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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!

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Biliary system and liver

Biliary System and Liver

1 23 2014


Liver
Liver

Largest gland of body

2nd largest organ

What is the 1st ?

Skin

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:

Right lobe

Left lobe

2 minor lobes:

Caudate lobe- part of right lobe -posterior

Quadrate lobe - part of right lobe -inferior


Functions of liver
Functions of liver regeneration of lost tissue!

Main function -formation of bile

Maintain a proper level or glucose in blood

Convert glucose to glycogen

Produce urea

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!

  • It has a dual blood supply!

  • Receives both oxygenated and

  • deoxygenated blood (portal system)

    • 1. Hepatic artery-

    • supplies liver with oxygenated blood from

    • abdominal aorta to like any other part of body

    • 2. Portal vein-

    • carries deoxygenated blood from digestive

    • organs to be modified and filtered by liver

    • blood then returns to heart (by hepatic veins)

    • and is circulated to rest of body


First pass effect problem
First Pass Effect Problem 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!

suppository

intravenously

intramuscularly

aerosol inhalation

sublingually

Nitroglycerin cannot be swallowed - liver would inactivate medication -must be taken under tongue or transdermally


Biliary system
Biliary regeneration of lost tissue! System

(Excretory system of liver)

Consists basically of :

1. gallbladder

2. bile ducts


Biliary combining forms
Biliary Combining Forms regeneration of lost tissue!

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

-iasis–presence of

-itis – inflammation of


2 primary functions of biliary system
2 Primary Functions of regeneration of lost tissue!Biliary System

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


Gall bladder
Gall bladder regeneration of lost tissue!

Reservoir for bile from liver – 2oz. capacity (50 percent of bile is stored in gallbladder)

Concentrates bile

How much bile does it produce per day?

1-3 pints

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


Transportation of bile sequence
Transportation of bile sequence regeneration of lost tissue!

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


Gallstones
Gallstones regeneration of lost tissue!

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!)


Two types of gallstones
Two types of gallstones regeneration of lost tissue!

80% are cholesterol stones:

usually yellow-green and made primarily of hardened cholesterol

20% are pigment stones:

small, dark stones made of bilirubin


Risk factors for gallstones
Risk Factors for Gallstones regeneration of lost tissue!

Female

Age 60 or older

American Indian or Mexican heritage

Overweight or obese

Pregnant

Eating a high-fat, high-cholesterol, or low fiber diet

Family history of gallstones

Diabetes

Losing weight very quickly

Taking cholesterol-lowering medications

Taking medications containing estrogen (such as hormone therapy drugs)


Complications from gallbladder stones
Complications from Gallbladder Stones regeneration of lost tissue!

Choledocholithiasis -

presence of bile stones in ducts

Cholecystitis -

bile sac inflammation

Pancreatitis

Increased risk of gallbladder cancer (very rare)


Treatment for gallstones
Treatment for Gallstones regeneration of lost tissue!

Surgical removal of gallbladder -

Cholecystectomy

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


If your gallbladder is removed
If your gallbladder is removed… regeneration of lost tissue!

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


Pancreas
Pancreas regeneration of lost tissue!

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)

Cholecystography

Study of gallbladder

Oral contrast is used

Cholangiography

Study of biliary ducts

IV contrast is used

(may be injected directly into ducts)


Indications for biliary tract exam

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 gallbladder

IndicationsforBiliary Tract Exam


Contra indications for performing biliary tract exams
Contra regeneration of lost tissue!indicationsfor performing Biliary Tract Exams

  • Allergy to contrast

  • Pyloric obstruction (blockage from stomach to duodenum)

  • Severe jaundice

  • Malabsorption

  • Liver dysfunction

  • Hepatocellular disease- liver typically inflamed and shows signs of injury


Patient prep
Patient Prep regeneration of lost tissue!

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


Position of gallbladder
Position of Gallbladder regeneration of lost tissue!

  • RUQ

  • In hypersthenic pt.

    • Superior and lateral

  • In Asthenic

    • Inferior and nearer to spine


Shielding what 3 things must you consider
Shielding regeneration of lost tissue!What 3 things must you consider?

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?


Gallbladder exam cholecystography
Gallbladder Exam regeneration of lost tissue!(Cholecystography)

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


Pa projection
PA Projection regeneration of lost tissue!

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?

expiration


Pa oblique projection
PA Oblique Projection regeneration of lost tissue!

LAO position

Pt rotated 15 - 40 degrees depending on body habitus

CR at level of elbow, between spine and (R or L?) midaxillary line 10x12 cassette


Rt lateral decubitus
Rt. Lateral Decubitus regeneration of lost tissue!

Demonstrates stones lighter than bile visible only by stratification

CR:

Directed horizontally to level of gallbladder


Intravenous cholangiography ivc

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 injection

Intravenous Cholangiography (IVC)


Percutaneous transhepatic cholangiography performed preoperatively
Percutaneous Transhepatic Cholangiography regeneration of lost tissue!(performed preoperatively)

(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


Cholangiography intra operative
Cholangiography regeneration of lost tissue! Intra-operative

Performed during a cholecystectomy

Examines patency of ducts during or after surgical removal of GB


T tube cholangiography
T-Tube Cholangiography regeneration of lost tissue!

Post-operative (after cholecystectomy) procedure performed through T-tube left in common hepatic and common bile ducts (for drainage)

To determine:

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!

Percutaneous

Intraoperative

T-Tube


ERCP 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


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