BILIARY TRACT
10.1 CONGENITAL CHOLEDOCHAL CYST
Choledochal cyst
is a dilatation which usually
involves the
supraduodenal portion of the common bile duct, but may
involve
the
common right and left hepatic
ducts. It is
considered a
congenital abnormality.
Clinical manifestations include pain, jaundice and a
palpable
epigastric mass.
Diagnosis is
confirmed by ultrasound and
treatment is by an
excision of
the cyst and internal
drainage by a
hepatico-
jejunostomy by
a Roux-en-Y. Drainage
of the cyst
directly
without excision
causes recurrent pancreatitis in
one of the
patients intestine.
11. GALL BLADDER FUNCTION
The gallbladder provides storage and
concentrates the bile.
*
Sodium chloride and water are
selectively absorbed and there
is a secretion of mucus.
*
This mucus is the
"white bile" present in mucocle of the
gallbladder when there is an
obstruction of the cystic duct
and no bile can enter.
*
Tonic contractions lasting
5 to 30 minutes
increase the
pressure within the gallbladder.
*
The passage of bile into the
duodenum is, however, dependent
upon the relaxation of the sphincter of Oddi
*
The stimulus for the contraction is cholescystokinin realeased
from the intestinal mucosa in response to food and fats being
a strong stimulus
*
With injection of cholecystokinin, the gall bladder begins to
contract in 1 to 2 minutes.
*
Cholexystokinin also relaxes the sphincter of Oddi and the
duodenal musculature
Gallbladder
The gallbladder functions as a reservoir for
secreted bile during not only does it store bile, but also it concentrates
bile. The concentrating ability of the gallbladder is based on the presence of
active sodium transport at the basolateral membrane, water moves both trans and
paracellularly down a concentration gradient leaving the lumen and entering the
interestitial fluid and blood stream gallbladder contraction is circulating CCK
from the S cells. Cholecystokinin has a direct effect on the gallbladder smooth
muscle cells gallbladder to empty its contents into the common hepatic duct.
The normal ejection fraction of the gallbladder should exceed 40%. Some
patients have a low ejection fraction, called billiary dyskinesia, which may be
associated with intermittent abdominal discomfort and a chronic feeling of
nausea.
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