Biliary System

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Biliary System

• Heartland Society of Gastroenterology Nurses and
  Associates
• Mary Ganley RN CGRN BSHA

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Objectives

• Describe the normal structure and histology of
  the biliary system.
• Name three diseases or diagnoses of the biliary
  tract and treatment.

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Diagram
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Biliary System Consist Of

• Gallbladder
• Hepatic Duct
• Cystic Duct
• Common Bile Duct
• Four Functions of the Biliary System
• Collect
• Concentrate
• Store
• Release
• This is accomplished by motility and secretion

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Four Divisions of the Gallbladder

• 1. Fundus
• 2. Funnel shaped body
• 3.Transitional region between the body and the
  neck. This is where gallstones get impacted
• 4. The neck which narrows at the cystic duct
• The cystic duct combines with the hepatic duct to
  form the common bile duct.
• The ampulla empties into the duodenum at the
  papilla of Vater or major papilla

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Sphincter of Oddi

• Smooth muscle surrounding the common bile duct, ,
  the pancreatic duct, and the ampulla of Vater.
• The functions of the sphincter of Oddi are
• Regulate the flow of bile and pancreatic juices
  into the intestine.
• Inhibit entry of bile into the pancreatic duct.
• Prevent reflux of intestinal contents in the
  ducts.
• (When the gallbladder is removed the sphincter of
  Oddi regulates bile flow.) Under normal condition
  Sphincter of Oddi remains open.

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Gallbladder

• The gallbladder wall is made up of serosa, a
  fibro- muscular layer and mucosa.
• The blood is supplied to the gallbladder by the
  hepatic artery.
• The maximum amount of bile that can be stored in
  the gallbladder is 50ml.
• The major component of bile that is produced in
  the liver is water. The functions of bile are
  emulsification of undigested fats, facilitating
  the absorption of fat soluble vitamins, and
  activation of intestinal and pancreatic enzymes.

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BILE

• Provision of a route for excretion of bilirubin,
  cholesterol, and certain sex, thyroid, and
  adrenal hormones.

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Diseases of the Biliary System

• Cholelithiasis is the presence of stones or
  calculi in the gallbladder. Accounts for 90 of
  biliary diseases.
• Two types of gallstones 1 is cholesterol
• Make up 80- yellow green in color. Made up
  primarily of cholesterol-associated with hepatic
  production of bile.
• 2 is Pigment stones - black pigment made up of
  bilirubin.
• Forty, female, fat

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Cholelithiasis

• Symptoms
• Steady pain mainly 3-6 hours after
  a meal
• Pain radiates - can be similar to
  MI
• Nausea and vomiting
• Fever and chills
• Ultrasound - most effective diagnostic
• CT, MRCP, ERCP
• Treatment
• Surgery
• Dissolution -- Disadvantage stones may return

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Choledocholithiasis

• Stones in the common bile duct or the hepatic
  duct.
• Symptoms Biliary colic, right upper quadrant
  abdominal pain, obstructive jaundice and
  pruritus, fever, and chills
• Treatment ERCP WITH SPHINCTEROTOMY

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Cholangitis

• Cholangitis is a rare bacterial infection of the
  bile duct associated with obstruction
• 85 stone in common bile duct.
• Is a medical and surgical emergency Decompression
  or drainage should produce immediate benefits

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Cholecystitis

• Is an acute or chronic inflammation that causes
  painful distention of the gallbladder. 90
  gallstones impacted in the cystic duct known as
  acute calculus cholecystitis - upper right
  quadrant abdominal pain, nausea, vomiting, fever,
  chills, tachycardia, abd tenderness with
  rebounding pain, and intolerance to fatty foods
  and heavy meals.
• Ultrasound , labs, and ERCP
• Decompression or stents

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Primary Sclerosing Cholangitis

• PSC is a rare inflammation process that results
  in multiple strictures of the bile duct causing
  chronic cholestatic liver disease.
• Symptoms fatigue, jaundice, Pruritis, abdominal
  pain, and elevated serum alkaline phosphate.
• US, ERCP or PTC

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Questions

• Classic radiological findings in primary
  sclerosing cholangitis would be
• a. multiple short biliary strictures and
  areas of dilation resulting in a beaded
  appearance
• b. progressive dilation of the pancreatic
  duct of Santorini
• c. double duct sign (BILIARYPANCREATIC
  OBSTRUCTION).
• d. diminishing intrahepatic ducts on the
  cholangiogram

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Questions

• 2. The gall bladder is connected to the common
  bile duct by the
• a. Hepatic Duct
• b. Cystic Duct
• c. Pancreatic duct

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Questions

• 3. Clinical manifestation of primary sclerosing
  cholangitis may include
• a. Pruritis
• b. Jaundice
• c. Abdominal Pain
• d. Portal Hypertension
• e. All of the above

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Questions

• 4. Progression of disease in a patient with
  primary sclerosing cholangitis has been listed to
  include the following
• a. Progressive stricture formation
• b. Cirrhosis
• c. Cholangiocarcinoma
• d. All of the above