The biliary system is the gall bladder with ducts. The liver, gastrointestinal tract, and bile ducts are collectively called the hepatobiliary system. The gall bladder (GI) 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 with food.
The structure of the bile ducts
All of them are divided into intrahepatic and extrahepatic. There are dozens of ducts themselves. Intrahepatic are located in the liver, they gradually collect the liver from hepatocytes.
The gallbladder duct flows into the main common. Extrahepatic include ducts from the left and right lobes of the liver. Leaving it, they form a common hepatic duct, common bile duct and gallbladder ducts. The gallbladder ducts, starting from the neck of the bladder, are connected with the common hepatic. Thus, the result is general. The ducts of the gallbladder form a whole system. Their purpose is to divert content. Their work is activated by eating - they bring bile to the duodenum (duodenum). Especially a lot of it requires fatty foods.
The work of the ducts differs by their purpose. The ducts of the gallbladder only divert bile into the bladder. Its advancement is possible due to pressure of the secretion of the liver. This happens with the help of bladder valves and contraction of the muscles of the prostate 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 (emulsification of fats).
- It activates the lipase enzyme necessary for the digestion of fats.
- Destroys toxins.
- It takes part in the balance of electrolytes.
- Activates peristalsis of the small intestine.
- Does not allow hydrochloric acid to pass into the small intestine, neutralizing it
- Participates in the absorption of nutrients from food.
- Prevents fermentation in the small intestine.
Pathologies of the bile ducts and their symptoms
Gallstone disease (cholelithiasis) develops both in the bladder itself and in its ducts. More common in fat people. Stones are formed due to cholestasis in impaired metabolism. With small sizes, the stones do not cause discomfort, but with their 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, radiating to the right shoulder, shoulder blade or right half of the body. Often the temperature may rise, nausea may be present, and vomiting of the patient's condition does not facilitate.
Duct obstruction
This condition is a consequence of cholelithiasis, inflammation, tumors, strictures, scars of the common duct. At the same time, the passage in any duct is blocked.
Symptoms of stones in the ducts of the gallbladder usually develop gradually, often after past infections of the biliary tract. Sharp manifestations are rare. The pain in the hypochondrium is cramping right, the person is losing weight, the temperature may increase, often yellowness of the skin, itching throughout the body.
Symptoms of stones in the ducts of the gallbladder also appear due to a lack of fatty acids in the intestines, so the stool becomes colorless. In turn, bilirubin is excreted by the kidneys, and the urine becomes dark. If the blockage is partial, an alternation of portions of dark and light feces is noted.
Symptoms of stones in the duct of the gallbladder can be aggravated by the defeat of hepatocytes, then the liver is disturbed, and liver failure develops. The body is flooded with toxins, there are disturbances in the functioning of other organs - the lungs, heart, and kidneys. Fatigue, weakness and headaches are observed. 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 ducts of the gallbladder is usually done 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 symptom.
The symptoms are as follows: after eating, after 2 hours, severity and pain occurs not only in the right hypochondrium, but also in the epigastrium, which complicates the diagnosis. Often there is nausea and vomiting.
Treatment of the ducts of the gallbladder with neurotic dyskinesia, requires the appointment of sedatives. The most commonly prescribed valerian root. In other cases, choleretic drugs.
Cholangitis
Cholangitis is an inflammation of the ducts of the gallbladder. Most often accompanies acute cholecystitis. In the right hypochondrium, pain, profuse sweating, fever, paroxysmal vomiting appear. 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. The pathology is aggravated after eating fatty foods or taking alcohol.
Cholangiocarcinoma
It 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. This is also associated with poor ecology.
All the symptoms of biliary tract pathologies are present: pain on the right, temperature, itchy skin, urine like beer and white stool, icteric skin, vomiting and nausea. During surgery, the affected ducts are removed, with growth in the liver - and part of the affected organ. Good results are obtained by donor liver transplantation.
Benign neoplasms do not give symptoms for a long time, but rapid growth resembles acute cholecystitis - pain appears, irritability, jaundice, increased general well-being appear.
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 can be distinguished:
- atresia of the ways;
- hypoplasia of the bile ducts;
- cyst of the common duct.
Atresia is a blockage of the lumen of the duct. Its main manifestation is growing jaundice in the baby. With atresia, feces and urine are unnaturally yellow. The child is restless, vomits, and he vilifies. It appears on the 2-3 day of life. Due to obstruction of the ducts, bile is not excreted, and the liver is enlarged. The diagnosis is established on the basis of radiographs after 4, 6 and 24 hours. With improper treatment, such a child can only live up to 8-12 months, then he dies from liver failure. Treatment of pathology is only operational.
Hypoplasia of the intrahepatic bile ducts
With it, the ducts are not capable of excreting bile. Symptoms are similar to atresia, but dim. Sometimes they are completely absent. At 4 months, an ongoing itching appears. Hypoplasia is often accompanied by pathologies of the heart. The treatment is long and complicated, cirrhosis of the liver may develop.
Common bile duct cyst
Occurs at the age of 3-5 years. Children complain of sharp pains, especially with palpation. In older children, vomiting and nausea are added, the temperature rises. The skin, urine and feces are uncharacteristically yellow. The treatment is only radical.
Duct injuries
Meet very rarely. They can occur only with targeted blows to the liver. A rapidly developing peritonitis becomes a complication. Diagnosis is complicated by the fact that, in addition to general pain, there are no other manifestations. In this condition, an urgent operation is necessary.
Diagnostic measures
Diagnostic methods are only the most modern:
- Choledo-or cholangioscopy during surgery.
- Ultrasound of the liver and GP. The method allows you to detect stones in the ducts, their size can also be determined, shows the state of the walls of the ducts, their size.
- Duodenal sounding - can be equally diagnostic and therapeutic. Gall bladder irritants are introduced, which cause its contraction and relaxation of the sphincter.
- The composition of bile is studied and its bacanalysis is carried out.
- Cholangiography - contrast medium is injected intravenously and the condition of the ducts is studied. The method is used in especially difficult cases.
- Radiography is rarely used. Calcium stones are clearly visible on the radiograph, and cholesterol stones are not visible.
- 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. With remission, diet and pills are enough.
With cholelithiasis, drugs are prescribed to dissolve the stones. These include compounds of cheno- and ursodeoxycholic acid, as well as herbal medicine. The treatment, although long-term, but 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! Cholagogue is prescribed only during the period of remission. The doctor prescribes hepatoprotectors for any ailment of the hepatobiliary system.
Especially often prescribed are “Hepabene”, “Hofitol”, “Hepa-Merz”, “Karsil”, etc. Herbal medicine is widely used - herbs of milk thistle, immortelle, St. John's wort, etc.
It is not advisable to take analgesics for pain, they do not have an effect, and they can immediately damage the gastric mucosa.
During treatment, a diet is always required. Diet, antispasmodics, choleretic remain important in remission. Intensive workouts are excluded. Inflammatory processes are treated with anti-inflammatory drugs and support the immune system.
Surgery
The choice of treatment for bile duct obstruction is determined by the surgeon and gastroenterologist. A serious condition requires being in the intensive care unit with a course of infusion, detoxification and antibacterial treatment.
The patient's condition for the operation must be stabilized. To do this, use non-invasive methods to facilitate bile duct. This is the extraction of bile duct stones, nasobiliary drainage, percutaneous puncture of the pancreas, 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, 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 (12 duodenal ulcer). The bile duct opens. At the same time, the unpleasant moment is that bile can seep through the seams into the abdominal cavity. To prevent this phenomenon, a Keru T-shaped tube is inserted and outward drainage occurs, i.e. removal of stagnant fluid into an external receiver. In the same way, medication can be injected through the drain.
External drainage of the bile ducts and removal of the gallbladder according to Halstead is carried out sequentially: first the gallbladder is removed, and then the ducts are drained.
If treatment with blockage is not carried out, sepsis develops, brain damage with bilirubin, cirrhosis and liver failure (it will be acute with complete obstruction, chronic with partial obstruction).
Large stones are first tried to grind by crushing. This procedure is called lithotripsy and is carried out by the shock-wave method, and then they begin the main operation.
The crushed stones from the intrahepatic ducts are removed using catheters that are inserted into the liver. The operation requires a highly qualified surgeon.
To kill the infection, antibiotic therapy is used, along with probiotics. Infusion therapy and enzyme therapy are also required. Conducting the most radical operation will not give a full recovery if the diet is not followed.
Forecast and Prevention
If the treatment was timely, as well as treatment, the prognosis for blockage of the ducts will be favorable. It becomes unfavorable with late treatment and the presence of an oncological process.
Prevention of obstruction of the bile ducts must be carried out constantly. If you do not change anything, lead the same unhealthy life, eat with a predominance of fried and fatty - the stones will not fail to remind you of yourself.
It is necessary to treat chronic inflammation of the hepatobiliary system, visit a doctor and be examined every year also regularly. Fried, fatty, extractive foods are excluded. Surely moderate physical activity should be present in life.