Bile and Pancreas – Hepatobiliary System (Nursing)

00:00 Okay, so we're talking about how bile travels. Take a look at that picture again. You've got the lobule. Now, we've got it right there for you to see. You know that bile is made in the, right, hepatocytes. It travels from the hepatocytes. What's the name of the structure that bile travels through? Bile canaliculi, good. You're getting really good at this. Now, it travels through the bile canaliculi, and it goes to those bile ducts on the outside right on the portal triad. There're six of them around each lobule, then it will drain into the right and left hepatic ducts wherever it's located. It will hit that common hepatic duct, hit into the common bile duct.

00:41 It may be stored in the gallbladder or might just keep on moving down those ducts. Right? Now, so we've got bile that runs from the gallbladder into the small intestine. It mixes with the foods, and it does help the intestine perform all its digestive functions. Okay, so we've run through a couple times how bile gets from hepatocytes all the way down to the small intestine, and we mentioned the ampulla of Vater and the sphincter of Oddi, but what is the difference between these two? Well, in case you need some trivia at dinner tonight, the ampulla of Vater is the union of the pancreatic duct, right, coming from the pancreas and the common bile duct, but the sphincter of Oddi is a muscle, and it opens and closes, so it's the gatekeeper. So think of a sphincter like that is a sphincter, you have a more personal sphincter where waste leaves your body, but that's a gatekeeper. Right? If I open my mouth, I can put food in it or I can close it. The sphincter of Oddi is the same type of muscle. It opens and closes, and that's what allows the bile and the pancreatic juices to flow between that duct and into the intestine.

01:53 So the ampulla is just where it all comes together, but the sphincter is actually the muscle that controls those juices from making it into the small intestine. So, the pancreas secretes digestive juices into the duodenum, and that's why it's sometimes considered a subsidiary part of the hepatobiliary system. So, even though at the beginning we said hepatobiliary really meant the liver and the biliary tract, we do consider the pancreas as part of it. It's got a little higher role than the planet Pluto does in the solar system now, but it's often considered part of the hepatobiliary system. So, why are we spending this much time teaching nursing students about the hepatobiliary system? Is this just more anatomy? Well, you can never have too much anatomy, but understanding how things are supposed to work and supposed to flow will really help you work with patients who have things like gallstones or liver disease because let's talk about that big finish at the end. The pancreatic juices and bile together are these incredibly powerful digesters. They have to be strong because they digest fats, carbohydrates, and proteins. In order for everything to function, the liver and pancreas need to be working well together and the plumbing needs to be clear. All those ducts that we talked about from the lobules to the tiny little ducts, right and left hepatic, common, cystic, all those, if there is any type of blockage, that's going to back up all those really strong digestive-type juices.

03:34 So, depending on where the blockage is, that's going to back up into your pancreas, that's going to back up into your gallbladder, that's going to back up into your liver. You're going to have inflammation. So, you can have hepatitis, inflammation of your liver; cholecystitis, inflammation of your gallbladder; and pancreatitis, inflammation of your pancreas, all at the same time. So, that's how a gallstone can wreak havoc on any part of those organs, the pancreas, the liver, and the gallbladder. That's a 3-for-1 deal that nobody wants.