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Common Bile Duct
The common bile duct (also bile duct) is a part of the biliary tract. It is formed by the union of the common hepatic duct and cystic duct. It ends by uniting with the pancreatic duct to form the ampulla of Vater (hepatopancreatic ampulla). Its sphincter the sphincter of Oddi, enables the regulation of bile flow. Anatomy The bile duct is some 6–8 cm long, and normally up to 8 mm in diameter. Its proximal supraduodenal part is situated within the free edge of the lesser omentum. Its middle retroduodenal part is oriented inferiorly and right-ward, and is situated posterior to the first part of the duodenum, and anterior to the inferior vena cava. Its distal paraduodenal part is oriented still more right-ward, is accommodated by a groove upon (sometimes a channel within) the posterior aspect of the head of the pancreas, and is situated anterior to the right renal vein. The bile duct terminates by uniting with the pancreatic duct (at an angle of about 60°) t ...
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Biliary Tract
The biliary tract (also biliary tree or biliary system) refers to the liver, gallbladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Some components are synthesized by hepatocytes (liver cells); the rest are extracted from the blood by the liver. Bile is secreted by the liver into small ducts that join to form the common hepatic duct. Between meals, secreted bile is stored in the gallbladder. During a meal, the bile is secreted into the duodenum (part of the small intestine) to rid the body of waste stored in the bile as well as aid in the absorption of dietary fats and oils. Structure The biliary tract refers to the path by which bile is secreted by the liver then transported to the duodenum, the first part of the small intestine. A structure common to most members of the mammal family, the biliary tract is often referred to as a tree bec ...
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Hepatic Artery Proper
The hepatic artery proper (also proper hepatic artery) is the artery that supplies the liver and gallbladder. It raises from the common hepatic artery, a branch of the celiac artery. Structure The hepatic artery proper arises from the common hepatic artery and runs alongside the portal vein and the common bile duct to form the portal triad. A branch of the common hepatic arterythe gastroduodenal artery gives off the small supraduodenal artery to the duodenal bulb. Then the right gastric artery comes off and runs to the left along the lesser curvature of the stomach to meet the left gastric artery, which is a branch of the celiac trunk. It subsequently bifurcates into the right and left hepatic arteries. Variant anatomy Of note, the right and left hepatic arteries may demonstrate variant anatomy. A misplaced right hepatic artery may arise from the superior mesenteric artery (SMA) and a misplaced left hepatic artery may arise from the left gastric artery. The cystic artery g ...
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Digestive System
The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase. The first stage, the cephalic phase of digestion, begins with secretions from gastric glands in response to the sight and smell of food, and continues in the human mouth, mouth with the mechanical breakdown of food by chewing, and the chemical breakdown by digestive enzymes in the saliva. Saliva contains amylase, and lingual lipase, secreted by the salivary glands, and serous glands on the tongue. Chewing mixes the food with saliva to produce a Bolus (digestion), bolus to be Swallowing, swallowed down the esophagus to enter the stomach. The second stage, the gastric phase ...
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Choledochoduodenostomy
Choledochoduodenostomy (CDD) is a surgical procedure to create an anastomosis, a surgical connection, between the common bile duct (CBD) and an alternative portion of the duodenum. In healthy individuals, the CBD meets the pancreatic duct at the ampulla of Vater, which drains via the major duodenal papilla to the second part of duodenum. In cases of benign conditions such as narrowing of the distal CBD or recurrent CBD stones, performing a CDD provides the diseased patient with CBD drainage and decompression. A side-to-side anastomosis is usually performed. Bile from the gallbladder is carried to the CBD and emptied into the duodenum. CBD drainage might be obstructed due to distal CBD stricture, which is narrowing of the CBD due to the presence of scar tissue within the duct, and choledocholithiasis, the presence of gallstones. Obstruction can occur when gallstones may be too large to pass through the CBD into the duodenum. Liver tests are performed before and after the operation ...
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Erasistratus
Erasistratus (; ; c. 304 – c. 250 BC) was a Greek anatomist and royal physician under Seleucus I Nicator of Syria. Along with fellow physician Herophilus, he founded a school of anatomy in Alexandria, where they carried out anatomical research. As well, he is credited with helping to found the methodic school of teachings of medicine in Alexandria whilst opposing traditional humoral theories of Hippocratic ideologies. Together with Herophilus, he is credited by historians as the potential founder of neuroscience due to his acknowledgements of nerves and their roles in motor control through the brain and skeletal muscles.Wills, Adrian, and A Wills. “Herophilus, Erasistratus, and the Birth of Neuroscience.” ''Lancet'' 354, no. 9191 (November 13, 1999): 1719–20. doi:10.1016/S0140-6736(99)02081-4. Furthermore, Erasistratus is seen as one of the first physicians/scientists to conduct recorded dissections and potential vivisections alongside Herophilus.Ferngren, Gary. “Vi ...
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Jaundice
Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. The most commonly associated symptoms of jaundice are itchiness, pale feces, and dark urine. Normal levels of bilirubin in blood are below 1.0  mg/ dl (17  μmol/ L), while levels over 2–3 mg/dl (34–51 μmol/L) typically result in jaundice. High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin. Causes of jaundice vary from relatively benign to potentially fatal. High unconjugated bilirubin may be due to excess red blood cell breakdown, large bruises, gen ...
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Biliary Atresia
Biliary atresia, also known as extrahepatic ductopenia and progressive obliterative cholangiopathy, is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired. Biliary atresia is the most common reason for pediatric liver transplantation in the United States. It has an incidence of one in 10,000–15,000 live births in the United States, and a prevalence of one in 16,700 in the British Isles. Globally, biliary atresia cases are most common in East Asia, with a frequency of one in 5,000. The cause of biliary atresia in Egyptian infants has been proven to be as a result of aflatoxin induced cholangiopathy acquired prenatally in infants who have glutathione S transferase M1 deficiency. The biliary atresia phenotype caused by congenital aflatoxicosis in GST M1 deficient neonates is named Kotb disease. Syndromic biliary atresia (e.g. Biliary Atresia Splenic Malformation (BASM)) has been associated ...
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Cholecystenterostomy
A cholecystoenterostomy is a surgical procedure in which the gall bladder is joined to the small intestine. It is performed in order to allow bile to pass from the liver to the intestine when the common bile duct The common bile duct (also bile duct) is a part of the biliary tract. It is formed by the union of the common hepatic duct and cystic duct. It ends by uniting with the pancreatic duct to form the ampulla of Vater (hepatopancreatic ampulla). ... is obstructed by an irremovable cause.Oxford Concise Medical Dictionary, e-book References Abdominal surgical procedures Colorectal surgery Accessory digestive gland surgery {{surgery-stub ...
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Ascending Cholangitis
Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from Ampulla of Vater, its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones. Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include jaundice, yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, hypotension, low blood pressure and mental confusion, confusion. Initial treatment is with intravenous fluids and antibiotics, but there is often an underlying problem (such as gallstones or Stenosis, narrowing in the bile duct) for which further tests and treatments may be necessary, usually in the form of endoscopy to relieve obstruction of the bile duct. The word is from Greek ''chol''-, bile + ''ang''-, vessel + -''itis'', inflammation. Signs an ...
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Choledocholithiasis
Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD) (thus '' choledocho-'' + '' lithiasis''). This condition can cause jaundice and liver cell damage. Treatments include choledocholithotomy and endoscopic retrograde cholangiopancreatography (ERCP). Signs and symptoms Murphy's sign is commonly negative on physical examination in choledocholithiasis, helping to distinguish it from cholecystitis. Jaundice of the skin or eyes is an important physical finding in biliary obstruction. Jaundice and/or clay-colored stool may raise suspicion of choledocholithiasis or even gallstone pancreatitis. If the above symptoms coincide with fever and chills, the diagnosis of ascending cholangitis may also be considered. More than 70% of people with gallstones are asymptomatic and are diagnosed incidentally during ultrasound. Studies have shown that 10% of those with gallstones will develop symptoms within 5 years of diagnosis, and ...
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Gallstone
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of migrated gallstones within bile ducts. Most people with gallstones (about 80%) are asymptomatic. However, when a gallstone obstructs the bile duct and causes acute cholestasis, a reflexive smooth muscle spasm often occurs, resulting in an intense cramp-like visceral pain in the right upper part of the abdomen known as a biliary colic (or "gallbladder attack"). This happens in 1–4% of those with gallstones each year. Complications from gallstones may include inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), obstructive jaundice, and infection in bile ducts ( cholangitis). Symptoms of these complications may include pain that lasts longer than five hours, fever, yellowish skin, vomiting, da ...
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Mass Effect (medicine)
In medicine, a mass effect is the effect of a growing mass that results in secondary pathological effects by pushing on or displacing surrounding tissue. In oncology, the mass typically refers to a tumor. For example, cancer of the thyroid gland may cause symptoms due to compressions of certain structures of the head and neck; pressure on the laryngeal nerves may cause voice changes, narrowing of the Vertebrate trachea, windpipe may cause stridor, pressure on the esophagus, gullet may cause dysphagia and so on. Surgery, Surgical removal or debulking is sometimes used to palliative care, palliate symptoms of the mass effect even if the underlying pathology is not curable. In neurology, a mass effect is the effect exerted by any mass, including, for example, hydrocephalus (cerebrospinal fluid buildup) or an evolving intracranial hemorrhage (bleeding within the skull) presenting with a clinically significant hematoma. The hematoma can exert a mass effect on the brain, increasing ...
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