Heartland Society of Gastroenterology Nurses and Associates

Mary Ganley RN CGRN BSHA

Describe the normal structure and histology of the biliary system.

Name three diseases or diagnoses of the biliary tract and treatment.

Gallbladder Hepatic Duct Cystic Duct Common Bile Duct

Four Functions of the Biliary System Collect Concentrate Store Release This is accomplished by motility and

secretion

1. Fundus 2. Funnel shaped body 3.Transitional region between the body and

the neck. This is where gallstones get impacted

4. The neck which narrows at the cystic duct

The cystic duct combines with the hepatic duct to form the common bile duct.

The ampulla empties into the duodenum at the papilla of Vater or major papilla

Smooth muscle surrounding the common bile duct, , the pancreatic duct, and the ampulla of Vater.

The functions of the sphincter of Oddi are: 1.Regulate the flow of bile and pancreatic

juices into the intestine. 2. Inhibit entry of bile into the pancreatic duct. 3.Prevent reflux of intestinal contents in the

ducts.(When the gallbladder is removed the

sphincter of Oddi regulates bile flow.) Under normal condition Sphincter of Oddi remains open.

The gallbladder wall is made up of serosa, a fibro- muscular layer and mucosa.

The blood is supplied to the gallbladder by the hepatic artery.

The maximum amount of bile that can be stored in the gallbladder is 50ml.

The major component of bile that is produced in the liver is water. The functions of bile are emulsification of undigested fats, facilitating the absorption of fat soluble vitamins, and activation of intestinal and pancreatic enzymes.

Provision of a route for excretion of bilirubin, cholesterol, and certain sex, thyroid, and adrenal hormones.

Cholelithiasis is the presence of stones or calculi in the gallbladder. Accounts for 90% of biliary diseases.

Two types of gallstones: #1 is cholesterol Make up 80%- yellow green in color. Made

up primarily of cholesterol-associated with hepatic production of bile.

#2 is Pigment stones - black pigment made up of bilirubin.

Forty, female, fat

Symptoms: Steady pain mainly 3-6 hours after a

meal Pain radiates - can be similar to MI Nausea and vomiting Fever and chillsUltrasound - most effective diagnostic

CT, MRCP, ERCP Treatment:SurgeryDissolution -- Disadvantage stones may return

Stones in the common bile duct or the hepatic duct.

Symptoms : Biliary colic, right upper quadrant abdominal pain, obstructive jaundice and pruritus, fever, and chills

Treatment: ERCP WITH SPHINCTEROTOMY

Cholangitis is a rare bacterial infection of the bile duct associated with obstruction

85% = stone in common bile duct.

Is a medical and surgical emergency Decompression or drainage should produce immediate benefits

Is an acute or chronic inflammation that causes painful distention of the gallbladder. 90% gallstones impacted in the cystic duct known as acute calculus cholecystitis - upper right quadrant abdominal pain, nausea, vomiting, fever, chills, tachycardia, abd tenderness with rebounding pain, and intolerance to fatty foods and heavy meals.

Ultrasound , labs, and ERCP Decompression or stents

PSC is a rare inflammation process that results in multiple strictures of the bile duct causing chronic cholestatic liver disease.

Symptoms: fatigue, jaundice, Pruritis, abdominal pain, and elevated serum alkaline phosphate.

US, ERCP or PTC

1. Classic radiological findings in primary sclerosing cholangitis would be:

a. multiple short biliary strictures and areas of dilation resulting in a beaded appearance

b. progressive dilation of the pancreatic duct of Santorini

c. ’double duct’ sign (BILIARY+PANCREATIC OBSTRUCTION).

d. diminishing intrahepatic ducts on the cholangiogram

2. The gall bladder is connected to the common bile duct by the:

a. Hepatic Ductb. Cystic Ductc. Pancreatic duct

3. Clinical manifestation of primary sclerosing cholangitis may include:

a. Pruritisb. Jaundicec. Abdominal Paind. Portal Hypertensione. All of the above

4. Progression of disease in a patient with primary sclerosing cholangitis has been listed to include the following:

a. Progressive stricture formationb. Cirrhosisc. Cholangiocarcinomad. All of the above