Biliary System and Liver. 1 23 2014. Liver. Largest gland of body 2nd largest organ What is the 1 st ? Skin How much does it weigh? Approx. 3 lbs. Liver is only internal human organ capable of natural regeneration of lost tissue!
1 23 2014
Largest gland of body
2nd largest organ
What is the 1st ?
How much does it weigh?
Approx. 3 lbs
Liver is only internal human organ capable of natural regeneration of lost tissue!
as little as 25% of a liver can regenerate into a whole liver
Not true regeneration!
lobes removed do not regrow-
function is restored, but not original form (aka: compensatory growth)
(in true regeneration, both original function and form are restored)
Falciform ligament divides liver into regeneration of lost tissue!:
2 major lobes:
2 minor lobes:
Caudate lobe- part of right lobe -posterior
Quadrate lobe - part of right lobe -inferior
Main function -formation of bile
Maintain a proper level or glucose in blood
Convert glucose to glycogen
Make certain amino acids
Filter harmful substances from blood (alcohol)
Store vitamins and minerals
Produce 80% of cholesterol
What is unique about liver? regeneration of lost tissue!
Many drugs taken orally are substantially metabolized by portal system of liver before reaching general circulation
Known as “first pass effect”
Thus certain drugs can only be taken via certain other routes!
Nitroglycerin cannot be swallowed - liver would inactivate medication -must be taken under tongue or transdermally
(Excretory system of liver)
Consists basically of :
2. bile ducts
chole – relationship with bile (aka: gall)
bladder – sac or bag serving as receptacle for a secretion
cyst – closed sac having distinct membrane and division with nearby tissue (May contain air, fluids, or semi-solid material)
docho – duct – tube or passage way for conducting a substance
angio - vessel
graph- representation of a set of objects
-itis – inflammation of
Aid in digestion- by controlling release of bile
(Bile - greenish-yellow fluid produced in liver (consisting of waste products, cholesterol, and bile salts)
(when excreted gives feces dark brown color)
Drain waste products from liver into duodenum
Reservoir for bile from liver – 2oz. capacity (50 percent of bile is stored in gallbladder)
How much bile does it produce per day?
How does bile get into gallbladder?
Sphincter of Oddi closes up, and bile is re-routed up into GB for temporary storage when not needed
When food containing fat enters digestive tract… regeneration of lost tissue!
the release of bile from the gallbladder is stimulated by secretion of a hormone called cholecystokinin
Liver secretes bile- into right and left hepatic ducts which join to become common hepatic duct
which joins with cystic duct from gallbladder to become the:
common bile duct which joins with pancreatic duct to form a junction known as:
hepatopancreaticampulla (or ampulla of vater
Spincter of Oddi (or spincter of hepatopancreaticampulla)controls emptying of bile into duodenum
Hardened deposits of digestive fluid that can form in gallbladder
Range in size from grain of sand to
Can have one or hundreds!
1 in 10 people have gallstones (can’t see if not calcified!)
80% are cholesterol stones:
usually yellow-green and made primarily of hardened cholesterol
20% are pigment stones:
small, dark stones made of bilirubin
Age 60 or older
American Indian or Mexican heritage
Overweight or obese
Eating a high-fat, high-cholesterol, or low fiber diet
Family history of gallstones
Losing weight very quickly
Taking cholesterol-lowering medications
Taking medications containing estrogen (such as hormone therapy drugs)
presence of bile stones in ducts
bile sac inflammation
Increased risk of gallbladder cancer (very rare)
Surgical removal of gallbladder -
Use medicines to dissolve stones (isn't suitable for everyone -may take a very long time)
Shock-wave lithotripsy ( high-energy sound waves) to break gallstones into tiny fragments, then dissolved by medicines
No longer a holding space to store bile
Bile continuously runs out of liver, through the hepatic ducts, into common bile duct, and directly into small intestine
When a high-fat meal is eaten - not enough bile available to digest it properly
Can result in chronic diarrhea
Small intestine’s ability to absorb essential fatty acids, vitamins and minerals is compromised without help of gallbladder
Both an exocrine and endocrine gland!
Endocrine- (Isle of Langerhans) produces glucagon and insulin to regulate sugar metabolism
Exocrine- secretes digestive enzymes
Generally cannot be seen on radiographs
Radiological exams of regeneration of lost tissue!Gallbladder
(largely replaced by Ultrsound, CT, MRI, nuclear medicine)
Study of gallbladder
Oral contrast is used
Study of biliary ducts
IV contrast is used
(may be injected directly into ducts)
Cholelithiasis regeneration of lost tissue! (gallstones) -bile calculi presence
Cholecystitis (inflammation of gallbladder)-bile sac inflammation
Check liver function
Biliaryneoplasia(tumor or mass in biliary system)
Biliarystenosis(abnormal narrowing of ducts)
Demonstrate concentrating/emptying ability of gallbladderIndicationsforBiliary Tract Exam
Fat-free meal evening before
Oral contrast taken 2 to 3 hours after evening meal
NPO after midnight until exam
Avoid laxitaves less than 24 hours to avoid prevent voiding of contrast medium with fecal material
Make sure patient can, will, and did follow instructions!
Early morning appointment
1. Are gonads within 2” of primary x-ray field after proper collimation?
2. Are clinical objectives compromised?
3. Does pt have reasonable reproductive potential?
Scout film will also demonstrate if contrast is visible in gallbladder
Dr. may do fluoroscopic examination
Post-fatty meal film may be obtained to demonstrate emptying ability of GB
Patient prone- or upright facing wallboard
Center 10x12 cassette at RUQ, level of the right elbow
70 - 80 kVp range
Exposure made at end of full?
Pt rotated 15 - 40 degrees depending on body habitus
CR at level of elbow, between spine and (R or L?) midaxillary line 10x12 cassette
Demonstrates stones lighter than bile visible only by stratification
Directed horizontally to level of gallbladder
Very rarely regeneration of lost tissue! performed anymore
Used when patients cannot tolerate oral contrast
Generally done in supine, and RPO positions
Films taken at timed intervals - up to about 40 minutes after injectionIntravenous Cholangiography (IVC)
(Percutaneous: any medical procedure where access to inner organs or other tissue is done via needle-puncture of skin, rather than by scapel)
Long needle (Chiba) is placed into bile ducts
Contrast is injected under fluoro
Biliary drainage or stone extraction may accompany this procedure
Performed during a cholecystectomy
Examines patency of ducts during or after surgical removal of GB
Post-operative (after cholecystectomy) procedure performed through T-tube left in common hepatic and common bile ducts (for drainage)
patency (openness) of biliary ducts after cholecystectomy
status of Spincter of oddi
presence of residual or undetected stones
3 Cholangiogram types compared regeneration of lost tissue!
Endoscopic Retrograde Cholangiopancreatography
Used to diagnose biliary and pancreatic pathologic conditions
when ducts are not dilated and ampulla is not obstructed
Fiberoptic endoscope passed through mouth into duodenum under fluoroscopy
Common bile duct is catheterized
Contrast is injected