Biliary system - gallbladder with ducts. The liver, gallbladder, and bile ducts are collectively referred to as the hepatobiliary system. The gallbladder (GB) is an unpaired hollow organ that has an auxiliary character. Its main purpose is the accumulation, storage, thickening of bile and its controlled release at the right time. The bubble itself does not produce anything. Bile production occurs in the liver. Bile from the bladder is released into the duodenum during meals.
The structure of the bile ducts
All of them are divided into intrahepatic and extrahepatic. There are dozens of channels themselves. Intrahepatic are located in the liver, they gradually collect the liver from hepatocytes.
The gallbladder duct flows into the main common. Extrahepatic ducts include ducts from the left and right lobes of the liver. Coming out of it, they form the common hepatic duct, the common bile duct and the ducts of the gallbladder. Gallbladderducts, starting from the neck of the bladder, are connected to the common hepatic. Thus, the general is obtained. The ducts of the gallbladder form a whole system. Their purpose is to divert content. Their work is activated when eating - they bring bile to the duodenum (duodenum). Especially a lot of it requires fatty foods.
The work of the ducts differs in their purpose. The gallbladder ducts only carry bile to the gallbladder. Its promotion is possible due to the pressure of the secretion of the liver. This happens with the help of the valves of the bladder and contraction of the muscles of the gallbladder under the tone of the walls of the gallbladder ducts themselves.
Bile per day can be produced up to 2 liters, but more often up to 1 liter. The regulation of the biliary system is carried out by the autonomic nervous system.
Bile function
Bile performs the following functions:
- Breaks down lipids into smaller fatty acids (fat emulsification).
- Activates the lipase enzyme needed to digest fats.
- Destroys toxins.
- Takes part in electrolyte balance.
- Activates the peristalsis of the small intestine.
- Does not allow hydrochloric acid to pass into the small intestine, neutralizing it
- Involved in the absorption of nutrients from food.
- Prevents fermentation processes in the small intestine.
Pathologies of the bile ducts and their symptoms
Cholelithiasis (GSD) develops both in the bladder itself and in its ducts. More common in fat people. Calculi are formed due to cholestasis with impaired metabolismsubstances. With small sizes, the stones do not cause discomfort, but when they shift, they can clog the duct and cause hepatic colic. In this case, the walls of the ducts are always damaged and inflammation develops. With colic, pain occurs in the region of the right hypochondrium, radiates to the right shoulder, shoulder blade or to the right half of the body. Often, the temperature may rise, nausea may be present, and vomiting does not alleviate the patient's condition.
Clogged ducts
This condition is a consequence of cholelithiasis, inflammation, tumors, strictures, scarring of the common duct. This clogs the passage in any duct.
Symptoms of gallstones usually develop gradually, often after a history of biliary tract infections. Acute manifestations are rare. Pain in the hypochondrium on the right is cramping, the person is losing weight, the temperature may rise, often there is yellowness of the skin, itching all over the body.
Symptoms of stones in the gallbladder ducts also appear due to a lack of fatty acids in the intestine, so the stool becomes colorless. In turn, bilirubin is excreted by the kidneys, and the urine becomes dark. If the blockage is partial, there is an alternation of portions of dark and light stools.
Symptoms of stones in the gallbladder duct can be aggravated by damage to hepatocytes, then the liver is disturbed, and liver failure develops. The body is flooded with toxins, there are violations of the work of other organs - lungs, heart, kidneys. Observedincreased fatigue, weakness and headaches. In the absence of urgent measures, the prognosis is poor. For diagnosis, it is important to conduct blood biochemistry, ultrasound, MRI and CT.
Removal of stones in the gallbladder ducts is usually performed by surgeons. The operation can be endo-, laparoscopic.
Dyskinesia
Pathology is characterized by impaired motility of the biliary tract and bladder. It can be an independent disease or a symptom.
Signs boil down to the following: after eating, after 2 hours, there is heaviness and pain not only in the right hypochondrium, but also in the epigastrium, which makes diagnosis difficult. Nausea and vomiting often occur.
Treatment of the gallbladder ducts in neurotic dyskinesia, requires the appointment of sedatives. The most commonly prescribed is valerian root. In other cases, choleretic drugs.
Cholangitis
Cholangitis is an inflammation of the gallbladder ducts. Most often accompanied by acute cholecystitis. Pain, profuse sweating, fever, paroxysmal vomiting appear in the right hypochondrium. Jaundice may appear.
Acute cholecystitis
Its origin is often infectious. It gives not only pain and temperature, but also an increase in the gallbladder in size. Pathology aggravates after eating fatty foods or drinking alcohol.
Cholangiocarcinoma
Can develop in any intrahepatic duct. The risk of its occurrence increases with chronic diseases such as duct cysts, stones, cholangitis. Recently, the number of such diagnoses is growing. Associate it with badecology.
All symptoms of biliary tract pathologies are present: pain on the right, temperature, skin itching, beer-colored urine and white feces, skin icterus, vomiting and nausea. During the operation, the affected ducts are removed, with growth in the liver - and part of the affected organ. Donor liver transplantation gives good results.
Benign neoplasms do not give symptoms for a long time, but rapid growth resembles acute cholecystitis - pain appears, irritability is increased, jaundice, general deterioration of well-being.
Congenital malformations of the biliary tract
No one is immune from such defects. It is better if they are detected in the hospital or in the first weeks of life. Then more help is possible.
Among the anomalies are:
- pathetic atresia;
- hypoplasia of bile ducts;
- common duct cyst.
Atresia is a blockage of the lumen of the duct. Its main manifestation is the growing jaundice in the baby. With atresia, feces and urine are unnaturally yellow. The child is restless, vomits and swears. It appears on the 2-3 day of life. Due to blockage of the ducts, bile is not excreted, and the liver enlarges. The diagnosis is established on the basis of the radiograph after 4, 6 and 24 hours. Such a child, with improper treatment, can only live up to 8-12 months, then he dies of liver failure. Treatment of pathology is only surgical.
Hypoplasia of intrahepatic bile ducts
With it, the ducts are not capable of excreting bile. Symptoms are similar toatresia, but not bright. Sometimes they are completely absent. At 4 months there is incessant itching. Hypoplasia is often accompanied by pathologies of the heart. The treatment is long and complicated, and cirrhosis of the liver may develop.
Cyst of common bile duct
Occurs at the age of 3-5 years. Children complain of sharp pains, especially during palpation. In older children, vomiting and nausea are added, the temperature rises. Skin, urine and feces are uncharacteristically yellow. Treatment is only radical.
Ductal injury
Very rare. They can only occur with targeted blows to the liver. Rapidly developing peritonitis becomes a complication. Diagnosis is complicated by the fact that, apart from general pain, there are no other manifestations. This condition requires urgent surgery.
Diagnostic measures
Diagnostic methods only the most modern:
- Choledo- or cholangioscopy during surgery.
- Ultrasound of the liver and gallbladder. The method allows you to detect stones in the ducts, their size can also be determined, shows the condition of the walls of the ducts, their size.
- Duodenal sounding - can be diagnostic and therapeutic in equal measure. Stimulants are injected into the gallbladder, which cause it to contract and relax the sphincter.
- The composition of bile is studied and its bacanalysis is carried out.
- Cholangiography - a contrast agent is injected intravenously and the state of the ducts is studied. The method is used in particularly difficult cases.
- X-ray is rarely used. On the radiograph, calcium stones are clearly visible, and cholesterol ones are notvisible.
- In difficult cases, doctors prescribe CT and MRI.
Treatment of diseases of the biliary tract
Therapy is completely determined by the stage of the disease. In remission, diet and pills are enough.
For cholelithiasis, drugs are prescribed to dissolve stones. These include compounds of cheno- and ursodeoxycholic acid, as well as herbal medicine. Although the treatment is long, the effect is expressed in the reduction of stones. In order to enhance the production of bile, choleretic drugs, antispasmodics, hepatoprotectors and tonic drugs can be prescribed.
Important! Cholagogues are prescribed only during the period of remission. Hepatoprotectors are prescribed by a doctor for any ailment of the hepatobiliary system.
Gepabene, Hofitol, Hepa-Merz, Karsil, etc. are especially often prescribed. Phytotherapy is widely used - herbs of milk thistle, immortelle, St. John's wort, etc.
Analgesics for pain are not advisable to take, they have no effect, and can damage the gastric mucosa immediately.
During treatment, a diet is always required. Remain important in remission diet, antispasmodics, choleretic. Intensive training is excluded. Inflammatory processes are treated with anti-inflammatory drugs and support immunity.
Surgical treatment
The choice of treatment for blockage of the bile ducts is determined by the surgeon and gastroenterologist. Severe condition requires a stay in the intensive care unittherapy with a course of infusions, detoxification and antibacterial treatment.
The patient's condition needs to be stabilized for the operation. To do this, use non-invasive methods to facilitate bile flow. These are extraction of bile duct stones, nasobiliary drainage, percutaneous puncture of the gallbladder, etc.
Stones in the gallbladder and in the duct - the operation can, as already indicated, be laparoscopic and endoscopic. It depends on the severity of the process.
After stabilization of the condition, the operation is better endoscopic. If this is not possible, an extended operation is performed laparoscopically. When the abdominal wall is cut, an anastomosis is applied from the bile duct to the duodenum (duodenum 12). The bile duct is opened. At the same time, the unpleasant moment is that bile can seep through the seams into the abdominal cavity. To prevent such a phenomenon, a T-shaped tube is inserted according to Ker and drainage occurs outward, i.e. removal of stagnant liquid into an external receiver. In the same way, drugs can be administered orally through the drain.
External drainage of the bile ducts and removal of the gallbladder according to Halsted are carried out sequentially: first the gallbladder is removed, and then the ducts are drained.
If the blockage is not treated, sepsis develops, brain damage with bilirubin in the blood, cirrhosis of the liver and liver failure (it will be acute with complete obstruction, chronic with partial).
Large stones first try to grind crushing. This procedure is calledlithotripsy and carried out by the shock wave method, and then proceed to the main operation.
Crushed stones from the intrahepatic ducts are removed using catheters that are inserted into the liver. The operation requires a highly skilled surgeon.
To destroy the infection, antibiotic therapy is used, along with probiotics. Infusion therapy and enzyme therapy are also required. The most radical operation will not give a complete recovery if the diet is not followed.
Forecast and prevention
If the appeal was timely, as well as the treatment, the prognosis for blockage of the ducts will be favorable. It becomes unfavorable with late treatment and the presence of an oncological process.
Prophylaxis of obstruction of the bile ducts must be carried out constantly. If you do not change anything, lead the same unhe althy life, eat with a predominance of fried and fatty - the stones will not fail to remind you of themselves.
It is necessary to treat chronic inflammation of the hepatobiliary system, it is also necessary to visit a doctor and be examined annually. Fried, fatty, extractive foods are excluded. Moderate physical activity must be present in life.
