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Journal of Clinical Ultrasound : JCU Jun 2019Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital... (Review)
Review
Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital cholelithiasis, and gallbladder duplication. Although most of these malformations are rare and benign conditions, they may occasionally represent a major threat to extrauterine life. Visualization of a normal-sized gallbladder should be a mandatory component of the second-trimester anomaly ultrasound scan. Advances in prenatal sonography enable the detection of biliary tract congenital malformations. In this review, we discuss the detection rates, sonographic features, and prognosis of the most frequently prenatally diagnosed biliary tract malformations.
Topics: Biliary Tract; Biliary Tract Diseases; Digestive System Abnormalities; Female; Humans; Pregnancy; Prognosis; Ultrasonography, Prenatal
PubMed: 30729537
DOI: 10.1002/jcu.22705 -
American Journal of Medical Genetics.... Nov 2003The biliary tree extends from the canals of Hering at the margin of the most peripheral portal tracts to the ampulla of Vater. Malformations occur at every level of this... (Review)
Review
The biliary tree extends from the canals of Hering at the margin of the most peripheral portal tracts to the ampulla of Vater. Malformations occur at every level of this structure. Phenotypic features dominate present understanding of these malformations and of the disorders with which they are associated. Classifications of disease will likely shift from a phenotypic basis to a genotypic basis as genes implicated in biliary tree development and function are identified. Involvement of such genes in biliary tree disorders now considered inflammatory, such as extrahepatic biliary atresia, awaits study. The concept of "feeble cholangiocytes" postnatally susceptible to the effects of "toxic bile" is presented.
Topics: Biliary Tract; Humans; Liver
PubMed: 14518074
DOI: 10.1002/ajmg.a.20479 -
Bailliere's Clinical Gastroenterology Jun 1991Gallbladder and sphincter of Oddi motility regulates the flow of bile from the liver to the duodenum. During the interdigestive period most secreted bile is diverted... (Review)
Review
Gallbladder and sphincter of Oddi motility regulates the flow of bile from the liver to the duodenum. During the interdigestive period most secreted bile is diverted into the gallbladder where it is concentrated, but a significant minority of the biliary secretion passes directly into the duodenum. Regulation of this flow is mainly via the phasic contractions of the sphincter of Oddi and the sphincter basal tone. The phasic contractions expel small volumes of fluid into the duodenum, but most of the flow occurs between the contractions and is therefore not dependent on peristaltic pumping, but rather on a small pressure gradient. During fasting, just prior to duodenal phase III activity, the gallbladder expels up to 40% of its volume and the sphincter phasic contractions increase. Following a meal, the gallbladder empties its contents, and the sphincter of Oddi resistance is reduced via a fall in basal pressure and inhibition of the amplitude of phasic contractions. Control of this activity is via an interplay of both neuronal and hormonal factors which together have an effect on both gallbladder and sphincter of Oddi motility. Abnormalities in motility are recognized for both the gallbladder and the sphincter of Oddi. Gallbladder dyskinesia is objectively diagnosed using the radionuclide GBEF. In patients with a GBEF less than 40% cholecystectomy results in relief of symptoms. In postcholecystectomy patients sphincter of Oddi dysfunction presents as either biliary-like pain or idiopathic recurrent pancreatitis. Endoscopic sphincter of Oddi manometry provides the most objective diagnostic information. In patients with a sphincter of Oddi stenosis, characterized manometrically as an elevated basal pressure, division of the sphincter results in relief of symptoms. For patients with biliary-like pain, division is performed as an endoscopic sphincterotomy, whereas for patients with idiopathic recurrent pancreatitis, a sphincteroplasty and pancreatic duct septectomy are required.
Topics: Biliary Tract; Biliary Tract Diseases; Humans
PubMed: 1912657
DOI: 10.1016/0950-3528(91)90035-y -
Abdominal Radiology (New York) Jan 2017Iatrogenic and traumatic bile leaks are uncommon. However, given the overall increase in number of hepatobiliary surgeries and the paradigm shift toward nonoperative... (Review)
Review
Iatrogenic and traumatic bile leaks are uncommon. However, given the overall increase in number of hepatobiliary surgeries and the paradigm shift toward nonoperative management of patients with liver trauma, they have become more prevalent in recent years. Imaging is essential to establishing early diagnosis and guiding treatment as the clinical signs and symptoms of bile leaks are nonspecific, and a delay in recognition of bile leaks portends a high morbidity and mortality rate. Findings suspicious for a bile leak at computed tomography or ultrasonography include free or contained peri- or intrahepatic low density fluid in the setting of recent trauma or hepatobiliary surgery. Hepatobiliary scintigraphy and magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary contrast agents can be used to detect active or contained bile leak. MRCP with hepatobiliary contrast agents has the unique ability to reveal the exact location of bile leak, which often governs whether endoscopic management or surgical management is warranted. Percutaneous transhepatic cholangiography and fluoroscopy via an indwelling catheter that is placed either percutaneously or surgically are useful modalities to guide percutaneous transhepatic biliary drain placement which can provide biliary drainage and/or diversion in the setting of traumatic biliary injury. Surgical treatment of a bile duct injury with Roux-en-Y hepaticojejunostomy is warranted if definitive treatment cannot be accomplished through percutaneous or endoscopic means.
Topics: Biliary Tract; Biliary Tract Diseases; Humans; Iatrogenic Disease
PubMed: 27503381
DOI: 10.1007/s00261-016-0856-y -
American Journal of Surgery Oct 1951
Topics: Biliary Tract; Biliary Tract Surgical Procedures; Humans
PubMed: 14878072
DOI: 10.1016/0002-9610(51)90373-x -
Radiologic Clinics of North America Jul 2014Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR)... (Review)
Review
Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization.
Topics: Artifacts; Biliary Tract; Biliary Tract Diseases; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Humans; Magnetic Resonance Imaging
PubMed: 24889169
DOI: 10.1016/j.rcl.2014.02.011 -
Microscopy Research and Technique Sep 1997This paper serves to introduce a topical section of fifteen invited original research contributions dealing with normal and pathological development of the human biliary... (Review)
Review
This paper serves to introduce a topical section of fifteen invited original research contributions dealing with normal and pathological development of the human biliary tract. This section also includes comparative anatomy of the gallbladder and the cystic duct as well as, the formation of gallstone. This series of reports have used advanced microscopic and ancillary techniques to study adaptative changes in gallbladder epithelial cell changes regarding permeability, renewal, mucous secretion as well as cholesterol uptake and nucleation. Several contributions deal with the blood and lymphatic drainage of the gallbladder. The gallbladder contractility is clarified by recent findings about its innervation, elegantly demonstrated and supported by complementary immunohistochemical and neurophysiological techniques. In vivo models for production of cholelithiasis in the ground squirrel and the Syrian hamster are introduced. Recent in vitro cellular and molecular models have substantially increased the understanding of biliary tract calculi formation. Finally, a survey and new data about progesterone gene regulation of both cholesterol metabolism and gallstone formation obtained in the Syrian hamster model are compared with cholelithogenesis in human.
Topics: Animals; Bile Acids and Salts; Biliary Tract; Cholelithiasis; Gallbladder; Humans; Lymphatic System; Mucus; Permeability
PubMed: 9330345
DOI: 10.1002/(SICI)1097-0029(19970915)38:6<547::AID-JEMT1>3.0.CO;2-C -
AJR. American Journal of Roentgenology Aug 1990
Review
Topics: Bile; Biliary Dyskinesia; Biliary Tract; Humans; Sphincter of Oddi
PubMed: 2115247
DOI: 10.2214/ajr.155.2.2115247 -
Journal of Veterinary Internal Medicine 1992Disorders of the gallbladder and extrahepatic biliary tract in the dog and cat can easily be confused with other intra-abdominal disorders. This confusion results... (Review)
Review
Disorders of the gallbladder and extrahepatic biliary tract in the dog and cat can easily be confused with other intra-abdominal disorders. This confusion results because many times the clinical course and signs of biliary tract disease are similar to these other intra-abdominal disorders. This review discusses the normal anatomy and physiology of the gallbladder, bile duct, and bile in the dog and cat and then summarizes the historic, physical examination, clinicopathologic, diagnostic, histologic and therapeutic aspects of all the cases of extrahepatic biliary tract disease reported in the veterinary literature.
Topics: Animals; Bile; Bile Ducts; Biliary Tract Diseases; Cat Diseases; Cats; Dog Diseases; Dogs; Gallbladder; Gallbladder Diseases
PubMed: 1619596
DOI: 10.1111/j.1939-1676.1992.tb00335.x -
Microscopy Research and Technique Sep 1997Microstructure and development of the normal biliary tract and the pathologies of several biliary tract diseases in humans are reviewed. The biliary tract, comprising... (Review)
Review
Microstructure and development of the normal biliary tract and the pathologies of several biliary tract diseases in humans are reviewed. The biliary tract, comprising the bile duct and peribiliary glands, is anatomically divided into the extrahepatic and intrahepatic biliary tree. The intrahepatic biliary tree is further divided into large bile ducts, corresponding to the right and left hepatic ducts and their first to third order branches, and into septal and interlobular bile ducts and bile ductules according to their size and location relative to the hepatic lobules and surrounding structures. The right and left hepatic ducts and the extrahepatic bile ducts are composed of dense fibrous duct walls lined by a layer of columnar biliary epithelium. The peribiliary glands, which may secrete mucinous and serous substances into the bile, are found along the extrahepatic and large intrahepatic bile ducts. They are divided in glands within and outside the duct wall. The former (intramural glands) drain directly into the lumen of the bile duct, while the latter (extramural glands) are composed of several lobules and drain into the ductal lumen via their own conduits. The biliary tract is supplied by a complex vasculature called the peribiliary vascular plexus. Afferent vessels of this plexus derive from hepatic arterial branches, and this plexus drains into the portal venous system or directly hepatic sinusoids. The development of the intrahepatic biliary tract is divided into three stages: the stage of the ductal plate, the stage of biliary cell migration into the mesenchyme, and the stage of bile duct formation in the portal tract. It remains unclear how the extrahepatic and intrahepatic biliary tract integrate. Along with these developmental changes in the biliary tract, the peribiliary glands and the vascular plexus also develop in a step-wise manner and their maturation is completed after birth. Pathologies of various biliary diseases are briefly reviewed noting their relevance to several histologic elements and the microenvironment of the biliary tract and the developmental anomalies of the biliary tract including ductal plate malformation.
Topics: Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Biliary Tract; Cell Division; Embryonic and Fetal Development; Epithelial Cells; Growth Substances; Humans; Phenotype
PubMed: 9330346
DOI: 10.1002/(SICI)1097-0029(19970915)38:6<552::AID-JEMT2>3.0.CO;2-H