00:01
So here let's look at the
relationship of the biliary system
to some common pathology
such as gallstones.
00:11
So here we see the
gallbladder and the biliary tract
is coming all the way
down towards the duodenum.
00:17
So gallstones can form in
a variety of circumstances.
00:21
And they can sometimes
just sit in the gallbladder
without causing any sorts
of problems whatsoever.
00:28
Sometimes though,
they can become lodged
and when they do they produce pain.
00:35
And where they become lodged,
can be anywhere really
in this biliary tract.
00:40
So for example,
they can be healed become lodged
in the cystic duct on its way
to form the common bile duct.
00:48
Or they can be lodged somewhere
within the bile duct itself.
00:52
Or they can make it all the way down
to that hepatic pancreatic ampulla.
00:58
That shared spot between the
bile duct and the pancreatic duct.
01:03
Now, if it gets
lodged there though,
then that's going to create
a second set of problems
because that's also the
drainage for the pancreatic duct
and a blockage there would cause
a buildup of pancreatic enzymes
and that can lead to pancreatitis.
01:20
And that could be a
real problem because
those pancreatic enzymes
are designed for digestion
and so they can
create a lot of damage
by digesting things
they're not supposed to.
01:33
So here let's take a look
at a cholecystectomy.
01:37
So cholecysts, again, it's just
another word for gallbladder.
01:41
We can see the
gallbladder sitting here
at the inferior portion
of the liver.
01:48
And we can see through
this laparoscopic surgery,
clamping the vessels
and biliary structures
to take out a gallbladder
that for example
may have a lot of gall stones
that are becoming lodged
in creating pain.
02:04
Because it's just a reservoir,
we can take out the gallbladder
without causing too much difficulty.
02:11
Here's another procedure called
esophagogastroduodenoscopy,
where the scope is actually entered
through the proximal portions
of the GI tract,
down the esophagus,
all the way down into the stomach,
which is the gastro portion,
and even past the pylorus,
into the duodenum.
02:34
That endoscope can see the mucosa
of all these structures
as it's passing down.
02:41
And it can locate any
pathologic abnormalities
and sample them via biopsy
for pathologic examination.
02:51
Furthermore,
there can be something called ERCP
or Endoscopic retrograde
cholangiopancreatography.
02:59
It's a lot of words,
but it's basically telling you
that it's a way of doing that scope
to look inside that biliary system.
03:09
So for example,
here's the endoscope,
and once you found that bump
that major duodenal papilla,
you know, you found an entrance
into the biliary system.
03:22
And that biliary system is
shared at the ampulla of Vater
with the pancreatic duct.
03:29
So you have a direct access to the
pancreas and biliary system here.
03:34
And that can be very useful.
03:36
If for example,
there's some sort of stricture
that's preventing bile from passing,
you can actually pass a
stent through this area,
and open up that bile duct
to to let bile flow through again.