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Anatomy and Physiology of The Biliary System
Anatomy and Physiology of The Biliary System
Anatomy and Physiology of The Biliary System
• Fossa on the inferior surface of the liver, anatomic division into right and left liver lobes
• 4 anatomic areas:
– Fundus: rounded, blind end; 1-2 cm beyond liver margin; most smooth ms of the organ
– Body: main storage area; most of the elastic tissue; from fundus tapers into neck
– Neck: funnel-shaped; connects w/ the cystic duct; deepest part of the GB fossa into free
portion of the hepatoduodenal ligament
• Histology:
– Single, highly-folded, tall columnar epithelium containing cholesterol & fat globules
• Venous return:
• Right & left hepatic ducts, common hepatic duct (CBD), cystic duct, common bile
duct/choledochus
• Cystic duct
– Variable length
– Variations of the cystic duct and its point of union w/ the common hepatic duct-
surgically important
Spiral valves of Heister = mucosal folds at the segment of cystic duct near GB neck; no valvular function
• Cystic duct crosses common hepatic duct posteriorly and joins common duct on left side. This
junction is posterior in some patients.
• Very short or absent cystic duct, usually seen in severe, chronic inflammation.
• Anomalous entry of right anterior or posterior segmental duct into cystic duct; it may also enter
the common hepatic duct.
Common bile duct :
• Upper third (supraduodenal) = downward in the free edge in the hepatoduodenal ligament, to
the right of the hepatic artery, anterior to the portal vein.
• Middle third (retroduodenal) = behind the D1; diverges laterally from the portal vein and
hepatic artery.
• Lower third (pancreatic) = curves behind the head of the pancreas in a grove or traverses
through it & enters the 2nd portion of the duodenum and joins together w/ the pancreatic duct
• Runs obliquely downward within the wall for 1 to 2 cm before opening on the ampulla of Vater ~
10 cm distal to the pylorus.
– 20% - within duodenal wall, w/ short or no common duct; open at same opening into
duodenum
– Sphincter of Oddi – a thick coat of circular smooth muscle surrounding the CBD at the
ampulla of Vater; controls bile flow into duodenum
• Histology:
• Arterial supply: gastroduodenal and right hepatic arteries w/ major trunks running along the
medial and lateral walls of the CBD ( 3’o clock & 9’o clock).
• Ducts of Luschka
– If (+) & not recognized during cholecystectomy à bile leak, formation of biloma
• HCL, CHON, and Fatty acids à release of secretin from the duodenum à increased bile production
& flow
• Bile flow from the liver à hepatic ducts à common hepatic duct à duodenum.
Gallbladder Function
• Main functions: concentrate and store hepatic bile & deliver bile into duodenum in response to
a meal
– GB mucosa: greatest absorptive power per unit area of any structure in the body
– Rapidly absorbs Na+, Cl- & H20 against significant concentration gradients à one
mechanism to prevent rise in pressure
• gradual relaxation
– Mucosal glands in infundibulum & neck – mucus glycoproteins w/c protect mucosa from
lytic actions of bile & facilitate passage of bile through cystic duct (“white bile” in
hydrops of the GB)
Sphincter of Oddi
• 4-6 mm in length
• Rise in CCKà relaxation à decreased amplitude of phasic contractions & reduced basal pressure à
increased bile flow into duodenum