WELCOME TO

SURGERY SYMPOSIUM

BY S4 UNIT

26.04.2011
TOPIC – OBSTRUCTIVE JAUNDICE
Anatomy – Nivash Maran. R
Physiology – Praveen. C
Epidemiology & Pathogenesis –
Clinical Features –
Management –
Recent Advances -
 Anatomy of the
Hepatobiliary System
Nivash Maran . R
Hepatobiliary System
Liver
Gallbladder
Bile ducts
Pancreas
LIVER
Liver is the largest of the
abdominal viscera
Liver lies in the upper right
part of the abdominal cavity,
occupying most of the right
hypochondrium and
epigastrium.
Liver weighs roughly about 2%
of the adult body weight.
BLOOD SUPPLY:
Dual blood supply – 80%
nutrient-rich blood from
Portal Vein. 20% oxygen-rich
blood from Hepatic Artery.
Liver weighs roughly about 2% of the adult body
weight.
BLOOD SUPPLY:
Dual blood supply – 80% nutrient-rich blood from
Portal Vein. 20% oxygen-rich blood from Hepatic
Artery.
Classically liver is divided into left and right lobes by the
main portal fissure which is also called the Cantlie’s Line.
Based on the hepatic blood supply, it can also be divided
into right and left hemilivers.
According to Couinad classification, there are 8
functionally independent segments in the liver.
Each segment has its own vascular inflow, outflow and
biliary drainage.
 CENTRAL VEIN

Bile is secreted by hepatocytes and flows through the

canaliculus into the bile ductule.
The bile ductules join together to form larger intrahepatic
bile ducts which in turn merge to form the right and left
Hepatic Ducts.
Gallbladder

The gallbladder is a flask-shaped organ attached to the

common bile duct by the cystic duct.
It is 7 – 10 cm long with a capacity of up to 50 ml.
It usually lies in a shallow fossa in the liver
parenchyma covered by peritoneum continued from
the liver surface.
Gallbladder has 3 parts –
Fundus, body and neck.
Widening of the neck to
form the body is called the
‘Hartmann’s pouch’.
Blood supply is from the
cystic artery which arises
from the right hepatic
artery.
Cystic duct drains the gallbladder into the common hepatic
duct to form the common bile duct.
It is 3 – 4 cm long.
Mucosa of cystic duct bears 5 – 12 crescentic folds
continuous with those in the neck of the gallbladder.
 Bile Ducts
Common Hepatic Duct:
Right and Left hepatic ducts unite
to form the common hepatic duct.
It is about 3 cm long.

Common Bile Duct:

Cystic duct joins the common hepatic
duct and forms the common bile duct.
It is about 8 cm long.
It has 4 parts:

1. Supraduodenal
2. Retroduodenal
3. Infraduodenal
4. Intraduodenal
Levels of obstruction in the biliary tree
Pancreas

Pancreas is both exocrine and endocrine organ

situated retroperitoneally behind the stomach.
It extends from the duodenum on the right side to the
spleen on the left side.
Length is about 6 inches.
Parts of Pancreas:
Pancreas has 4 parts –
Head
Neck
Body
Tail
Pancreatic Duct

The main pancreatic duct (duct of Wirsung) drains the

pancreas and joins the common bile duct forming the Ampulla
of Vater at the junction.
Ampulla opens in the 2nd part of the duodenum.
Normal diameter is 2 – 3mm.
Accessory pancreatic duct of Santorini drains the uncinate
process and lower portion of the head and opens into the
duodenum 2 cm above the opening of the main duct.