Common bile duct

Supra-additivity This is a special case of cooperation where the blockade of a single receptor is not sufficient to reduce the overall response. Capsaicin-induced nonadrenergic, noncholinergic contraction in the guinea pig ileum or common bile duct can be inhibited only when at least two different TK receptors are blocked (e.g., NKX + NK2, NKX + NK3, NK2 + NK3)... 

Conjugated hyperbilirubinemia commonly results from blockage of the hepatic or common bile ducts, most often due to a gallstone or to cancer of the head of the pancreas. Because of the obstruction, bilirubin diglu-curonide cannot be excreted. It thus regurgitates into the hepatic veins and lymphatics, and conjugated bilirubin appears in the blood and urine (choluric jaundice). 

The commonest causes of obstructive (posthepatic) jaundice are cancer of the head of the pancreas and a gallstone lodged in the common bile duct. The presence of bilirubin in the urine is sometimes referred to as choluria—therefore, hepatitis and obstruction of the common bile duct cause choluric Jaundice, whereas the Jaundice of hemolytic anemia is referred to as acholuric. The laboratory results in patients with hepatitis are variable, depending on the extent of damage to parenchymal cells and the extent of micro-obstruction to bile ductules. Serum levels of ALT and AST are usually markedly elevated in hepatitis, whereas serum levels of alkaline phosphatase are elevated in obstructive liver disease. 

Table 32-3 summarizes laboratory results obtained on patients with three different causes of jaundice—hemolytic anemia (a prehepatic cause), hepatitis (a hepatic cause), and obstruction of the common bile duct (a posthepatic cause). Laboratory tests on blood (evaluation of the possibihty of a hemolytic anemia and measurement of prothrombin time) and on semm (eg, electrophoresis of proteins activities of the enzymes ALT, AST, and alkahne phosphatase) are also important in helping to distinguish between prehepatic, hepatic, and posthepatic causes of jaundice. 

Various conditions such as perforated peptic ulcer, cholecystitis, common bile duct and intestinal obstruction, trauma to the abdomen inducing pancreatitis and ruptured ectopic pregnancy may cause an elevated serum amylase but the levels are usually not as high as those found in acute pancreatitis. Mumps and bacterial parotitis, which block the secretion of salivary amylase are associated with mild elevations of serum amylase. 

Chronic obstruction of the common bile duct by the inflamed pancreas can cause icterus, cholangitis, and biliary cirrhosis.36... 

The serum bilirubin or alkaline phosphatase may be elevated due to inflammation near the common bile duct. 

CBD Common bile duct DJD Degenerative joint disease... 

Sphincter of Oddi A muscular valve separating the common bile duct from the duodenum. The sphincter of Oddi is the structure through which the common bile duct empties bile and pancreatic secretions into the duodenum. 

Bile is produced continuously by the liver bile salts are secreted by the hepatocytes and the water, sodium bicarbonate, and other inorganic salts are added by the cells of the bile ducts within the liver. The bile is then transported by way of the common bile duct to the duodenum. Bile facilitates fat digestion and absorption throughout the length of the small intestine. In the terminal region of the ileum, the final segment of the small intestine, the bile salts are actively reabsorbed into the blood, returned to the liver by way of the hepatic portal system, and resecreted into the bile. This recycling of the bile salts from the small intestine back to the liver is referred to as enterohepatic circulation. 

Bile is secreted by the liver, stored in the gallbladder, and used in the small intestine. It is transported toward the small intestine by the hepatic duct (from the liver) and the cystic duct (from the gallbladder), which join to form the common bile duct. Pancreatic juice is transported toward the small intestine by the pancreatic duct. The common bile duct and the pancreatic duct join to form the hepatopancreatic ampulla, which empties into the duodenum. The entrance to the duodenum is surrounded by the Sphincter of Oddi. This sphincter is closed between meals in order to prevent bile and pancreatic juice from entering the small intestine it relaxes in response to the intestinal hormone cholecystokinin, thus allowing biliary and pancreatic secretions to flow into the duodenum. 

Elevations of serum bilirubin are common in end-stage liver disease and obstruction of the common bile duct, but other causes of hyperbilirubinemia are numerous. 

Malabsorption of protein and fat occurs when the capacity for enzyme secretion is reduced by 90%. A minority of patients develop complications including pancreatic pseudocyst, abscess, and ascites or common bile duct obstruction leading to cholangitis or secondary biliary cirrhosis. 

The biliary system consists of the liver, the gall bladder and its associated drainage ducts which combine with the pancreatic duct to form the common bile duct. Situated in the upper right quadrant of the abdomen this is a highly vascular organ being perfused by... 

VI. Van Damme, B., Fevery, J., and Heirwegh, K. P. M., Altered composition of bilirubin conjugates in rat bile after obstruction of the common bile duct. Ex-perientia 26, 27-38 (1971). 

Shepherd H A, et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct a randomized trial. BrJSurg 1988 75(12) 1166-1168. 

Gallbladder (cholecyst vesica bUiaris vesica fellea). The pear-shaped reservoir for the bile in the post inferior surface of he liver, between the right and quadrate lobe the cystic duct projects to join the common bile duct. 

Pancreatic enzyme replacement or supplement when enzymes are absent or deficient, such as with chronic pancreatitis, cystic fibrosis, or ductal obstruction from cancer of the pancreas or common bile duct to reduce malabsorption treatment of steatorrhea associated with bowel resection or postgastrectomy syndrome PO 1-3 capsules ortablets before or with meals or snacks. May increase to 8 tablets/dose. 

The gastrointestinal tract is the only system outside the central nervous system (CNS) with significant concentrations of opioid receptors. This reflects their common embryonic origins. Opioids increase intestinal tone and decrease propulsive peristalsis, resulting in delayed gastric emptying and constipation or ileus. Opioids increase common bile duct pressure and decrease bile production and flow, primarily because of spasm of the sphincter of Oddi. The tone of the bile duct itself is also increased. 

Daqono, Sleight SD, Stowe HD, et al. 1983. Vitamin A status, polybrominated biphenyl (PBB) toxicosis, and common bile duct hyperplasia in rats. Toxicol Appl Pharmacol 71 184-193. 

Bile consists of a watery mixture of organic and inorganic compounds. Phosphatidylcholine (lecithin, see p. 201) and bile salts (conjugated bile acids) are quantitatively the most important organic components of bile. Bile can either pass directly from the liver where it is synthesized into the duodenum through the common bile duct, or be stored in Ihe gallbladder when not immediately needed for digestion. 

Riederer J. Verschlussikterus durch sludge im Ductus cho-ledochus. [Obstructive jaundice due to sludge in the common bile duct.] Dtsch Med Wochenschr 2000 125(1-2) 11-4. 

These agents are administered to aid in the digestion of food. The primary digestant preparations contain pancreatic enzymes or bile salts. Pancreatic enzymes such as amylase, trypsin, and lipase are responsible for digestion of carbohydrates, proteins, and lipids, respectively. These enzymes are normally synthesized in the pancreas and secreted into the duodenum via the pancreatic duct. Bile salts are synthesized in the liver, stored in the gallbladder, and released into the duodenum via the common bile duct. Bile salts serve to emulsify lipids in the intestinal tract and are important in lipid digestion and absorption. 

Liver changes in rats, mice, and hamsters appear to be secondary to the injury to the bile ducts presumably caused by either the di- or tributyltin compounds (Barnes and Magee 1958 Jang et al. 1986). These animals have common bile-duct systems. In rabbits and guinea pigs that have separate bile duct systems hepatic lesions were not observed, suggesting that bile duct structure may influence susceptability to hepatic damage. 

Jaques WE, McAdams AJ. 1957. Reversible biliary cirrhosis in rat after partial ligation of common bile duct. AMA Arch Pathol 63 149-153. 

Lai, C., Chan, R., Cheng, A., Sung, J., Leung, J. Common bile duct stones a cause of chronic salmonellosis. Am J Gastroenterol 87 (1992) 1198-1199. 

Gallo-Torres et al. (1979) described in detail a method for the bioassay of antisecretory activity in the conscious rat with acute gastric fistula with additional collection of the biliary and pancreatic secretion by means of a catheter in the common bile duct. The gastric secretions are collected by gravity via a cannula in the most gravity dependent site of the glandular stomach. 

After laparotomy, the common bile duct is cannulated in the upper half with polyethylene tubing and bile is collected every 30 minutes up to 7 hours. The drug candidate is administered at an appropriate dose by bolus injections intravenously into the jugular vein one hour after finishing surgery or by intraperitoneal administration of a 1 % carboxymethylcellulose suspension, if not adequate soluble for an intravenous... 

Cannulas are made of silicon rubber. The proximal bile cannula, which will be inserted into the common bile duct in the direction to the liver, is 18 cm long (Silastic tubing, Dow Coming, no. 605-135 0.51 i.d. and 0.94 o.d.) and has one square cut and one bevelled end. Two silicon rings are wrapped around the cannula at 7 mm and 50 mm, respectively, from the bevelled end. 

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