Thebile duct[1][4](formerly known as thecommon bile duct[4]) is a part of thebiliary tract.[4]It is formed by the union of thecommon hepatic ductandcystic duct.It ends by uniting with thepancreatic ductto form thehepatopancreatic ampulla.It possesses itssphincterto enable the regulation of bile flow.
| Common bile duct | |
|---|---|
 Diagram of the biliary tree showing the common bile duct | |
| Details | |
| Part of | Biliary tract |
| Identifiers | |
| Latin | ductus choledochus,[1] ductus biliaris[1] |
| Acronym(s) | CBD[2] |
| MeSH | D003135 |
| TA98 | A05.8.02.013 |
| TA2 | 3103 |
| FMA | 14667 |
| Anatomical terminology | |
2.Intrahepatic bile ducts
3.Left and right hepatic ducts
4.Common hepatic duct
5.Cystic duct
6.Common bile duct
7.Ampulla of Vater
8.Major duodenal papilla
9.Gallbladder
10–11.Rightandleftlobes ofliver
12.Spleen
13.Esophagus
14.Stomach
15.Pancreas:
16.Accessory pancreatic duct
17.Pancreatic duct
18.Small intestine:
19.Duodenum
20.Jejunum
21–22. Right and leftkidneys
The front border of the liver has been lifted up (brown arrow).[3]
Anatomy
editThe bile duct is some 6–8 cm long, and normally up to 8 mm in diameter.[4]
Its proximal supraduodenal part is situated within the free edge of thelesser 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 rightrenal vein.[4]
The bile duct terminates by uniting with thepancreatic duct(at an angle of about 60°) to form thehepatopancreatic ampulla.[4]
The distal extremity of the bile duct invariably features its ownsphincteric muscle(the pancreatic duct and the hepatopancreatic ampulla usually possess sphincters of their own to allow the flow of pancreatic juice to be regulated independently, however, these two can be absent).[4]
Clinical significance
editSeveral problems can arise within the common bile duct, usually related to its obstruction. Opinions vary slightly on the maximum calibre of a normal CBD, but 6 mm is one accepted upper limit of normal[5]with a further 1mm diameter allowed for each decade over 60 years.
It normally gets slightly dilated aftercholecystectomy,with upper limit (95%prediction interval) being about 10 mm after a few months.[6]
Onabdominal ultrasonography,the common bile duct is most readily seen in theporta hepatis(where the CBD lies anterior to theportal veinandhepatic artery). The absence ofDopplersignal distinguishes it from theportal veinandhepatic artery.
-
Borderline of a dilated perihilar bile duct, measuring 8 mm. -
Dilatation of CBD due to Ampullary tumor.
Obstruction
editTumours in the head of the pancreasmay come toobstruct the distal bile duct.[4]
If obstructed by agallstone,a condition calledcholedocholithiasiscan result.[7]In this obstructed state, the duct is especially vulnerable to an infection calledascending cholangitis.One form of treatment is acholecystenterostomy.Rare deformities of the common bile duct are cystic dilations (4 cm), choledochoceles (cystic dilation of the ampula of Vater (3–8 cm)), andbiliary atresia.
History
editObstruction of the common bile duct and relatedjaundicehas been documented since at least since the time ofErasistratus.[8]
Additional images
edit-
The gall-bladder and bile ducts lay open.
See also
edit- Choledochoduodenostomy- a surgical procedure to create a connection between the common bile duct (CBD) and an alternative portion of the duodenum.
References
edit- ^abc"Anatonomina".terminologia-anatomica.org.Retrieved2023-07-07.
- ^Agabegi, Steven S.; Agabegi, Elizabeth D. (23 August 2012).Step-Up to Medicine.Lippincott Williams & Wilkins. p. 136.ISBN9781609133603.
- ^Standring S, Borley NR, eds. (2008).Gray's anatomy: the anatomical basis of clinical practice.Brown JL, Moore LA (40th ed.). London: Churchill Livingstone. pp. 1163, 1177, 1185–6.ISBN978-0-8089-2371-8.
- ^abcdefghSinnatamby, Chummy S. (2011).Last's Anatomy(12th ed.). pp. 263–266.ISBN978-0-7295-3752-0.
- ^Oh, Lawrence."Common bile duct | Radiology Reference Article | Radiopaedia.org".Radiopaedia.Retrieved2021-08-30.
- ^Feng, B; Song, Q (1995). "Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients".American Journal of Roentgenology.165(4): 859–861.doi:10.2214/ajr.165.4.7676981.ISSN0361-803X.PMID7676981.
- ^Humes, H. David (2001).Kelley's Essentials of Internal Medicine.Lippincott Williams & Wilkins. p. 229.ISBN978-0781719377.
- ^Bateson, Malcolm C., ed. (1986).Gallstone Disease and its Management.Dordrecht: Springer Netherlands. p. Epidemiology (chapter).ISBN9400941730.
- Miederer, S.; Lindstaedt, H.; Siedek, M.; Franken, Th. (1978). "Endoskopische transpapilläre Spaltung einer Choledochocele" [Endoscopic transpapillary Splitting of a choledochocele].Deutsche Medizinische Wochenschrift(in German).103(5): 216–219.doi:10.1055/s-0028-1104409.PMID631041.
External links
edit- Anatomy figure: 38:06-08at Human Anatomy Online, SUNY Downstate Medical Center— "The gallbladder and extrahepatic bile ducts."
- Anatomy image:8336at the SUNY Downstate Medical Center
- Anatomy image:7957at the SUNY Downstate Medical Center
- Liverat The Anatomy Lesson by Wesley Norman (Georgetown University) (biliarysystem)
