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The Gall Bladder and Bile Ducts

The document discusses the anatomy and surgical aspects of the gall bladder and bile ducts. It describes various investigations, congenital abnormalities, extrahepatic biliary atresia, Caroli's disease, and choledochal cyst. It provides details on the clinical features, treatments, and complications of these conditions.

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Giles Fanny
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28 views14 pages

The Gall Bladder and Bile Ducts

The document discusses the anatomy and surgical aspects of the gall bladder and bile ducts. It describes various investigations, congenital abnormalities, extrahepatic biliary atresia, Caroli's disease, and choledochal cyst. It provides details on the clinical features, treatments, and complications of these conditions.

Uploaded by

Giles Fanny
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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The Gall Bladder and Bile ducts

Surgical Anatomy
• Pear shaped, 7.5 to 12 cm long, normal
capacity – 25-30 ml
• Fundus, body and neck
• Hartmann’s pouch
• Calots triangle
• Moynihans hump
Investigations
• X rays
• Ultrasonography
• Computed tomography
• Magnetic resonance
Cholangiopancreatography
• Endoscopic Retrograde
Cholangiopancreatography
• Percutaneous transhepatic cholangiography
Congenital Abnormalities
• Absent gall bladder
• Phrygian cap
• Floating gall bladder
• Absence of cystic duct
• Low insertion of cystic duct
Extra hepatic Biliary Atresia
• Atresia is present in 1/12000 live births
• Males = females
• Progressive destruction of EHBR around the
time of birth
• Intra hepatic changes can also occur –
resulting in biliary cirrhosis and portal
hypertension
• Clinical features
– Jaundice at birth
– Pale coloured stools
– Osteomalacia
– Pruritis
– Clubbing, Skin Xanthomas
• D/D
– Alpha 1 anti trypsin deficiency
– Cholestasis associated with IV feeding
– Choledochal cyst
– Inspissated bile syndrome
• Treatment
– Roux en Y Hepatico Jejunostomy
– Kasai Procedure (Porto enterostomy)
– Liver transplantation
• Complications
– Bacterial cholangitis
– Hepatic fibrosis
– Portal Hypertension
Caroli’s Disease
• Multiple irregular saccular dilatations of the intrahepatic
ducts, separated by normal or stenotic ducts
• Associated with congenital hepatic fibrosis
• C/F – abdominal pain, cholangitis or end stage liver
disease
• Management –
– IV antibiotics
– Stenting
– Hepatic resection
– Liver Transplantation
Choledochal cyst

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