Surgical anatomy of the biliary tract (BIT). Brief anatomy of the adjacent organs Top anatomy of the extrahepatic biliary tract diagram

gallbladder, vesica fellea (biliaris), is a bag-shaped reservoir for bile produced in the liver; it has an elongated shape with wide and narrow ends, and the width of the bubble gradually decreases from the bottom to the neck. The length of the gallbladder ranges from 8 to 14 cm, the width is 3-5 cm, the capacity reaches 40-70 cm 3. It has a dark green color and a relatively thin wall.

In the gallbladder, the fundus of the gallbladder, fundus vesicae felleae, is distinguished - its most distal and widest part, the body of the gallbladder, corpus vesicae felleae, - the middle part and neck of the gallbladder, collum vesicae felleae, - the proximal narrow part, from which the cystic duct departs , ductus cysticus. The latter, having connected with the common hepatic duct, forms a common bile duct, ductus choledochus.

The gallbladder lies on the visceral surface of the liver in the gallbladder fossa, fossa vesicae felleae, which separates the anterior right lobe from a square lobe of the liver. Its bottom is directed forward to the lower edge of the liver in the place where a small notch is located, and protrudes from under it; the neck is turned towards the gate of the liver and lies along with the cystic duct in the duplication of the hepatoduodenal ligament. At the place of transition of the body of the gallbladder into the neck, a bend is usually formed, so the neck is lying at an angle to the body.

The gallbladder, being in the fossa of the gallbladder, adjoins to it with its upper surface, devoid of peritoneum, and connects to the fibrous membrane of the liver. Its free surface, facing down into the abdominal cavity, is covered with a serous sheet. visceral peritoneum passing to the bladder from the adjacent areas of the liver. The gallbladder can be located intraperitoneally and even have a mesentery. Usually, the bottom of the bladder protruding from the liver notch is covered with peritoneum on all sides.

The structure of the gallbladder.

The structure of the gallbladder. The wall of the gallbladder consists of three layers (with the exception of the upper extraperitoneal wall): serous membrane, tunica serosa vesicae felleae, muscular membrane, tunica muscularis vesicae felleae, and mucous membrane, tunica mucosa vesicae felleae. Under the peritoneum, the wall of the bladder is covered with a thin loose layer of connective tissue - the subserous base of the gallbladder, tela subserosa vesicae felleae; on the extraperitoneal surface, it is more developed.

Muscular membrane gallbladder, tunica muscularis vesicae felleae, is formed by one circular layer of smooth muscles, among which there are also bundles of longitudinal and obliquely arranged fibers. The muscular layer is less pronounced in the bottom area and stronger in the cervical region, where it directly passes into the muscular layer of the cystic duct.

The mucous membrane of the gallbladder, tunica mucosa vesicae felleae, is thin and forms numerous folds, plicae tunicae mucosae vesicae felleae, giving it the appearance of a network. In the region of the neck, the mucous membrane forms several oblique spiral folds, plicae spirales, one after the other. The mucous membrane of the gallbladder is lined with a single-row epithelium; in the neck in the submucosa there are glands.

Topography of the gallbladder.

Topography of the gallbladder. The bottom of the gallbladder is projected on the anterior abdominal wall in the corner formed by the lateral edge of the right rectus abdominis muscle and the edge of the right costal arch, which corresponds to the end of the IX costal cartilage. Syntopically, the lower surface of the gallbladder is adjacent to the anterior wall of the upper part. duodenum; on the right, the right flexure of the colon adjoins it.

Often gallbladder may be connected to the duodenum or colon peritoneal fold.

Blood supply: from the gallbladder artery, a. cystica, branches of the hepatic artery.

Bile ducts.

There are three extrahepatic bile ducts: common hepatic duct, ductus hepaticus communis, cystic duct, ductus cysticus, and common bile duct, ductus choledochus (biliaris).

The common hepatic duct, ductus hepaticus communis, is formed at the gates of the liver as a result of the confluence of the right and left hepatic ducts, ductus hepaticus dexter et sinister, the latter are formed from the intrahepatic ducts described above. duct coming from the gallbladder; thus arises the common bile duct, ductus choledochus.

Cystic duct, ductus cysticus, has a length of about 3 cm, its diameter is 3-4 mm; the neck of the bladder forms two bends with the body of the bladder and with the cystic duct. Then, as part of the hepatoduodenal ligament, the duct goes from top to right down and slightly to the left and usually merges with the common hepatic duct at an acute angle. The muscular membrane of the cystic duct is poorly developed, although it contains two layers: longitudinal and circular. Throughout the cystic duct, its mucous membrane forms a spiral fold, plica spiralis, in several turns.

Common bile duct, ductus choledochus. embedded in the hepatoduodenal ligament. It is a direct continuation of the common hepatic duct. Its length is on average 7-8 cm, sometimes reaching 12 cm. There are four sections of the common bile duct:

1. located above the duodenum;
2. located behind the upper part of the duodenum;
3. lying between the head of the pancreas and the wall of the descending part of the intestine;
4. adjacent to the head of the pancreas and passing obliquely through it to the wall of the duodenum.

The wall of the common bile duct, in contrast to the wall of the common hepatic and cystic ducts, has a more pronounced muscular membrane, which forms two layers: longitudinal and circular. At a distance of 8-10 mm from the end of the duct, the circular muscle layer is thickened, forming the sphincter of the common bile duct, m. sphincter ductus choledochi. The mucous membrane of the common bile duct does not form folds, except for the distal area, where there are several folds. In the submucosa of the walls in the non-hepatic bile ducts, there are mucous glands of the bile ducts, glandulae mucosae biliosae.

The common bile duct connects with the pancreatic duct and flows into a common cavity - the hepatic-pancreatic ampulla, ampulla hepatopancreatica, which opens into the lumen of the descending part of the duodenum at the top of its major papilla, papilla duodeni major, at a distance of 15 cm from the pylorus. The size of the ampoule can reach 5×12 mm.

The type of confluence of the ducts may vary: they may open into the intestine by separate mouths, or one of them may flow into another.

In the region of the major papilla of the duodenum, the mouths of the ducts are surrounded by a muscle - this is the sphincter of the hepatic-pancreatic ampulla (sphincter of the ampulla), m. sphincter ampullae hepatopancreaticae (m. sphincter ampulae). In addition to the circular and longitudinal layers, there are separate muscle bundles that form an oblique layer that combines the sphincter of the ampulla with the sphincter of the common bile duct and with the sphincter of the pancreatic duct.

Topography of the bile ducts. The extrahepatic ducts lie in the hepatoduodenal ligament along with the common hepatic artery, its branches, and the portal vein. At the right edge of the ligament is the common bile duct, to the left of it is the common hepatic artery, and deeper than these formations and between them - portal vein; in addition, between the leaves of the ligament lie lymphatic vessels, nodes and nerves.

The division of the proper hepatic artery into the right and left hepatic branches occurs in the middle of the length of the ligament, and the right hepatic branch, heading upward, passes under the common hepatic duct; at the place of their intersection, the gallbladder artery departs from the right hepatic branch, a. cystica, which goes to the right and up to the area of ​​\u200b\u200bthe angle (gap) formed by the confluence of the cystic duct with the common hepatic duct. Next, the gallbladder artery passes along the wall of the gallbladder.

Innervation: liver, gallbladder and bile ducts - plexus hepaticus (truncus sympathicus, nn. vagi).

Blood supply: liver - a. hepatica propria, and its branch a. cystica approaches the gallbladder and its ducts. In addition to the artery, v. portae, collecting blood from unpaired organs in the abdominal cavity; passing through the system of intraorgan veins, leaves the liver through vv. hepaticae. falling into v. cava inferior. From the gallbladder and its ducts deoxygenated blood drains into the portal vein. Lymph is drained from the liver and gallbladder into nodi lymphatici hepatici, phrenici superior et inferior, lumbales dextra, celiaci, gastrici, pylorici, pancreatoduodenales, anulus lymphaticus cardiae, parasternales.

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Liver cells produce up to 1 liter of bile per day, which enters the intestine. Hepatic bile is a liquid yellow color, cystic bile is more viscous, dark brown in color with a greenish tinge. Bile is produced continuously, and its entry into the intestine is associated with food intake. Bile consists of water, bile acids (glycocholic, taurocholic) and bile pigments (bilirubin, biliverdin), cholesterol, lecithin, mucin and inorganic compounds (phosphorus, potassium and calcium salts, etc.). The value of bile in digestion is enormous. First of all, bile, irritating the nerve receptors of the mucous membrane, causes peristalsis, keeps fat in an emulsified state, which increases the field of influence of the lipase enzyme. Under the influence of bile, the activity of lipase and proteolytic enzymes increases. Bile neutralizes hydrochloric acid coming from the stomach, thereby preserving the activity of trypsin, and inhibits the action of gastric pepsin. Bile also has bactericidal properties.

The biliary system of the liver should include bile capillaries, septal and interlobular bile ducts, right and left hepatic, common hepatic, cystic, common bile ducts and gallbladder.

Bile capillaries have a diameter of 1-2 microns, their gaps are limited by liver cells (Fig. 269). Thus, the hepatic cell faces the blood capillary with one plane, and the other limits the bile capillary. Bile capillaries are located in beams at a depth of 2/3 of the radius of the lobule. From the bile capillaries, bile enters the periphery of the lobule into the surrounding septal bile ducts, which merge into the interlobular bile ducts (ductuli interlobulares). They merge into the right (1 cm long) and left (2 cm long) hepatic ducts (ductuli hepatici dexter et sinister), and the latter merge into the common hepatic duct (2-3 cm long) (ductus hepaticus communis) (Fig. 270) . It leaves the gates of the liver and connects with the cystic duct (ductus cysticus) 3-4 cm long. From the junction of the common hepatic and cystic ducts, the common bile duct (ductus choledochus) 5-8 cm long begins, flowing into the duodenum. At its mouth there is a sphincter that regulates the flow of bile from the liver and gallbladder.

269. Scheme of the structure of the bile capillaries.
1 - liver cell; 2 - bile capillaries; 3 - sinusoids; 4 - interlobular bile duct; 5 - interlobular vein; 6 - interlobular artery.

270. Gall bladder and open bile ducts (according to R. D. Sinelnikov).

1 - ductus cysticus;
2 - ductus hepaticus communis;
3 - ductus choledochus;
4 - ductus pancreaticus;
5 - ampulla hepatopancreatica;
6 - duodenum;
7 - fundus vesicae fellae;
8 - plicae tunicae mucosae vesicae fellae;
9 - plica spiralis;
10 - collum vesisae fellae.

All ducts have an identical structure. They are lined with cuboidal epithelium, while the large ducts are lined with columnar epithelium. In large ducts, the connective tissue layer is also much better expressed. There are practically no muscle elements in the bile ducts, only in the cystic and common bile ducts there are sphincters.

The gallbladder (vesica fellea) has the shape of an elongated bag with a volume of 40-60 ml. In the gallbladder there is a concentration of bile (6-10 times) due to the absorption of water. The gallbladder is located in front of the right longitudinal sulcus of the liver. Its wall consists of mucous, muscular and connective tissue membranes. The part of the wall facing the abdominal cavity is covered by the peritoneum. In the bladder, the bottom, body and neck are distinguished. The neck of the bladder faces the gates of the liver and, together with the cystic duct, is located in the lig. hepatoduodenale.

Topography of the bladder and common bile duct. The bottom of the gallbladder is in contact with the parietal peritoneum, projecting in the angle formed by the costal arch and the outer edge of the rectus abdominis muscle or at the intersection with the costal arch of the line connecting the top of the axillary fossa with the navel. The bubble is in contact with the transverse colon, the pyloric part of the stomach and upper division duodenum.

The common bile duct lies in the lateral part of the lig. hepatoduodenale, where it can be easily palpated on a corpse or during surgery. Then the duct passes behind the upper part of the duodenum, located to the right of the portal vein or 3-4 cm from pyloric sphincter, penetrating into the thickness of the head of the pancreas; its end part pierces inner wall descending part of the duodenum. In this part of the intestinal wall, the sphincter of the common bile duct (m. sphincter ductus choledochi) is formed.

Mechanism of bile secretion. Since bile is constantly produced in the liver, during the period between digestion, the sphincter of the common bile duct is reduced and bile enters the gallbladder, where it is concentrated by absorption of water. During digestion, the gallbladder wall contracts and the sphincter of the common bile duct relaxes. The concentrated bile of the bladder is mixed with liquid hepatic bile and flows into the intestines.

The common hepatic duct (ductus hepaticus communis) originates at the gate of the liver as a result of the fusion of the right hepatic duct and the left hepatic duct, the length of which is 0.5-2 cm. The confluence (confluens) in 90-95% of cases is extrahepatic. Rarely, the right hepatic duct and the left hepatic duct join intrahepatically or after the cystic duct joins the right hepatic duct. It should be noted that the intrahepatic ducts in the region of the liver gate have numerous lateral branches (150-270 microns in diameter), some of which end blindly, while others anastomose with each other, forming a kind of plexus.

The functional significance of these formations has not been fully elucidated. It is believed that the blind branches can serve as a place for the accumulation and modification of bile (possibly, stone formation), while the bile plexuses provide a wide anastomosis of the bile ducts. The average length of the common hepatic duct is 3cm. The length of the common bile duct, which begins at the confluence of the cystic duct into the common hepatic duct, ranges from 4 to 12 cm (average 7 cm). Its diameter normally does not exceed 8 mm, averaging 5-6 mm. It is important to remember that the size of the common bile duct depends on the research method. Thus, the diameter of the duct during endoscopic or intraoperative cholangiography (IOCH) usually does not exceed 10-11 mm, and a larger diameter indicates biliary hypertension. With percutaneous ultrasound (), it is normally smaller, amounting to 3-6 mm. According to the results of magnetic resonance cholangiography (MRCG), the diameter of the common bile duct, equal to 7-8 mm, is considered acceptable.

There are four sections in the duct: 1) supraduodenal, 2) retroduodenal, 3) pancreatic, 4) duodenal.
The supraduodenal region is located above the duodenum. The retroduodenal passes behind the upper part of the duodenum. The pancreatic region is located between the head of the pancreas (PG) and the wall of the descending part of the duodenum and can be located both outside (then the duct is located in the groove along the posterior surface of the pancreatic head) and inside the pancreatic tissue. This section of the common bile duct is most often subjected to compression in tumors, cysts and inflammatory changes head of the pancreas.

The extrahepatic bile ducts are part of the hepatoduodenal ligament (HDL) along with the common hepatic artery, portal vein, lymphatic vessels, lymph nodes, and nerves. The following arrangement of the main anatomical elements of the ligament is considered typical: the CBD lies laterally at the edge of the ligament; medial to it is the common hepatic artery; dorsal (deeper) and between them is the portal vein. Approximately halfway through the length of the SMS, the common hepatic artery divides into the right and left hepatic arteries. In this case, the right hepatic artery goes under the common hepatic duct and, at the place of their intersection, gives off the gallbladder artery.

The CBD in its last (duodenal) section connects with the pancreatic duct (PJD), forming the hepato-pancreatic ampulla (HPA; ampulla hepatopancreatica), which opens into the lumen of the duodenum at the apex of the major duodenal papilla (PSDP; papilla duodeni major). In 10-25% of cases, the accessory pancreatic duct (APD) can open separately at the top of the minor duodenal papilla (MSDPK; papilla duodeni minor). The place of confluence of the common bile duct into the duodenum is variable, but in 65-70% of cases it flows into the middle third of the descending part of the duodenum along its posteromedial contour. By moving the intestinal wall, the CBD forms a longitudinal fold of the duodenum.

It is important to note that the CBD narrows before entering the duodenum. It is this area that is most often obstructed by calculi, bile sludge, mucous plugs, etc.

A large number of options anatomical structure VZHP requires not only knowledge of these features, but also precision operating techniques in order to avoid their possible damage.

The common hepatic duct and the CBD have mucosal, muscular, and adventitious membranes. The mucosa is lined with a single-layer cylindrical (prismatic, columnar) epithelium. The muscular coat is very thin and is represented by separate bundles of myocytes, oriented spirally. There is a lot of connective tissue between the muscle fibers. The outer (adventitial) shell is formed by loose connective tissue and contains blood vessels. In the walls of the ducts are glands that secrete mucus.

The article was prepared and edited by: surgeon

Anatomy

What is dangerous blockage of the ducts

Diagnosis of diseases

Features of treatment

Therapeutic diet

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Dear readers, the bile ducts (bile ducts) perform one important function - they conduct bile to the intestines, which plays a key role in digestion. If for some reason it periodically does not reach the duodenum, there is a direct threat to the pancreas. After all, bile in our body eliminates the properties of pepsin that are dangerous for this organ. It also emulsifies fats. Cholesterol and bilirubin are excreted through bile, because they cannot be filtered out by the kidneys in full.

If the gallbladder ducts are obstructed, the whole digestive tract. Acute blockage causes colic, which can result in peritonitis and an urgent operation, partial obstruction disrupts the functionality of the liver, pancreas and other significant organs.

Let's talk about what is especially in the bile ducts of the liver and gallbladder, why they begin to conduct bile poorly and what needs to be done to avoid the adverse effects of such blockage.

The anatomy of the bile ducts is quite complex. But it is important to understand it in order to understand how the biliary tract functions. The bile ducts are intrahepatic and extrahepatic. From the inside, they have several epithelial layers, the glands of which secrete mucus. The bile duct has a biliary microbiota - a separate layer that forms a community of microbes that prevent the spread of infection in the organs of the biliary system.

The intrahepatic bile ducts have a tree structure. The capillaries pass into the segmental bile ducts, and those, in turn, flow into the lobar ducts, which, outside the liver, form the common hepatic duct. It enters the cystic duct, which drains bile from the gallbladder and forms the common bile duct (choledochus).

Before entering the duodenum, the common bile duct passes into the pancreatic excretory duct, where they combine to form the hepatopancreatic ampulla, which is separated by the sphincter of Oddi from the duodenum.

Diseases that cause obstruction of the bile ducts

Diseases of the liver and gallbladder in one way or another affect the state of the entire biliary system and cause blockage of the bile ducts or their pathological expansion as a result of a chronic inflammatory process and stagnation of bile. Provoke obstruction such diseases as cholelithiasis, cholecystitis, excesses of the gallbladder, the presence of structures and scars. In this condition, the patient needs urgent medical attention.

Blockage of the bile ducts is caused by the following diseases:

• cysts biliary tract;
• cholangitis, cholecystitis;
• benign and malignant tumors pancreas and organs of the hepatobiliary system;
• scars and strictures of the ducts;
• cholelithiasis;
• pancreatitis;
• hepatitis and cirrhosis of the liver;
• helminthic invasions;
• enlarged lymph nodes of the hepatic gate;
• surgical interventions on the bile ducts.

Most diseases of the biliary system cause chronic inflammation of the biliary tract. It leads to thickening of the walls of the mucosa and narrowing of the lumen of the ductal system. If, against the background of such changes, the stone enters the gallbladder duct, the calculus partially or completely blocks the lumen.

Bile stagnates in the bile ducts, causing them to expand and exacerbate the symptoms of the inflammatory process. This can lead to empyema or dropsy of the gallbladder. Long time man endures minor symptoms blockage, but eventually irreversible changes in the biliary mucosa will begin to occur.

Why is it dangerous

If the bile ducts are clogged, it is necessary to consult a specialist as soon as possible. Otherwise, almost complete prolapse liver from participating in detoxification and digestive processes. If the patency of the extrahepatic or intrahepatic bile ducts is not restored in time, liver failure may occur, which is accompanied by damage to the central nervous system, intoxication and goes into a severe coma.

Blockage of the bile ducts can occur immediately after an attack of biliary colic https://site/zhelchnaya-kolika against the background of the movement of stones. Sometimes obstruction occurs without any prior symptoms. A chronic inflammatory process that inevitably occurs with bile duct dyskinesia, cholelithiasis, cholecystitis, leads to pathological changes in the structure and functionality of the entire biliary system.

At the same time, the bile ducts are dilated, they may contain small stones. Bile stops flowing into the duodenum at the right time and in the required amount.

The emulsification of fats slows down, metabolism is disturbed, the enzymatic activity of the pancreas decreases, food begins to rot and ferment. Stagnation of bile in the intrahepatic ducts causes the death of hepatocytes - liver cells. Bile acids and direct active bilirubin begin to enter the bloodstream, which provokes damage internal organs. The absorption of fat-soluble vitamins against the background of insufficient intake of bile into the intestine worsens, and this leads to hypovitaminosis, a violation of the functions of the blood coagulation system.

If a large stone gets stuck in the bile duct, it immediately closes its lumen. Arise acute symptoms, which signal the severe consequences of obstruction of the biliary tract.

How does blockage of the ducts manifest?

Many of you probably believe that if the bile ducts are clogged, the symptoms will immediately be so acute that they cannot be tolerated. Actually clinical manifestations blockages may develop gradually. Many of us have experienced discomfort in the right hypochondrium, which sometimes even lasts for several days. But we are not in a hurry with these symptoms to specialists. And such aching pain may indicate that the bile ducts are inflamed or even clogged with stones.

As the ductal patency worsens, additional symptoms appear:

• acute girdle pain in the right hypochondrium and abdomen;
• yellowing of the skin, the appearance of obstructive jaundice;
• discoloration of feces due to a lack of bile acids in the intestine;
• itching of the skin;
• dark urine due to active excretion direct bilirubin through a kidney filter;
• severe physical weakness, increased fatigue.

Pay attention to symptoms of obstruction of the bile ducts and diseases of the biliary system. If on initial stage undergo diagnostics, change the nature of nutrition, you can avoid dangerous complications and preserve the functionality of the liver and pancreas.

Diseases of the biliary system are treated by gastroenterologists or hepatologists. You should contact these specialists if you have complaints of pain in the right hypochondrium and other characteristic symptoms. The main method for diagnosing diseases of the bile ducts is ultrasound procedure. It is recommended to look at the pancreas, liver, gallbladder and ducts.

If the specialist detects strictures, tumors, expansion of the choledochus and ductal system, the following studies will be additionally assigned:

• MRI of the bile ducts and the entire biliary system;
• biopsy of suspicious areas and neoplasms;
• feces on the coprogram (detect low maintenance bile acids);
• blood biochemistry (increased direct bilirubin, alkaline phosphatase, lipase, amylase and transaminases).

Blood and urine tests are prescribed in any case. In addition to the characteristic changes in the biochemical study, with duct obstruction, prothrombin time is prolonged, leukocytosis is observed with a shift to the left, and the number of platelets and erythrocytes decreases.

Features of treatment

The tactics of treating pathologies of the bile ducts depends on concomitant diseases and the degree of blockage of the lumen of the ductal system. AT acute period antibiotics are prescribed, detoxification is carried out. In this state, serious surgical interventions contraindicated. Specialists try to limit themselves to minimally invasive methods of treatment.

These include the following:

• choledocholithotomy - an operation to partially excise the common bile duct in order to free it from stones;
• bile duct stenting (installation of a metal stent that restores ductal patency);
• drainage of the bile ducts by inserting a catheter into the bile ducts under the control of an endoscope.

After the duct system is restored, specialists can plan more serious surgical interventions. Sometimes the blockage is provoked by benign and malignant neoplasms, which have to be removed, often together with the gallbladder (with calculous cholecystitis).

Total resection is performed using microsurgical instruments, under the control of the endoscope. Doctors remove the gallbladder through small punctures, so the operation is not accompanied by heavy blood loss and a long rehabilitation period.

During cholecystectomy, the surgeon must assess the patency of the ductal system. If stones or strictures remain in the bile duct after bladder removal, postoperative period severe pain and emergencies may occur.

Removal of a stone-filled bladder in a certain way saves other organs from destruction. And the streams too.

Do not refuse the operation if it is necessary and threatens the entire biliary system. From stagnation of bile, inflammation, reproduction infectious agents the entire digestive tract and immune system are affected.

Often a person against the background of diseases of the ducts begins to lose weight dramatically, feel bad. He is forced to limit his activity, give up his favorite work, because constant pain attacks and health problems do not allow him to live a full life. And the operation in this case warns dangerous consequences chronic inflammation and stagnation of bile, including malignant tumors.

Therapeutic diet

For any diseases of the bile ducts, diet No. 5 is prescribed. This involves the exclusion of fatty, fried foods, alcohol, carbonated drinks, foods that provoke gas formation. The main goal of such nutrition is to reduce the increased load on the biliary system and prevent a sharp course of bile.

In the absence of severe pain, you can eat as usual, but only if you have not abused prohibited foods before. Try to completely abandon trans fats, fried foods, spices, smoked meats, convenience foods. But at the same time, nutrition should be complete and varied. It is important to eat often, but in small portions.

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Resort to treatment folk remedies when the bile ducts are clogged, it is necessary with extreme caution. Many herbal recipes have a strong choleretic effect. Using such methods, you risk your own health. Since it is impossible to clean the bile ducts with herbal preparations without the risk of developing colic, you should not experiment with herbs at home.

First, make sure that there are no large stones that can cause blockage of the ductal system. If you use choleretic herbs, give preference to those that have a mild effect: chamomile, rosehip, flax seeds, immortelle. Beforehand, nevertheless, consult a doctor and conduct an ultrasound. You should not joke with choleretic compounds if there is a high risk of blockage of the bile ducts.

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This video describes a gentle cleansing of the gallbladder and ducts that can be used at home.

The extrahepatic bile ducts include the right and left hepatic, common hepatic, cystic and common bile ducts. At the gates of the liver, the right and left hepatic ducts exit the parenchyma, ductus hepaticus dexter et sinister. The left hepatic duct in the liver parenchyma is formed by the confluence of the anterior and posterior branches. The anterior branches collect bile from the quadrate lobe and from the anterior section of the left lobe, while the posterior branches collect bile from the caudate lobe and from the posterior section of the left lobe. The right hepatic duct is also formed from the anterior and posterior branches, which collect bile from the corresponding sections of the right lobe of the liver.

Common hepatic duct ductus hepaticus communis formed by the fusion of the right and left hepatic ducts. The length of the common hepatic duct ranges from 1.5 to 4 cm, the diameter is from 0.5 to 1 cm.

Sometimes the common hepatic duct is formed from three or four bile ducts. In some cases, there is a high confluence of the cystic duct with the bile ducts in the absence of a common hepatic duct (Fig. 21). (V. I. Shkolnik, E. V. Yakubovich).

Fig.21. Gallbladder and bile ducts:

1 - ductus hepaticus sinister; 2 - ductus hepaticus dexter; 3 - ductus hepaticus communis;
4 - ductus cysticus; 5 - ductus choledochus; 6 - ductus pancreaticus; 7 - duodenum;
8 - collum vesicae felleae; 9-corpus vesicae felleae; 10-fundus vesicae felleae.

Sometimes both hepatic ducts or one of them open directly into the gallbladder at its bed.

Behind the common hepatic duct is the right branch of the hepatic artery; in rare cases, it passes anterior to the duct.

Cystic duct ductus cysticus has a length of 1-5 cm, an average of 2-3 cm, a diameter of 0.3-0.5 cm. It passes in the free edge of the hepatoduodenal ligament and merges with the common hepatic duct, forming the common bile duct. Cystic and common hepatic ducts can be connected at an acute, right and obtuse angle. Sometimes the cystic duct spirals around the common hepatic duct. The figure below shows the main options for the connection of the cystic and common hepatic ducts.

The common bile duct opens, as a rule, together with the pancreatic duct on the major papilla of the duodenum papilla duodeni major. At the place of its confluence there is an annular pulp.

The ducts most often merge and form an ampulla 0.5-1 cm long. In rare cases, the ducts open into the duodenum separately (Fig. 22).

Fig.22. Options for connecting the cystic and common bile ducts.

The location of the major papilla is very variable, so it is sometimes difficult to detect it when dissecting the duodenum, especially in cases where the intestine is deformed due to any pathological process (perioduodenitis, etc.). Most often, the major papilla is located at the level of the middle or lower third of the descending posteromedial parts of the duodenum, rarely in the upper third of it.

The hepatoduodenal ligament is more clearly defined if upper part pull the duodenum down, and lift the liver and gallbladder up. In the ligament on the right in its free edge is the common bile duct, on the left is its own hepatic artery, and between them and somewhat deeper is the portal vein (Fig. 23).

Fig. 23. Topography of formations enclosed in the hepatoduodenal ligament:

1 - ductus hepaticus communis; 2 - ramus sinister a. hepaticae propriae; 3 - ramus dexter a. hepaticae propriae; 4-a. hepatica propria; 5-a. gastrica dextra; 6-a. hepatica communis; 7-ventriculus; 8 - duodenum; 9-a. gastroduodenalis; 10-v. portae; 11 - ductus choledochus; 12-ductus cysticus; 13 - vesica fellea.

Rarely, the cystic duct is absent and the gallbladder communicates directly with the right hepatic, common hepatic, or common bile ducts.

Common bile duct ductus choledochus has a length of 5-8 cm, a diameter of 0.6-1 cm. Four parts are distinguished in it: pars supraduodenalis, pars retroduodenalis, pars pancreatica, pars intramuralis (Fig. 24).

Pars supraduodenalis

Pars retroduodenalis

Pars pancreatica

pars intramuralis

Rice. 24. Departments of the common bile duct

In addition to these main formations, in the hepatoduodenal ligament there are smaller arterial and venous vessels (a. et v. gastrica dextra, a. et v. cystica, etc.), lymphatic vessels, The lymph nodes and hepatic plexuses. All these formations are surrounded by connective tissue fibers and adipose tissue.