The common bile duct is formed. What symptoms indicate that the bile ducts are clogged? Hypoplasia of interlobular intrahepatic bile ducts

For many decades, priority invasive research methods, such as oral cholecystocholangiography, intravenous and infusion cholegraphy, percutaneous, transhepatic, laparoscopic cholecystocholangiography, endoscopic retrograde pancreatic angiography, have been quite widely and effectively used to study the biliary tract.

The information content of radiological methods has increased significantly with the introduction of computed tomography and magnetic resonance into clinical practice. However, along with high information content, these methods are complex, expensive, unsafe for the patient’s health, and have a wide range of contraindications.

When examining the bile ducts, echography in the hands of a good specialist in a matter of minutes in 95-97% of cases can correctly answer the task set by the clinician, i.e. differentiate obstructive jaundice from parenchymal jaundice, determine the level and cause of duct obstruction. In this regard, it should be used widely, especially at the initial stage of the diagnostic process, and for the purpose of selecting patients for complex invasive research methods.

Indications:

— as a screening method in the study of newborns with icteric syndrome;

— all readings for .

Bile ducts are divided into intra- and extrahepatic.

The extrahepatic bile ducts include: cystic, common hepatic, common bile.

Cystic duct- drains bile from the gallbladder, has an average length of 4.5 cm, width of 0.3-0.5 cm. Usually at the gate of the liver within the hepatic duodenal ligament it connects with the common hepatic duct. Its relationship with the common hepatic duct can vary up to its independent flow into the duodenum.

Common hepatic duct is formed from the confluence of the right and left hepatic ducts at the right side of the porta hepatis in front of the bifurcation of the portal vein.

The length of the duct varies from 2 to 10 cm, width from 0.3 to 0.7 cm. The common hepatic duct is formed at the porta hepatis and is, as it were, a continuation of the left hepatic stream, located in front of the bifurcation of the portal vein.

The common bile duct is formed from the confluence of the common hepatic and cystic ducts and is a continuation of the common hepatic duct. Depending on the anatomical location, the common bile duct is divided into 4 parts:

- supraduodenal - above the duodenum;

- retroduodenal - behind the upper part of the intestine;

- retropancreatic - behind the head of the pancreas;

- intramural - pierces the posterior wall of the descending part of the duodenum.

The length of the duct varies from 2 to 12 cm (average 5-8 cm), and the width is 0.5-0.9 cm.

Before entering the pancreatic tissue, the duct widens slightly, and then, passing through the pancreatic tissue, it narrows, especially at the point of entry into the duodenum. In its last section, the common hepatic duct merges with the pancreatic duct, forming a common ampulla, or opens separately into the duodenum. It should be noted that a wide variety of anatomical variations in its location may occur.

Research methodology

The specialized literature provides a lot of data on the high capabilities of echography in visualizing intra- and especially extrahepatic ducts. The data obtained by the author from more than 216,000 thousand studies of the gallbladder and bile ducts indicate the rather modest capabilities of the ultrasound method at the present stage of its development in identifying and visualizing normal extrahepatic bile ducts. It seems that the researchers are wishful thinking. One of the main reasons for the low information content of ultrasound examination of extrahepatic bile ducts is the rather wide variability of the topographic-anatomical picture of the examination in the hilum and, which practically does not make it possible to identify and offer a specific projection of the ultrasound beam, providing identification and complete visualization of the ducts in one scan. The information content of the method increases significantly if the ultrasound device is equipped with Doppler Color, which allows you to differentiate the portal vein and the hepatic artery itself from the common bile duct.

The ducts are carried out after the gallbladder, pancreas and vessels of the portal and inferior vena cava in the position of the patient on the back and left side while holding the breath at the height of inspiration or when protruding the abdomen, on the back with an inflatable rubber pillow placed under the lower back, resulting in the liver moves down and the bile ducts become closer to the anterior abdominal wall.

In some patients, good results of visualization of the ducts can be obtained two to three minutes after the patient is in an upright position. In this case, the transverse colon moves downwards and frees the gates of the liver.

Many techniques for ultrasound scanning of extrahepatic bile ducts have been proposed, but it should be remembered that there is no universal method. Each experienced specialist develops his own individual methodological approach to identifying extrahepatic bile ducts. In practice, generally accepted classical scanning techniques are used - longitudinal, transverse and oblique.

The frequency of detection of extrahepatic bile ducts (in normal conditions and in pathology) mainly depends on the resolution of the device, the scanning method, the preparation of the patient and, of course, on the experience of the specialist. We obtained the best results in identifying extrahepatic bile ducts using a combination of linear, convex and sector sensors with a frequency of 3.5-5 MHz. As already noted, the intrahepatic bile ducts are not located normally; it is rarely possible to locate the left and right common hepatic ducts in the form of narrow tubular formations, merging in the form of the letter V. The left hepatic duct is located in the porta hepatis above the portal vein, its length is 1.5-2.5 cm and diameter 0.3-0.5 cm.

The right hepatic duct is also located at the porta hepatis above the right branch of the portal vein, its length is 0.5-1.5 cm, diameter 0.2-0.5 cm. It is very rarely possible to locate their fusion into the common hepatic duct, especially when it forms in the thickness of the hepatoduodenal ligament at some distance from the portal of the liver.

The length of the common hepatic duct ranges from 2 to 10 cm with a diameter of 0.3-0.7 cm; in children under 14 years of age, the length is 2.5 cm and the diameter is up to 0.3 cm. The cystic duct is rarely detected and only in the immediate vicinity of the neck of the gallbladder. Echographically, the average length of the duct is 4-5 cm, and the diameter is up to 0.25 cm.

Its connection with the common hepatic duct, which usually occurs in the hepatoduodenal ligament, is almost rarely seen. Ultrasound visualization of the common bile duct is also difficult due to the fact that anatomical examination in the hepatoduodenal ligament does not allow one to obtain an image of the entire duct in the plane of one section. In almost all cases, only an echographic picture of its segments can be obtained.

The specialized literature describes many techniques for detecting the bile duct. In particular, V. Demidov suggests using a longitudinal scan to find the portal vein and its bifurcation, a mark is made in its projection on the skin of the abdomen, and in the area of ​​the head of the pancreas a cross-section of the common bile duct is found, and a mark is also made in this area on the skin of the abdomen.

In the area of ​​these two connected points, a thorough scan is carried out using a line, and, according to the author, in most cases the common bile duct can be detected along almost its entire length. In our practice, ultrasound examination of the common bile duct began from the head of the pancreas, where its cross section can almost always be detected as a round anechoic formation with a diameter of 0.5-0.6 cm. Without losing connection with the found oval formation (transverse scan of the duct), the sensor is slowly rotated along or against clockwise until an elongated echo-negative track of the common bile duct is obtained from the transverse scan. Normally, the common bile duct is a thin-walled tubular non-pulsatile formation, in contrast to the hepatic artery itself, which is usually located more medially from the right branch of the portal vein and runs more horizontally in relation to the common bile ducts. There is no need to talk about its true length; in most cases, only its segments are located. The diameter is the same throughout almost its entire length and should not exceed 5 mm.

The ultrasound specialist should remember that if the common bile duct in the areas of topographic examination in the porta hepatis (this is the right free edge of the hepatoduodenal ligament) above the portal vein is not identified and there is no clinical interest in searching for it, then it should be considered echographically normal, and there is no need to waste time looking for it.

The reasons that prevent good visualization of the common bile duct can be very different. Among them:

- technical - low resolution of the device, lack of technical capabilities, that is, an optimal set of sensors that could combine various scanning methods;

- poor preparation of the patient - the presence of gases in the transverse colon, a shadow from the contents of the duodenum covering the gates of the liver;

— location anomaly;

— reasons associated with the presence of volumetric structural and liquid formations;

- shadows from gallstones;

- scars on the anterior abdominal wall;

— lack of experience of a specialist, etc.

Despite certain difficulties of a subjective and objective nature, echography in most cases provides quick and valuable information about the normality and pathology of the extrahepatic bile ducts and is the method of choice.

Pathology

Developmental defects

Bile duct atresia

A severe pathology that is rare and diagnosed during the neonatal period. The main symptom that forces the doctor to resort to examining the biliary tract is jaundice, which appears in the child at the time of birth and rapidly progresses. Bile duct atresia can manifest itself focally, when the ducts of a part of the liver are affected; on the echogram, the bile ducts are presented in the form of thin echogenic, often tortuous, cords. If there is atresia of only the distal parts, the overlying areas are dilated and visible as anechoic tortuous tubes. With diffuse damage, when the pathology covers all intrahepatic bile ducts, and sometimes extrahepatic ones, many intertwining thin echogenic lines are located in the liver parenchyma.

Ultrasound imaging for this pathology is highly informative, allows you to determine the degree of underdevelopment of the gallbladder and bile ducts, differentiate from physiological and hemolytic jaundice, septic diseases, postpartum hepatitis and other diseases of newborns, and also select patients for invasive research methods.

Anomaly of the cystic duct

It is extremely rare and refers to various types of connection of the cystic duct with the hepatic ducts, these are also bends, narrowings, expansions and accessory cystic ducts. To identify this pathology, echography is of little or almost no information. Diagnosis is carried out using invasive methods. The absence of the cystic duct is of particular interest for echography.

Absence of cystic duct

Rarely seen. In this case, the gallbladder often has a rounded shape; instead of the cystic duct, an echogenic cord is located, and an anechoic path is located in the wall, connected to the common bile duct, the functioning of which is clearly visible when taking a choleretic breakfast. In the presence of stones, they easily enter the common bile duct and, accumulating, significantly and tortuously expand it, which leads to obstructive jaundice.

Anomalies of the development of the main bile ducts

There are anomalies of the bile ducts, hypoplasia of the bile ducts, congenital perforation of the common bile duct and cystic dilatation of the bile ducts, which have little effect on bile secretion in childhood and appear only in older age.

Of echographic interest is only cystic dilatation of the bile ducts. This pathology includes: cystic simultaneous dilatation of both extra- and intrahepatic bile ducts (Caroly's disease). It manifests itself in the form of uneven focal or diffuse dilations of the ducts, which are easily diagnosed echographically, although sometimes they can be confused with liver metastases.

It should be noted that congenital dilatation of the ducts, especially in adults, is difficult to differentiate from that caused by compression of the ducts by a cancerous tumor, enlarged lymph nodes, or blockage by a stone. In these cases, it is almost always possible to find the cause, since obstructive jaundice is present.

Usually this anomaly is combined with fibrotic changes in the liver, which cause hepatomegaly and portal hypertension.

Common bile duct cysts

They can be observed in the form of expansion along the entire length of the duct, lateral expansion of the common bile duct (congenital diverticulum), associated with it by a pedicle of varying width (we observed this pathology in 5 patients), and in the form of choledochocele - dilatation of only the intraduodenal part of the common bile duct, which is located as an oval-elongated, hypoechoic, with uneven contours formation associated with the wall of the duodenum.

Bile duct stones

One of the most common pathologies of intra- and extrahepatic ducts is stones. The issue of echodiagnosis of intrahepatic duct stones is complex, since due to the difficulty of clarifying the location and depth of the duct with a stone, these patients rarely undergo surgical treatment, perhaps because a clinic is rarely present. They are a finding of the echographer. They can be very difficult to distinguish from calcifications of the liver parenchyma, which can be located in any area. The only distinguishing feature for a stone of 10-15 mm is that an echo-negative track and an expanded section of the duct are located behind it.

Common hepatic bile duct stones

Stones of the common hepatic ducts are often located closer to the gates of the liver, that is, at the point of transition into the common bile duct; They are usually small in size (up to 0.5 - 0.7 cm), round or oval in shape, often with smooth contours, highly echogenic, but rarely leave an acoustic shadow, unlike large calcifications of the liver parenchyma. A section of the dilated duct (echo-negative track) is located next to the stone.

When the duct is completely blocked, its proximal section and third-order ducts of a given lobe expand significantly. It should be noted that it can be very difficult to determine which lobe of the common hepatic duct is affected. According to our data, the left common hepatic duct is most often affected.

Common bile duct stones

In most cases, stones enter the common bile duct from the gallbladder and rarely (1-5%) form directly in the duct.

The incidence of damage is up to 20% of the total number of patients with cholelithiasis. Duct stones can be single or multiple, of different sizes and shapes, but more often they are round, of different echogenicity and rarely leave an acoustic shadow. The duct may be distally or proximally dilated; with partial blockage of the duct, transient jaundice is caused, with complete blockage - stable obstructive jaundice. When the terminal part of the duct is blocked by a stone, biliary hypertension occurs, leading to significant dilation of the extrahepatic and partially intrahepatic ducts.

In these cases, the jaundice may temporarily disappear.

Cholangitis

Acute or chronic inflammation of intra- and extrahepatic bile ducts.

Main reason- this is cholestasis with choledocholithiasis and infected bile. Inflammation of the bile ducts is common in clinical practice, but difficult and rarely diagnosed. Echographically, with cholangitis, the ducts are unevenly linearly dilated, the walls with the catarrhal form are homogeneously thickened, weakly echogenic (edema), with purulent form they are unevenly thickened, echogenic and dilated. Sometimes it is possible to locate echogenic contents—purulent bile—in their lumen. With this form there is always a specific clinical picture: an increase in body temperature to fibrile, chills, heaviness and dull pain in the right hypochondrium, nausea, and possibly vomiting.

Due to damage to the liver parenchyma and cholestasis, jaundice appears.

With progression, small abscesses can form in the walls of the bile ducts, and multiple abscesses of different sizes can form in the liver parenchyma.

In the process of effective treatment, narrowing of the lumen of the ducts, thinning of the wall, and disappearance of contents from the lumen can be observed.

Primary sclerosing cholangitis

A rare disease characterized by segmental or diffuse narrowing of the extra- and intrahepatic ducts, leading to severe cholestasis and cirrhosis of the liver. Sonographic picture: the echogenicity of the ducts or periportal zones is significantly increased, the walls of the common bile duct are thickened.

The liver has a motley picture - a combination of zones of low and high echogenicity.

Bile duct tumors

Among benign tumors, adenomas, papillomas, fibroids, lipomas, adenofibromas, etc. can be found. An echogram can reveal a tumor-like formation of different sizes and echogenicity with localization in the projection of the extrahepatic bile ducts, but more often in the projection of the common bile duct, without specifying the histological forms, the differentiation of which is carried out by using a targeted biopsy of the tumor site.

Bile duct cancer

Very rare (0.1-0.5%), but more common than gallbladder cancer. The most common are cholangiocarcinoma and adenocarcinoma, which can be localized in any part of the extrahepatic bile ducts. Most often noted in the area of ​​the papilla of Vater, at the junction of the hepatic duct with the cystic duct and at the junction of both hepatic ducts. Ultrasound diagnosis is difficult due to the small size of the cancer. There are two forms of tumor growth: exophytic and endophytic.

In the exophytic form, the tumor grows in the lumen of the duct and quite quickly obstructs it. At the initial stage, it is located on the echogram in the form of a focal tumor-like, often echogenic, small-sized formation, protruding into the lumen of the duct, with its expansion before and after the tumor.

In the endophytic form, the duct gradually narrows due to thickening of its wall and becomes clogged, also leading to obstructive jaundice.

Given the slow growth and late metastasis to regional lymph nodes and the liver, extrahepatic duct cancer manifests itself late, when obstructive jaundice is noted.

Obstructive jaundice

Thus, echography in the study of the bile ducts is a priority method that allows you to quickly answer many questions related to the normality and pathology of the bile ducts.

Bile ducts are a system of channels designed to drain bile into the duodenum from the gallbladder and liver. The innervation of the bile ducts is carried out using branches of the nerve plexus located in the liver area. Blood comes from the hepatic artery, the blood outflows into the portal vein. Lymph flows to the lymph nodes that are located in the area of ​​the portal vein.

The movement of bile in the biliary tract occurs due to the secretory pressure exerted by the liver, as well as due to the motor function of the sphincters, the gallbladder and due to the tone of the walls of the bile ducts themselves.

The structure of the bile ducts

Depending on their location, the ducts are divided into extrahepatic (this includes the left and right hepatic ducts, the common hepatic duct, the common bile duct and the cystic duct) and intrahepatic. The hepatic bile duct is formed due to the fusion of two lateral (left and right) hepatic ducts, which drain bile from each hepatic lobe.

The cystic duct, in turn, originates from the gallbladder, then, merging with the common hepatic duct, forms the common bile duct. The latter consists of 4 parts: supraduodenal, retropancreatic, retroduodenal, intramural. Opening on the papilla of Vater of the duodenum, the intramural part of the common bile duct forms an orifice where the pancreatic and bile ducts unite into the so-called hepatopancreatic ampulla.

Bile duct diseases

The biliary tract is susceptible to various diseases, the most common of which are described below:

• Cholelithiasis. Characteristic not only of the gallbladder, but also of the ducts. A pathological condition that most often affects people who are prone to obesity. It consists of the formation of stones in the bile ducts and bladder due to stagnation of bile and metabolic disorders of certain substances. The composition of stones is very diverse: it is a mixture of bile acids, bilirubin, cholesterol and other elements. Often, stones in the bile ducts do not cause significant discomfort to the patient, which is why their carriage can last for years. In other situations, the stone can clog the bile ducts and damage their walls, which leads to inflammation in the bile ducts, which is accompanied by hepatic colic. The pain is localized in the area in the right hypochondrium and radiates to the back. Often accompanied by vomiting, nausea, and high fever. Treatment of bile ducts with the formation of stones often includes a diet based on eating foods rich in vitamins A, K, D, low in calories and excluding foods rich in animal fats;
• Dyskinesia. A common disease in which the motor function of the biliary tract is impaired. Characterized by changes in bile pressure in various parts of the gallbladder and ducts. Dyskinesias can be either independent diseases or accompany pathological conditions of the biliary tract. Symptoms of dyskinesia are a feeling of heaviness and pain in the upper right area of ​​the abdomen, which occurs 2 hours after eating. Nausea and vomiting may also occur. Treatment of bile ducts with dyskinesia caused by neurotization is carried out using drugs aimed at treating neuroses (primarily valerian root);
• Cholangitis or inflammation in the bile ducts. In most cases, it is observed in acute cholecystitis, but it can also be an independent disease. It manifests itself in the form of pain in the right hypochondrium, fever, profuse sweating, and is often accompanied by attacks of nausea and vomiting. Jaundice often occurs against the background of cholangitis;
• Acute cholecystitis. Inflammation in the bile ducts and gallbladder due to infection. Just like colic, it is accompanied by pain in the right hypochondrium and increased temperature (from low-grade to high). In addition, there is an increase in the size of the gallbladder. As a rule, it occurs after eating a lot of fatty foods or drinking alcohol;
• Cholangiocarcinoma or bile duct cancer. Intrahepatic, distal bile ducts, as well as those located in the area of ​​the hepatic gate are susceptible to cancer. As a rule, the risk of developing cancer increases with the chronic course of a number of diseases, including biliary tract cysts, stones in the bile ducts, cholangitis, etc. Symptoms of the disease are very varied and can manifest themselves in the form of jaundice, itching in the duct area, fever, vomiting and/or nausea and others. Treatment is carried out by removing the bile ducts (if the size of the tumor is limited to the internal lumen of the ducts), or if the tumor has spread outside the liver, it is recommended to remove the bile ducts from the affected part of the liver. In this case, a donor liver transplant is possible.

Methods for studying the bile ducts

Diagnosis of biliary tract diseases is carried out using modern methods, descriptions of which are presented below:

• intraoperative chaledo- or cholangioscopy. Methods appropriate for determining choledochotomy;
• Ultrasound diagnostics with a high degree of accuracy reveals the presence of stones in the bile ducts. The method also helps to diagnose the condition of the walls of the bile ducts, their size, the presence of stones, etc.;
• duodenal intubation is a method that is used not only for diagnostic purposes, but also for therapeutic purposes. It consists of introducing irritants (usually parenterally) that stimulate contractions of the gallbladder and relax the sphincter of the bile duct. Advancement of the probe along the digestive tract causes the release of secretions and bile. Assessment of their quality, along with bacteriological analysis, gives an idea of ​​the presence or absence of a particular disease. Thus, this method allows you to study the motor function of the biliary tract, as well as identify blockage of the biliary tract with a stone.

In such cases, medications are prescribed or surgery is performed to remove the stones.

Location, structure and functions

Small hepatic ducts carry bile from the liver into its common channel. The length of the common hepatic tract is about 5 cm, the diameter is up to 5 mm. It unites with the cystic duct, which is about 3 cm long and has a lumen width of about 4 mm. The common bile duct (choledochus, CBD) begins from the confluence of the extrahepatic ducts. It has 4 sections, the total length of which reaches 8-12 cm, and leads to the large papilla of the initial section of the small intestine (located between the stomach and large intestine).

The sections of the common bile duct are distinguished based on their location:

• above the duodenum - supraduodenal;
• behind the upper segment of the duodenum - retroduodenal;
• between the descending part of the small intestine and the head of the pancreas - retropancreatic;
• runs obliquely through the posterior wall of the intestine and opens in the papilla of Vater - intramural.

The terminal parts of the CBD and the pancreatic duct together form the ampulla in the papilla of Vater. It mixes pancreatic juice and bile. The ampoule dimensions are normal: width from 2 to 4 mm, length from 2 to 10 mm.

In some people, the terminal parts of the ducts do not form an ampulla in the major papilla, but open with two openings into the duodenum. This is not a pathology, but a physiological feature.

The walls of the common duct consist of two muscle layers, longitudinal and circular. Due to the thickening of the last layer, at a distance of 8-10 mm before the end of the common bile duct (obturator valve) is formed. It and other sphincters of the hepatopancreatic ampulla prevent bile from entering the intestine when there is no food in it, and also prevent the outflow of contents from the intestine.

The mucous membrane of the common duct is smooth. It forms several folds only in the distal part of the papilla of Vater. The submucosal layer has glands that produce protective mucus. The outer lining of the bile duct is loose connective tissue that includes nerve endings and blood vessels.

Possible diseases and how they manifest themselves

The physician diagnoses diseases of the biliary tract more often than gastric ulcers. The pathological process inside the bile duct is caused by:

The risk group is women. This is due to the fact that they suffer from hormonal imbalance and excess weight more often than men.

Blockage

Bile duct obstruction is most often the result. A tumor, cyst, infection with worms, bacteria, or inflammation of the canal walls can lead to obturation (closing of the lumen).

A sign that the ducts are clogged is pain in the right hypochondrium. When the bile ducts are blocked, the stool becomes gray-white in color and the urine darkens.

Narrowing

The main cause of narrowing (stricture) of the bile ducts is surgery or a neoplasm (cyst, tumor) in the excretory canal. The operated area remains inflamed for a long time, which leads to swelling and narrowing of the gallbladder. The pathological condition is manifested by low-grade fever, pain in the right side, and lack of appetite.

Scars and ties

With sclerosing cholangitis, the bile duct becomes inflamed, which leads to the replacement of its walls with scar tissue. As a result, the duct collapses (contracts), which causes a disruption in the outflow of liver secretions, its absorption into the blood and stagnation in the bladder. The danger of this condition lies in its asymptomatic development and subsequent death of liver cells.

Edema

Catarrhal cholangitis is one of the reasons why the walls of the bile ducts are thickened. The disease is characterized by hyperemia (overcrowding of blood vessels), swelling of the duct mucosa, accumulation of leukocytes on the walls, and peeling of the epithelium. The disease often takes a chronic course. The person constantly feels discomfort in the right side, accompanied by nausea and vomiting.

ZhKB

Liver secretion in the bladder and a violation of cholesterol metabolism lead to the formation. When, under the influence of drugs, they begin to leave the bladder through the bile ducts, they make themselves felt with stabbing pain in the right side.

If the calculus is large, it partially or completely blocks the lumen of the bile canal. This condition causes spasm of the gallbladder, which is accompanied by pain, nausea and vomiting.

Tumors and metastases

Elderly people with a problematic biliary system are often diagnosed with Klatskin tumor. Malignant neoplasms affect the common bile duct in 50% of cases. If left untreated, the tumor metastasizes to regional lymph nodes and neighboring organs (liver, pancreas).

At an early stage, the pathology manifests itself as pain in the right hypochondrium, radiating to the shoulder blade and neck.

Dyskinesia

From Greek, this term means movement disorder. With this disease, the walls and ducts of the gallbladder contract inconsistently. Bile enters the duodenum either in excess or in insufficient quantities. negatively affects the digestion of food and the absorption of nutrients by the body.

Inflammation

This is inflammation of the bile ducts. It occurs against the background of their blockage or infection of the liver secretion by pathogenic bacteria. Inflammation occurs:

• Spicy. It comes up unexpectedly. During an attack, the skin turns yellow, headache appears, colic on the right side under the ribs, pain radiates to the neck and shoulder area.
• Chronic. Low-grade fever persists, mild pain appears on the right side, and the upper abdomen swells.
• Sclerosing. It is asymptomatic and then manifests itself as irreversible liver failure.

Extension

The expansion of the common bile duct is most often provoked by increased contractility of the bladder walls (hyperkinesia). Other reasons may be blockage of the lumen of the common canal with a stone or tumor, disruption of the sphincters. These factors lead to increased pressure in the biliary system and dilation of its ducts both in the liver and outside the organ. The presence of pathology is indicated by persistent pain in the right hypochondrium.

Atresia

The term "biliary atresia" means that a person's bile ducts are blocked or absent. The disease is diagnosed immediately after birth. In a sick child, the skin acquires a yellow-green tint, urine has the color of dark beer, and feces have a white-gray tint. In the absence of treatment, the baby's life expectancy is 1-1.5 years.

How are ductal diseases diagnosed?

When asked how to check the condition of the biliary system, specialists from modern clinics advise:

The gallbladder and bile ducts should be treated comprehensively. Therapy is based on dietary nutrition and medication.

The patient’s diet directly depends on the type, degree and severity of the disease; the diet for gallbladder disease should be aimed at reducing the load on the liver and normalizing the outflow of bile.

In difficult cases, surgical intervention is prescribed.

Operations on the bile ducts

The operation is performed to remove an obstacle (scar tissue, tumor, cyst) that interferes with the outflow of liver secretions. Different treatment methods are used for different diseases:

• Bile duct stenting is indicated in case of narrowing of the biliary tract. A stent (an elastic, thin plastic or metal tube) is inserted into the lumen of the canal, which restores its patency.
• Praderi drainage - used to create an anastomosis (artificial connection of organs) between the bile duct and the small intestine to prevent narrowing of the operated area. It is also used to maintain normal pressure in the common bile duct.
• Endoscopic papillosphincterotomy (EPST) is a non-surgical operation. Removing stones from the bile ducts using a probe.

Conservative therapy

Non-surgical treatment of biliary tract diseases includes the following methods:

• . Warm, fractionally (up to 7 times a day), you can consume low-fat meat broth, slimy pureed porridge, steamed protein omelet, soufflé from fish and dietary meat in small portions.
• Broad-spectrum antibiotics - Tetracycline, Levomycetin.
• Antispasmodics - Drotaverine, Spazmalgon.
• - Holosas, Allohol.
• B vitamins, vitamins C, A, K, E.

Additional measures

Inflammation of the bile ducts is most often the result of a person’s lack of exercise and poor diet. Therefore, for preventive purposes, you should do moderate physical activity every day (half an hour of walking, cycling, morning exercises).

You need to permanently exclude fatty, fried, spicy foods from the menu, and greatly reduce the amount of sweets. It is recommended to consume foods that are a source of dietary fiber (oatmeal, lentils, rice, cabbage, carrots, apples), which helps quickly cleanse the body of bile pigments, toxins, and excess cholesterol.

Literature

• Aliev, M.A. Use of magnetic resonance cholangiopancreatography for iatrogenic injuries of the bile ducts / M.A. Aliev, E.A. Akhmetov // Med. visualization. – 2003. – No. Z. – pp. 13–18.
• Vasilyev, A. Yu. Diagnostic capabilities of magnetic resonance cholangiography in identifying diseases of the gallbladder and bile ducts // The role of radiation diagnostics in multidisciplinary clinics / ed. V. I. Amosova / A. Yu. Vasiliev, V. A. Ratnikov. – St. Petersburg: Publishing house of St. Petersburg State Medical University, 2005. – pp. 43–45.
• Dobrovolsky, A. A. Robot-assisted laparoscopic cholecystectomy // Surgery. Journal named after N.I. Pirogova / A. A. Dobrovolsky, A. R. Belyavsky, N. A. Kolmachevsky and others - 2009. - No. 6. - P. 70-71.
• Kulikovsky, V.F. Minimally invasive methods of treatment of complicated cholelithiasis // Modern problems of science and education / V.F. Kulikovsky, A.A. Karpachev, A.L. Yarosh, A.V. Soloshenko. – 2012. – No. 2.
• Mayorova, E. M. The relationship of anomalies of the gallbladder and biliary tract with the clinical picture of cholecystitis: Dissertation for the degree of candidate of medical sciences / Kazan State Medical Academy. Kazan, 2008.
• Malakhova, E. V. Functional diseases of the gallbladder: pain perception and characteristics of the psycho-emotional state: Dissertation for the degree of candidate of medical sciences / GOUDPO Russian Medical Academy of Postgraduate Education of the Federal Agency for Health Care and Social Development. Moscow, 2006.

The bile ducts are a tubular system in the body that often requires treatment. The common hepatic duct is the most painful place in the biliary system. Even a person leading a healthy lifestyle is not immune from health problems (especially the digestive system). Therefore, you need to know what problems lie in wait and how therapy is carried out. If you start a therapeutic course of any disease on time, it will go away faster and bring fewer problems.

The bile ducts are a system of channels that are designed to drain bile into the duodenum from the liver and gallbladder.

general characteristics

Bile is an auxiliary enzyme, it is secreted in the human liver to improve digestion. In humans, the bile ducts are a system of channels through which bile is discharged into the intestine. The bile ducts of the liver open into the duodenum, which leads to the stomach. The system of pathways and bile ducts vaguely resembles the image of a tree: the crown of the tree is the small channels located in the liver, the trunk is the common hepatic duct connecting the duodenum with the liver. The movement of bile is carried out using pressure, it is created by the liver.

Biliary tract: structure

The structure of the canal is not very complicated. All small ducts originate in the liver. The fusion of the left and right canals (both located in the liver) forms the common hepatic canal. The channels carry the burn formed by the hepatic lobes. The bile duct is formed in the bladder, then it connects with the common hepatic duct and forms the common bile duct. A bend in the gallbladder may indicate abnormalities in its development. Strictures of the common hepatic duct are not normal. Occurs due to strong blows to the liver area.

Congenital pathologies and developmental anomalies of the biliary tract

Congenital tract anomalies are a defect from which no one is immune. Anomalies should be detected in the maternity hospital or in the first year of the child’s life. Otherwise, it can lead to death or worsening health problems in older age. There is no universally accepted classification of anomalies of this organ yet. Scientists also do not agree on whether the pathologies are hereditary. Most often, they appear if during pregnancy a woman led an unhealthy lifestyle or took illegal drugs. There are the following types of congenital abnormalities:

• tract atresia;
• hypoplasia of interlobular intrahepatic bile ducts;
• common duct cysts.

Biliary atresia

Atresia is an obstruction of the lumen of several or all extrahepatic bile ducts. The main symptom is rapidly developing jaundice in newborns. If it is physiological, then you should not be afraid. It will go away in 2-3 weeks after the baby is born.

Apart from the icteric color, the child does not experience any discomfort, feces and urine are normal, but the amount of bilirubin in the blood is increased. It is worth making sure that its level does not increase too rapidly. To speed up its elimination, you need to place the baby on a well-lit surface under indirect sunlight.

But, if the feces and urine are of an unnatural yellow color, the child diarrhea and vomits, and feels constant anxiety, then this is not obstructive jaundice, but tract atresia. It appears 2-3 days after birth. The pathways are not able to remove bile, this leads to an increase in the size of the liver and its compaction, and the angle becomes sharper. Doctors advise taking x-rays after 4, 6 and 24 hours for an accurate diagnosis. Atresia can lead to acute liver failure at 4-6 months and death of the child at 8-12 months. It can only be treated surgically.

Hypoplasia of interlobular intrahepatic bile ducts

This disease is due to the fact that the intrahepatic ducts are not able to remove bile. The main symptoms of the disease are similar to atresia, but they are not as pronounced. The disease sometimes goes away without symptoms. Sometimes itchy skin appears at the age of 4 months, the itching does not stop. The disease can be an addition to other diseases, for example, the cardiovascular system. The treatment is difficult. Sometimes leads to cirrhosis of the liver.

Common bile duct cysts

This disease manifests itself in children 3−5 years old. Children experience sharp attacks of pain, especially during pressing; in older age, nausea and vomiting occur. The skin has an uncharacteristic icteric tint, feces and urine have an uncharacteristic yellowish color. Fever is common. Ruptures and peritonitis, malignant cyst tumors are possible. It is treated by removing cysts from the affected organ.

Damage to the bile ducts

Canal ruptures can be seen very rarely. They can be provoked by a strong blow to the right side. Damage of this type quickly leads to peritonitis. It is worth noting that with ruptures of other organs it is very difficult to diagnose damage to the ducts. In addition, in the first hours there are no signs other than painful sensations. In addition, if there is an infection, the situation can be greatly aggravated by a sharp increase in temperature. It can only be treated with urgent surgery, sometimes the inflammation ends in death.

Bile duct diseases

Diseases of the bile ducts are characterized by changes in skin color (it turns yellow), itching, and pain in the right side. It can be constant with frequent worsening and vomiting, then the pain is referred to as hepatic colic. The pain increases after intense physical activity, long driving and eating spicy, salty foods. The pain increases when pressing on the right side.

Chronic cholecystitis is a disease caused by a virus. Due to inflammation of the gallbladder, it enlarges. This entails painful sensations in the right side. The pain doesn't stop. If the diet is violated or if there is a strong shake, the pain increases. Proper treatment is prescribed by a gastroenterologist. Following a simple diet is important for health.

Biliary tract cholangitis

Cholangitis is an inflammation of the bile ducts. The disease is caused by pathogenic bacteria. The cause is inflammation of the gallbladder. Sometimes it is purulent in nature. With this disease, the excretion of bile worsens due to blockage of the channels. The patient experiences severe pain on the right side, bitterness in the mouth, nausea and vomiting, and loss of strength. This disease is characterized by the fact that in the early stages it can be effectively treated with folk remedies, but in later stages only by surgery.

Biliary dyskinesia

Dyskenisia is a violation of the tone or motility of the biliary tract. It develops against the background of psychosomatic diseases or allergies. The disease is accompanied by mild pain in the hypochondrium, bad mood, and depression. Constant fatigue and irritability also become constant companions of the patient. Men and women report problems in their intimate lives.

Cholelithiasis

Cholangiolithiasis is the formation of stones in the bile ducts. Large amounts of cholesterol and salt can lead to this disease. At the moment of the formation of sand (the precursor of stones), the patient does not experience any discomfort, but as the grains of sand grow and pass through the bile ducts, the patient begins to notice severe pain in the hypochondrium area, which radiates to the shoulder blade and arm. The pain is accompanied by nausea and vomiting. To speed up the process of stone passage, you can increase your physical activity (the best way is to walk up the stairs).

Biliary tract cholestasis

Cholestasis is a disease in which the flow of bile into the intestines decreases. Symptoms of the disease: itching of the skin, darkening of the color of urine and yellowing of stool. Yellowness of the skin is noted. The disease sometimes entails dilation of bile capillaries and the formation of blood clots. May be accompanied by anorexia, fever, vomiting and flank pain. There are the following causes of the disease:

• alcoholism;
• cirrhosis of the liver;
• tuberculosis;
• infectious diseases;
• cholestasis during pregnancy and others.

Bile duct blockage

Blockage of the canals can be a consequence of other diseases of the digestive system. Most often it is a consequence of gallstone disease. This tandem occurs in 20% of humanity, and women suffer from this disease 3 times more often than men. In the first stages, the disease does not make itself felt. But after suffering an infectious disease, the digestive system begins to progress rapidly. The patient's temperature rises, the skin begins to itch, feces and urine take on an unnatural color. A person is rapidly losing weight and suffers from pain in his right side.

- (ductus choledochus) a duct formed from the connection of the gallbladder duct with the hepatic duct (ductus hepaticus) and flows into the intestine (in humans, into the duodenum). In humans, the gastrointestinal duct is as thick as the trunk of a goose feather. Relationship… … Encyclopedic Dictionary F.A. Brockhaus and I.A. Efron

Bile duct is a duct of the liver for removing bile, part of the digestive system of higher vertebrates and humans. Formed by the confluence of the hepatic duct and the gallbladder duct. In higher vertebrates it leads into the lumen of the duodenum (in... ... Wikipedia

common bile duct- (ductus choledochus) a duct formed at the porta hepatis from the confluence of the common hepatic and cystic ducts, has a length of 5-8 cm. Initially located in the hepatic-duodenal ligament, then passes behind the upper part of the duodenum ... Glossary of terms and concepts on human anatomy

- (ductus choledochus, PNA, BNA, JNA; synonym bile duct) extrahepatic gland, formed by the connection of the hepatic and cystic ducts; opens on the major duodenal papilla... Large medical dictionary

Gallbladder- (vesica fellea) (Fig. 151, 159, 165, 166, 168) has a bag-like shape, a characteristic dark green color and is located on the inner surface of the liver in the fossa of the gallbladder (fossa vesicae felleae), while connecting with the fibrous... ... Atlas of Human Anatomy

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Gallbladder. Bile ducts- The gallbladder, vesica fellea (biliaris), is a sac-like reservoir for bile produced in the liver; it has an elongated shape with wide and narrow ends, and the width of the bladder from the bottom to the neck decreases gradually. Length… … Atlas of Human Anatomy

The gallbladder is an organ in vertebrates and humans in which bile is stored. In humans, it is located in the right longitudinal groove, on the lower surface of the liver, has the shape of an oval sac, the size of a small chicken egg and is filled with... ... Wikipedia

Gallbladder (vesica fel-lea) and bile ducts (ducti biliferi)- bottom of the gallbladder; body of the gallbladder; neck of the gallbladder; spiral fold; common hepatic duct; common bile duct; pancreatic duct; hepatic-pancreatic ampulla; duodenum … Atlas of Human Anatomy

An auxiliary organ of digestion, a reservoir for storing bile and its accumulation between periods of digestion. The gallbladder in humans is a pear-shaped sac located in a recess on the lower surface of the right hepatic lobe.… … Collier's Encyclopedia