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    SDL B

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    SDL B

    Uploaded by

    photosmarrow
    3 views20 pages

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    3 views20 pages

    SDL B

    Uploaded by

    photosmarrow

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    of 20

    Extrahepatic Biliary

    Apparatus
    Cystohepatic Triangle of Callot
    Applied Aspects with Clinical scenarios
    Cystohepatic Triangle Of Callot
    Boundaries….
    Boundaries
    Contents…

    Right Hepatic artery


    Cystic artery
    Cystic Lymph node of
    Lund ( Enlarged in
    Cholecystitis, at Apex
    of triangle )
    Most of the abnormal segments of
    Right hepatic ducts as well as arteries
    are found here
    In about 15 % of Subjects, accessory
    hepatic ducts issuing from Right lobe
    of Liver terminate into…
    These’re responsible for Oozing of
    bile from wound after
    cholecystectomy ( so Draining Bile
    from gallbladder beforehand is better )
    Surgical aspect
    Helps Surgeon to locate Cystic Pedicle/ Pedicle of gallbladder to be ligated in
    Cholecystectomy
    Errors in Surgery occur often due to ignorance of common variations in Extrahepatic Biliary
    system, most common being Caterpillar-loop shaped Right hepatic artery in Triangle of Calot ;
    called as MOYniHan’s Hump.
    Clinical Aspects
    ERCP
    Endoscopic Retrograde ColangioPancreatography

    Through endoscope, Physician can see


    inside of the stomach and Duodenum
    (Endoscopy)
    Inject a contrasting medium into the ducts
    of Biliary tree and Pancreas so as to see on
    radiographs
    Bile Duct can be accessed from duodenum
    by this procedure
    Ultrasound
    It’s an imaging test that uses Sound
    waves to create pictures of organs
    ( called as Sonogram ) of organs, tissues
    and other structures inside the body.
    Gallbladder function can be accessed
    with Ultrasound
    Gallstone Ileus
    Gallstones may penetrate
    into to duodenum, and later
    lead to Ileocaecal Junction
    after passing through small
    intestine
    Presence of
    CholecystoEnteric Fistula
    helps gallstones to pass into
    the duodenum
    Typhoid fever
    Gall bladder is infected in
    typhoid fever, due to
    Salmonella Typhi bacteria
    accumulation
    In fact, treatment for chronic
    typhoid infection is removal
    of Gallbladder
    Hormonal Control of Gallbladder
    On ingestion of Fat rich food, cells of
    duodenum releases CCK, which
    causes contraction of Gallbladder and
    dilatation of sphincters
    Biliary Obstruction
    Can Be in intrahepatic or
    Extrahepatic Bile ducts
    Causes:
    1. Gallstones slipped into the
    bile duct and blocking it
    2. Bile duct compression due to
    Carcinoma of Pancreas
    Cont….
    Biliary Obstruction
    Light Coloured stool with dark coloured Urine in Obstructive jaundice
    Because Bile Pigments reach blood instead of duodenum
    Associated with :
    1. Loss of weight - Carcinoma of Pancreas
    2. Episodes of Pain - Gallstones
    COURvoisier’s Law : Dilatation of Gallbladder occurs only in Extrahepatic biliary obstruction (
    Eg. Cancer of Pancreas ), fibrosis in intrahepatic biliary obstruction prevents dilatation.
    Referred Pain
    Pain from gallbladder referred to
    different body parts as it travels
    along :
    1. Phrenic Nerve to right Shoulder
    2. Sympathetic nerves to inferior
    angle of Scapula
    3. Vagus nerve to Stomach
    Cholecystis
    Pain in the right shoulder or
    Inferior angle of Right
    scapula

    Murphy’s Sign
    Cholelithiasis
    Gallstones within
    gallbladder
    Biliary Colic ( Spasmodic
    pain ) - Murphy’s Sign of
    great Diagnostic value
    High fatty acid in bile
    prevents gallstones in
    Dog, Cat, Rabbit and
    Sheeps, unlike Humans,
    Ox and Hog
    Case Discussion

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