Gross anatomy and histology of extrahepatic biliary apparatus
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This document summarizes the gross anatomy and histology of the extrahepatic biliary apparatus. It describes the components and functions of the extrahepatic biliary apparatus, which includes the right and left hepatic ducts, common hepatic duct, gallbladder, cystic duct, and common bile duct. Key anatomical structures like Calot's triangle and their clinical significance in conditions like cholelithiasis and surgical procedures like cholecystectomy are discussed. The microanatomy and blood supply of the gallbladder are also outlined.
Gross anatomy and histology of extrahepatic biliary apparatus
- 1. Gross anatomy and histology of extrahepatic biliary apparatus. Dr. Laxman Khanal Associate Professor, Department of Human Anatomy BPKIHS, Dharan, Nepal
- 2. Q. Cystic artery is the branch of: a. Hepatic artery proper b. Right hepatic artery c. Left hepatic artery d. common hepatic artery Q. Gall bladder is located in: a. Inferior surface of right lobe of liver b. Posterior surface of right lobe of liver c. Inferior surface of left lobe of liver d. Posterior surface of left lobe of liver Q. Clinically GB pain is referred to: a. Inferior angle of Rt scapula b. Tip of Rt shoulder c. Stomach region d. All of the above
- 3. What is extrahepatic biliary apparatus (EHBA)? The extrahepatic biliary apparatus receives the bile from liver, stores and concentrates it in the gallbladder, and transmits it to the second part of the duodenum when required. Consists of five components: 1. Right and left hepatic ducts 2. Common hepatic duct 3. Gallbladder 4. Cystic duct 5. Bile duct or common bile duct Anatomical knowledge about it is important to understand various disease processes such as cholelithiasis and cholecystitis and also to understand the surgical process like cholecystectomy.
- 4. Rt lobe Rt lobe Lt lobe Lt lobe • Gallbladder is located in fossa for gallbladder in right lobe of liver. • It is attached to the liver by right and left hepatic duct. • Fundus of gallbladder is extended below the lower margin of liver. Porta hepatis is the point of initiation of EHBA.
- 5. Components of EHBA Extends below the lower margin of liver and lies at the tip of Rt 9th costal cartilage of the costal margin.
- 6. Hartmann’s pouch: Prone to lodgment of stone 50 ml Functions of GB 1. Storage of bile 2. Concentration of bile 3. Acidification of bile Bile is an emulsifying agent which facilitates pancreatic lipase for hydrolysis of lipid. Gall bladder
- 7. Peritoneal covering of gallbladder Covered by peritoneum except for the surface resting on liver.
- 8. Microanatomy of gall bladder Mucous membrane • lined by columnar epithelium (cholangiocyte) • Forms folds (Rugae) • Similar to villi (but no goblet cells) • No Muscularis mucosa Muscle layer (smooth muscle fibers) Serous (peritoneal) layer • Lined by mesothelium Poorly developed submucosa layer
- 10. Supra duodenal part Retro duodenal part Infra duodenal part Intra duodenal part
- 11. Hepatopancreatic ampulla (ampulla of Vater) 1. Sphincter choledochus 2. Sphincter pancreaticus 3. Sphincter ampullae (sphincter of Oddi) Major duodenal papilla Fore gut- midgut transition point
- 12. CCK + _
- 13. Blood supply of biliary system Common hepatic artery Rt gastric artery Gastroduodenal artery Hepatic artery proper Cystic artery Artery: cystic artery Vein: cystic vein Lymph : cystic LN Nerve: cystic plexus Sympathetic: T7-T9 Parasympathetic: Vagus nerve
- 14. Blood supply of bile duct 1. Descending branch of cystic artery 2. Ascending branch of sup pancreaticoduodenal artery
- 15. Blood supply of GB and Calot’s triangle Contents of Calot’s triangle: 1. Cystic artery & vein 2. Cystic LN Boundaries of calot’s triangle 1. Undersurface of liver (sup) 2. CHD (left side) 3. Cystic duct (right side) Ligation of cystic artery in this triangle is the one of the crucial steps in surgical removal of gall bladder. • Also called as cystohepatic triangle
- 17. Gall stone (cholelithiasis) • Gallstones are present in approximately 10% of people over the age of 40 and are more common in women. • They are predominantly a mixture of cholesterol and bile pigment. • They may undergo calcification, which can be demonstrated on plain radiographs. • The gallbladder cannot empty normally and contractions of the gallbladder wall produce severe pain. • If pain persists a cholecystectomy (removal of the gallbladder) may be necessary.
- 18. Cholesterol stone Pigment stoneMixed stone
- 20. Cholecystitis • Inflammation of the gall bladder is called as cholecystitis. • Most commonly caused by cholelithiasis which causes obstruction of bile duct or cystic duct. • Symptoms Biliary colic Jaundice Murphy’s sign positive Murphy’s sign Deep pressure at GB point at the height of inspiration Patient feels stabbing pain Catch in breath
- 21. Cholecystectomy