Biliary Tree Flashcards
How is the biliary tree examined by endoscopy?
Retrograde through the sphincter of Oddi into the ampulla of Vater (distal common bile duct)
Where and with what structures does the biliary tree commence
Liver
Intrahepatic ducts
The intrahepatic ducts form what structures?
Left and right hepatic ducts
What forms the common hepatic duct and where?
Convergence of left and right hepatic ducts
At the porta hepatis
What structure joins the gall bladder to the common hepatic duct?
Cystic duct
What forms the common bile duct?
Convergence of the cystic duct and common hepatic duct
Describe the course of the common bile duct
Passes posterior to the duodenum
Runs in a groove in the posterior of the head of the pancreas/pancreas substance
Opens into 2nd part of duodenum
What are the consequences of occlusion of the common bile duct?
Obstruction of bile flow
Jaundice
Dark urine
Pale stool
What is the most common cause of painless obstructive jaundice
Carcinoma of the head of the pancreas
Tumours that cause obstructive jaundice include:
Carcinoma of head of pancreas
Cholangiocarcinoma
Adenocarcinoma of duodenum
Hepatic tumour causing extrinsic compression
What is the most common cause of painful obstructive jaundice?
Gallstone disease
What is the maximum diameter of the common bile duct? Why is this important to remember?
7mm
Distortions indicate obstruction
Where does the common bile duct run superior to the duodenum?
What other structures run here?
The free edge of the lesser omentum
Portal vein and hepatic artery
(Free edge is the anterior border of the epiploic foramen of Winslow, the entrance to the lesser sac)
How is the Pringles manoeuvre performed and what does it do?
Pressure applied to free edge (anterior border) of lesser sac
Occluded portal vein and hepatic artery
