Common Pathologies of the Upper Gastrointestinal Tract (Nursing)

by Darren Salmi, MD, MS

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    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.

    About the Lecture

    The lecture Common Pathologies of the Upper Gastrointestinal Tract (Nursing) by Darren Salmi, MD, MS is from the course Anatomy of the Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. Anywhere in the biliary tract
    2. Gallbladder neck
    3. Cystic duct
    4. Right hepatic duct
    5. Ampulla of Vater
    1. Major duodenal papilla
    2. First portion of the duodenum
    3. Ascending duodenum
    4. Major cystic duct entrance
    5. Minor cystic duct entrance

    Author of lecture Common Pathologies of the Upper Gastrointestinal Tract (Nursing)

     Darren Salmi, MD, MS

    Darren Salmi, MD, MS

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