bile ducts run parallel to the branches of the portal vein and the hepatic artery. Connecting with each other, they form larger intrahepatic ducts and eventually form extraorganic hepatic ducts for the right and left lobes of the liver.

In the right lobe for the outflow of bile from the anterior and posterior segments, there are 2 main ducts - anterior and posterior, which are formed from the confluence of the ducts of the upper and lower zones - subsegments. The anterior and posterior ducts lead to the gates of the liver, and the posterior duct is located somewhat higher and has a greater length. Merging, they form the right hepatic duct. In 28% of cases, fusion does not occur, and the inferior segmental duct is considered as the right accessory hepatic duct. However, this is wrong, because bile flows through it from a certain part of the liver.

In the bed of the gallbladder, you can often find a thin duct that drains bile from the V segment of the right lobe and has a direct connection with the right hepatic duct; damage to it during cholecystectomy should be avoided. Direct communication of this duct with the gallbladder has not been established.

From the left lobe of the liver, as well as from the right, the outflow of bile is carried out through 2 segmental ducts - lateral and medial.

The lateral segmental duct drains bile from the left anatomical lobe and is formed by the fusion of the ducts of the upper and lower zones. The confluence is located along the line of the left sagittal sulcus (50% of cases) or somewhat to the right of it (42% of cases) -K. Schwartz (1964).

The medial duct is formed from several (usually 2) ducts of the upper and lower zones and joins the lateral duct at the hilum of the liver, forming the left hepatic duct.

In the caudate lobe, the ducts are divided into 2 systems. From the right section, bile flows into the right hepatic duct, from the left - into the left. Intrahepatic communication between the left and right hepatic ducts in the region of the caudate lobe was not established.

Hepatic ducts. Usually, the fusion of the left and right ducts occurs outside the liver parenchyma at 0.75-1.5 cm from its surface (95% of cases) and much less often (5% of cases) in the hepatic parenchyma (IM Talman, 1965). The left hepatic duct is narrower and longer than the right one, always located outside the parenchyma in front of the left portal vein. Its length ranges from 2 to 5 cm, diameter - from 2 to 5 mm. More often it is located in the transverse groove posterior to the posterior edge of the square lobe. At the posterior corner of the square lobe there is a dangerous place where the anterior surface of the left hepatic duct is crossed by the branches of the hepatic artery leading to the IV segment (A. N. Maksimenkov, 1972). Bile enters the left hepatic duct from segments I, II, III, and IV of the liver. It should be noted that the bile ducts of the I segment in some cases can flow into both the left and right hepatic ducts, although significant anastomoses between both ducts were not detected even at the height of bile hypertension with obstructive jaundice (A. I. Krakovsky, 1966).

The right hepatic duct, located at the gates of the liver, is often shrouded in its parenchyma. Its length is less than the left one (0.4-1 cm), and its diameter is slightly larger. The right hepatic duct is located most often behind and above the right portal vein. It is usually located above the hepatic artery, and sometimes below it. Essential for surgery of the biliary tract is the fact that at the level of the location of the neck of the gallbladder at a distance of 1-2 cm posterior to it or the initial section of the cystic duct, the right hepatic duct passes very superficially in the liver parenchyma (A. I. Krakovsky, 1966), which can easily be damaged during cholecystectomy or when suturing the gallbladder bed.

The study of the intrahepatic architectonics of the bile ducts and the projection of these ducts onto the surface of the liver (A.F. Khanzhinov, 1958; G.E. Ostroverkhoe et al., 1966; A.I. Krakovsky, 1966) served as the basis for creating accurate visualization schemes for the most accessible intrahepatic ducts and biliodigestive anastomoses.

The wall of the intrahepatic bile ducts consists of loose fibrous connective tissue, internally covered with a single layer of cuboidal epithelium.

The common hepatic duct originates at the confluence (fork) of the lobar hepatic ducts at the hilum of the liver and ends at the confluence with the cystic duct. Depending on the confluence of the latter, the length of the common hepatic duct varies from 1 to 10 cm (usually 3-7 cm), and the diameter is from 0.3 to 0.7 cm. The common hepatic duct is formed at the gate of the liver, being, as it were, a continuation of the left hepatic duct, and is located in front of the bifurcation of the portal vein. Most often, it is formed as a result of the fusion of 2 hepatic ducts - the right and left (67% of cases, according to G. A. Mikhailov, 1976) and less often 3, 4, 5 ducts. This branching of the common hepatic duct is of particular interest when performing interventions on the bifurcation of the ducts at the hilum of the liver.

The common hepatic duct is located at the right edge of the hepatic-duodenal ligament, in front of the right edge of the portal vein. In the event that the fusion of the hepatic ducts occurs at the edge of the duodenum, both ducts run in parallel, and the cystic duct can flow into one of them at a different level.

Common bile duct. From the confluence of the cystic duct to the duodenum is the common bile duct. Its length varies depending on the level of confluence of the cystic duct (average - 5-8 cm). The diameter of the duct is 5-9 mm. Before entering the pancreatic tissue, the common bile duct expands somewhat, then gradually narrows, passing through the pancreatic tissue, especially at the confluence with the duodenum. Under pathological conditions, the common bile duct can expand to 2-3 cm or more.

The common bile duct is usually divided into 4 parts: 1) supraduodenal - from the confluence of the cystic duct to the upper edge of the duodenum (0.3-3.2 cm); 2) retroduodenal (about 1.8 cm). It is located behind the upper horizontal part of the duodenum before the entry of the duct into the pancreas. To the left of the common bile duct is the portal vein, below it is the inferior vena cava separated by a thin layer of connective tissue; 3) pancreatic (about 3cm). Located between the head of the pancreas and the duodenum. More often (in 90% of cases) the common bile duct passes through the pancreas, and sometimes it is located on its dorsal surface. The common bile duct, passing through the pancreas, has the shape of a gutter

and not completely surrounded by the parenchyma of the gland (IM Talmai, 1963). Hess (1961), on the contrary, notes that in 90% of people this part of the common bile duct is located inside the pancreatic parenchyma; 4) intramural. The introduction of the common bile duct into the duodenum occurs along the left medial edge of its vertical section on the border with the posterior wall 8-14 cm from the pylorus when measured along the intestine (M. D. Anikhanov, 1960; I. M. Talman, 1963; A. N. Maksimenko, 1972; A. I. Edemsky, 1987), that is, in the middle part of the vertical section. In some cases, the place of confluence may be 2 cm from the pylorus or even in the stomach, as well as in the region of the duodenal-intestinal flexure. According to Baynes (1960), who studied 210 preparations, the place of confluence of the common bile duct into the duodenum in the upper horizontal part was in 8 patients, in the upper half of the vertical part - in 34, in the lower half of the vertical part - in 112, at the transition to the lower the horizontal part - 36, in the lower horizontal part - in 6, to the left of the midline near the duodenal flexure - in 4 patients. All this, of course, must be borne in mind when performing surgical interventions on the major duodenal papilla and the distal common bile duct.

The higher the confluence of the common bile duct, the straighter the angle of perforation of the intestinal wall and the greater the predisposition to duodenal-papillary reflux.

The intraparietal part of the common bile duct is 10–15 mm long. It obliquely perforates the wall of the duodenum, forming the major duodenal papilla from the mucosal side.

The wall of the common hepatic and common bile ducts consists of a plate of connective tissue rich in elastic fibers. The latter are located in two layers - along the long axis of the duct and circularly covering it. Among the fibers are smooth muscle cells, but there is no continuous layer of muscles. Only in certain areas (at the point of transition of the cystic duct into the gallbladder, at the confluence of the common bile duct and the pancreatic duct, and also when they flow into the duodenum) do accumulations of smooth muscle cells form sphincters.

The inner surface of the ducts is lined with a single layer of high prismatic epithelium, which in some places forms crypts. The mucosa also contains goblet cells.

Major duodenal papilla. At the site of passage of the intestinal wall, the common bile duct narrows somewhat and then expands in the submucosal layer, forming an ampullar extension 9 mm long, and sometimes 5.5 mm. The ampulla ends in the intestinal lumen with a papilla the size of a millet grain. The papilla is located on a longitudinal fold formed by the mucosa itself. In the major duodenal papilla there is a muscular apparatus, consisting of circular and longitudinal fibers - the sphincter of the hepato-pancreatic ampulla. The longitudinal fibers are divided into ascending and descending, while the ascending ones are a continuation of the muscle fibers of the duodenum, and the descending ones go along the duodenal side of the common bile duct and end at the same level with the circular fibers.

The results of the study of the anatomical and histological characteristics of the major duodenal papilla in children, conducted by A. I. Edemsky (1987), showed that in the first years of life, its submucosal and intramuscular sections are poorly developed. Studying the topography of the confluence of the bile and pancreatic ducts, the author found that in children they always merge, resulting in a common canal 2-3.5 mm long. The presence of a common channel from the moment of birth contributes to the mixing of bile and pancreatic juice, which ensures normal digestion. The mucous membrane of the common canal is represented by many high triangular folds, which are the prototype of valves that fill the lumen of the canal and are directed towards the mouth with their ends, which in itself prevents the occurrence of reflux. Studying the function of the sphincter of the major duodenal papilla using retrograde film or telecholangiopancreatograms, M. D. Semin (1977) found that the own sphincter of the distal common bile duct (sphincter of the hepato-pancreatic ampulla) has 3 more internal sphincters, the work of which is close associated with both the release of bile into the duodenum and the prevention of duodenobiliary reflux. As studies conducted in our clinic have shown, at rest these three sphincters are not differentiated and tightly closed, radiographs show a blunt or cone-shaped breakage of the contrast agent in the common bile duct at a distance of more than 1 cm from the duodenal wall (this is the length of the sphincter zones ). Differentiation of the sphincter zones begins during the passage of bile or in a state of atony.

Ampoule-like extensions, like a true ampulla of the major duodenal papilla at the confluence of the bile duct and pancreatic duct, we found only in 15 of 1387 retrograde endoscopic cholangiopancreatograms. Most often, both ducts, connecting, form a common channel of uniform width, and ampullar expansion is a consequence of pathological conditions (cicatricial stenosis of the papilla orifice, strangulated or fixed stone in the papilla).

The common canal in the region of the sphincter zone, which opens at the top of the major duodenal papilla with a hole about 3 mm in diameter, in its direction is, as it were, a continuation of the main pancreatic duct, and the common bile duct in most cases flows into it at an acute angle. This explains the easier - catheterization of the pancreatic duct when performing retrograde pancreatic cholangiography and the risk of damage to the latter during surgery, when the ampulla of the duodenal papilla is slightly expressed.

Own sphincter of the main pancreatic duct is less pronounced and does not have complex differentiation (MD Semin, 1977). It is much shorter than the sphincter zone of the terminal common bile duct.

The excretory duct of the pancreas, perforating the wall of the duodenum, merges with the terminal section of the common bile duct at different levels and at different angles. All options for connecting the common bile duct with the excretory duct of the pancreas are usually divided into 3 groups.

1. The common bile duct connects with the pancreatic duct to the top of the major duodenal papilla. In this case, both ducts flow into the ampulla, or the common bile duct forms the ampulla, and the pancreatic duct flows into it (86%).

2. There is no connection of the ducts, but they flow into the ampulla with a common opening (6%).

Both ducts flow independently and even at a distance of 1-2 cm from each other (8%).

Schumacher (1928) proposed his scheme of variations in the connection of the common bile duct with the excretory duct of the pancreas (Fig. 38).

In view of the frequent interventions on the major duodenal papilla, this scheme has a certain practical interest. The total length of the major duodenal papilla in adults is (17.2 ± 1.5) mm (A. I. Edemsky, 1987). The blood supply to the major duodenal papilla occurs at the expense of small branches of the gastroduodenal, pancreatoduodenal and superior mesenteric arteries.

The gallbladder is located in the right longitudinal groove of the lower surface of the liver, in the groove of the gallbladder; 2/3 of this thin-walled organ is covered by the peritoneum, and 1/3 is adjacent to the liver.

And the following layers are distinguished in the wall of the gallbladder: serous, subserous, fibromuscular and mucous membranes. The pear-shaped gallbladder has 3 sections: the bottom, body and neck. Usually there is a bend at the place where the body of the gallbladder passes into the neck. Here, near the neck, the wall of the gallbladder forms 1, less often - 2 pockets, which are often the location of stones and obstruction of the cystic duct. Due to the activity of the muscle fibers located on the neck and cystic duct, due to the bend between them, there is a pressure drop in the gallbladder and bile ducts.

There are also various deviations in the topographic anatomical position of the gallbladder. There is a double, or additional, gallbladder; movable gallbladder; dystopia of the gallbladder; intrahepatic location of the gallbladder; absence of a gallbladder.

The cystic duct is a tube 3 to 10 mm long, slightly narrowed in the anterior-posterior direction, originating from the surface of the gallbladder neck facing the gates of the liver. Here the cystic duct, bending, goes to the gates of the liver, and then at an angle goes down to the hepatic duct and flows into it. The lumen of the proximal segment of the cystic duct resembles an irregularly shaped corkscrew due to the spiral structure of its mucous membrane. Both in the place of confluence, and in shape, length and location, there are quite a lot of different variants of the cystic duct, which are described in detail in the chapter on the surgical treatment of congenital malformations of the gallbladder and bile ducts.

The blood supply to the gallbladder is carried out mainly by the cystic artery, which most often departs from the right branch of the proper hepatic artery (64-91% of cases). The cystic artery can also depart from the superior mesenteric, proper hepatic, left and common hepatic, gastroduodenal, gastroepiploic arteries. Sometimes it is a steam room (Fig. 39).

The vessel goes along the left surface of the gallbladder from the neck to the bottom. At the neck, it gives an anterior branch, which also goes to the bottom of the gallbladder. The trunk of the cystic artery is 1–2 cm long.

The cystic artery does not always pass in its usual way. In 4-9% of cases, it is located below and behind the cystic duct. Of particular danger are those options when the hepatic artery, located along the cystic duct, can be mistaken for the cystic artery and crossed during cholecystectomy. When a vessel is found near the cystic duct with a diameter of 3 mm or more, Moosman (1975) recommends ligating it after isolation from the surrounding tissues only at the very wall of the gallbladder.

The physiology of the biliary tract has not yet been sufficiently studied, however, it has been established that the flow of bile secreted by hepatocytes from the liver is regulated by nerve endings located in the walls of the extrahepatic biliary tract.

The main function of the extrahepatic biliary tract, including the gallbladder, is the accumulation of bile and its periodic excretion into the duodenum at the moment necessary for the full act of digestion. In the absence of the gallbladder, this role is taken over by the common bile duct, which expands to 1 cm and empties more frequently than the gallbladder. In addition, bile constantly flows through it into the duodenum, regardless of the phase of digestion. The outflow of bile through the hepatobiliary duct into the duodenum also occurs with a functioning gallbladder, but it is very insignificant.

In the intervals between meals, the gallbladder, due to an increase in the muscle tone of the sphincter of the hepatic-pancreatic ampulla and a decrease in pressure in its cavity, is filled with bile, where it is concentrated due to the reabsorption of electrolytes, water, chlorides and bicarbonate into the bloodstream. Thus, a small (30-70 mm) gallbladder, concentrating hepatic bile 5-10 times or more, ensures normal digestion, throwing high-concentration into the intestines.

a centered colloidal solution of bile salts, pigment and cholesterol. The flow of bile from the bile ducts and gallbladder into the duodenum is caused by food, especially rich in fats. The amount of bile secreted is directly proportional to the amount of food taken. In the gallbladder, regardless of the effect of these reasons, after the release of bile into the duodenum, a small amount of it still remains (residual bile).

In pathological conditions, all physiological functions of the digestive organs are violated. So, with obstruction of the cystic duct, bile pigments can completely disappear from the cystic bile. At the same time, the amount of bicarbonates and cholesterol, water and chlorides increases in it, and exudation of serous fluid and mucus into the bladder cavity occurs, which leads to an increase in the volume of the bladder, and its contents become transparent and watery. A similar process occurs in the common bile duct during its obstruction in the terminal section. Thus, "white" bile appears due to a violation of the physiological function of the biliary tract.

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Part II. Surgery of the biliary tractChapter 2. Anomalies in the development of the biliary tract

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, form the common bile duct. The length of the common bile duct is 6-8 cm, width is 0.5-1 cm.

Four sections are distinguished in the common bile duct: 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 part of the common bile duct forms a large duodenal papilla (vater papilla), located in the submucosal layer of the duodenum. The major 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 major duodenal papilla, forming, together with the terminal section of the common bile duct, the ampulla of the duodenal papilla. Various options for the relationship of the bile and pancreatic ducts should always be taken into account when performing surgery on the major duodenal papilla.

Rice. 153. The structure of the bile ducts (scheme).

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 pancreatic duct (santorini duct); 9 - large papilla of the duodenum; 10 - pancreatic duct (virsung duct).

The gallbladder is located on the lower surface of the liver in a small depression. Most of its surface is covered by the 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 with inflammatory and cicatricial changes. Allocate the bottom, body and neck of the gallbladder, which passes into the cystic duct. Often, a bay-like protrusion forms at the neck of the gallbladder - Hartmann's pocket. 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 region of the neck of the bladder and the initial part of the cystic duct, they are called the Heister valves, which, together with bundles of smooth muscle fibers, form the sphincter of Lutkens in the more distal sections of the cystic duct. The mucous membrane forms multiple protrusions located between the muscle bundles - the Rokitansky-Ashoff sinuses. In the fibrous membrane, more often in the region 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 place of microflora retention, which causes inflammation of the entire thickness of the gallbladder wall.

Blood supply to the gallbladder It is carried out through the cystic artery, going to it from the side of the neck of the gallbladder with one or two trunks from its own hepatic artery or its right branch. Other options for the origin of the cystic artery are also known.

Lymph drainage occurs in the lymph nodes of the gate of the liver and the lymphatic system of the liver itself.

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

The 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 sphincter of Lütkens opens, and bile from the hepatic ducts enters the gallbladder. The gallbladder concentrates bile by reabsorbing water and electrolytes. At the same time, the concentration of the main components of bile (bile acids, pigments, cholesterol, calcium) increases by 5-10 times from their initial content in hepatic bile. Food, acidic gastric juice, fats, getting on the mucous membrane of the duodenum, 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 again become alkaline, the release of hormones into the blood stops, 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. and others, 1986