Biliary Duct System

Question 1

What do the right and left hepatic ducts drain?

Answer 1

the corresponding functional halves of the liver

Question 2

What forms the common hepatic duct?

Answer 2

the union of the left and right hepatic ducts

Question 3

What does the cystic duct drain?

Answer 3

gallbladder

Question 4

What forms the bile duct?

Answer 4

the union of the common hepatic duct and cystic duct

Question 5

What forms the hepatopancreatic ampulla (ampulla of Vater) and where does it drain?

Answer 5

• the union of the bile duct and pancreatic duct

- empties into the second part of the duodenum at the major duodenal papilla

Question 6

Describe the sphincter of ampulla?

Answer 6

• surrounds the hepatopancreatic ampulla
• very strong, resists pressure
• narrowest point in the biliary passages

Question 7

Describe the sphincter of the bile duct.

Answer 7

surrounds the inferior terminus of the bile duct

Question 8

Describe the sphincter of the pancreatic duct.

Answer 8

• surrounds the terminal part of the pancreatic duct

- relatively weak

Question 9

Describe the spiral folds (valves).

Answer 9

• located within the cystic duct
• function to keep it open
• not true valves

Question 10

What are gallstones?

Answer 10

• hard masses formed by the solidification of bile constituents
• mainly composed of cholesterol crystals
• most commonly become impacted at the distal end of the hepatopancreatic ampulla (at sphincter of ampulla), as this is the narrowest point in the biliary passages
• blockage at this location causes backup of bile through the pancreatic duct; acute pancreatitis results
• risk factors:
  1. being female
  2. obesity
  3. pregnancy
  4. high fat diet

Question 11

What is the chiropractic note regarding the gallbladder?

Answer 11

• upper abdominal diseases involving the liver, gallbladder, or stomach may refer pain to lower thoracic spinal cord segments (T8-T12)
• a gallbladder attack most commonly causes pain in the right upper quadrant of the abdomen
• in 30% of patients, pain is also referred to the right subscapular region of the back, just below the inferior angle of the scapula