WordNet

the physical condition of blocking or filling a passage with an obstruction (同)blockage
any structure that makes progress difficult (同)obstructor, obstructer, impediment, impedimenta
getting in someones way
the act of obstructing; "obstruction of justice"
relating to the bile ducts or the gallbladder

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/04 23:25:40」(JST)

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The biliary tract, (biliary tree or biliary system) refers to the liver, gall bladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Some components are synthesised by hepatocytes (liver cells), the rest are extracted from the blood by the liver.

Bile is secreted by the liver into small ducts that join to form the common hepatic duct. Between meals, secreted bile is stored in the gall bladder, where 80%-90% of the water and electrolytes can be absorbed, leaving the bile acids and cholesterol. During a meal, the smooth muscles in the gallbladder wall contract, leading to the bile being secreted into the duodenum.

Structure

1. Bile ducts: 2. Intrahepatic bile ducts, 3. Left and right hepatic ducts, 4. Common hepatic duct, 5. Cystic duct, 6. Common bile duct, 7. Ampulla of Vater, 8. Major duodenal papilla
9. Gallbladder, 10–11. Right and left lobes of liver. 12. Spleen.
13. Esophagus. 14. Stomach. Small intestine: 15. Duodenum, 16. Jejunum
17. Pancreas: 18: Accessory pancreatic duct, 19: Pancreatic duct.
20–21: Right and left kidneys (silhouette).

The anterior border of the liver is lifted upwards (brown arrow). Gallbladder with Longitudinal section, pancreas and duodenum with frontal one. Intrahepatic ducts and stomach in transparency.

The biliary tract is the common anatomical term for the path by which bile is secreted by the liver then transported to the first part of the small intestine, also known as the duodenum. A structure common to most members of the mammal family, it is often referred to as a tree because it begins with many small branches which end in the common bile duct, sometimes referred to as the trunk of the biliary tree. The duct, the branches of the hepatic artery, and the portal vein form the central axis of the portal triad. Bile flows in the direction opposite to that of the blood present in the other two channels.

The system is usually referred to as the biliary tract or system, ^[1]and can include the use of the term hepatobiliary when used to refer just to the liver and bile ducts.^[2]The name biliary tract is used to refer to all of the ducts, structures and organs involved in the production, storage and secretion of bile.^[3]

The path is as follows:

Bile canaliculi >> Canals of Hering >> intrahepatic bile ductule (in portal tracts / triads) >> interlobular bile ducts >> left and right hepatic ducts >>
merge to form >> common hepatic duct >>
exits liver and joins >> cystic duct (from gall bladder) >>
forming >> common bile duct >> joins with >> pancreatic duct >>
forming >> ampulla of Vater >> enters duodenum

Function

To see how this relates to the metabolism of bile, read bilirubin metabolism.

Clinical significance

Pressure inside in the biliary tree can give rise to gallstones and lead to cirrhosis of the liver.

The biliary tract can also serve as a reservoir for intestinal tract infections. Since the biliary tract is an internal organ, it has no somatic nerve supply, and biliary colic due to infection and inflammation of the biliary tract is not a somatic pain. Rather, pain may be caused by luminal distension, which causes stretching of the wall. This is the same mechanism that causes pain in bowel obstructions.^{[citation needed]}

An obstruction of the biliary tract can result in jaundice, a yellowing of the skin and whites of the eyes. ^[4]

References

^ Biliary tract at the US National Library of Medicine Medical Subject Headings (MeSH)
^ Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 846. ISBN 978-1-4160-6257-8.
^ Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 1946. ISBN 978-1-4160-6257-8.
^ "Definition: biliary tract from Online Medical Dictionary".

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 急性胆管炎 acute cholangitis
2. 黄疸または無症候性高ビリルビン血症の分類および原因 classification and causes of jaundice or asymptomatic hyperbilirubinemia
3. 悪性膵胆管閉塞に対する内視鏡下ステント留置術 endoscopic stenting for malignant pancreaticobiliary obstruction
4. 胆管癌の臨床症状および診断 clinical manifestations and diagnosis of cholangiocarcinoma
5. 成人における合併症のない胆石症 uncomplicated gallstone disease in adults

English Journal

Endoscopic ultrasound-guided biliary drainage: an update.

Kumta NA1, Kedia P, Kahaleh M.Author information 1Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, 10021, USA.AbstractOPINION STATEMENT: Endoscopic retrograde cholangiopancreatography (ERCP) is currently the preferred procedure for biliary drainage in both benign and malignant obstructions. While ERCP is successful in approximately 95 % of cases, a small subset of cases are unsuccessful due to variant anatomy, ampullary pathology, or malignant luminal obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a promising route for biliary decompression that provides multiple advantages over percutaneous and surgical biliary drainage. Multiple retrospective as well as some prospective studies have shown EUS-BD to be safe and effective. Based on the current literature, the cumulative success rate is 84-93 %, regardless of the approach, with an overall complication rate of 16-35 %. EUS-BD appears to a viable therapeutic modality for failed ERCP when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and biliary endoscopy. Larger prospective multicenter randomized comparative studies are needed to further define indications, outcomes, and complications.
Current treatment options in gastroenterology.Curr Treat Options Gastroenterol.2014 Jun;12(2):154-68. doi: 10.1007/s11938-014-0011-1.
OPINION STATEMENT: Endoscopic retrograde cholangiopancreatography (ERCP) is currently the preferred procedure for biliary drainage in both benign and malignant obstructions. While ERCP is successful in approximately 95 % of cases, a small subset of cases are unsuccessful due to variant anatomy, amp
PMID 24623591

The effect of acetaminophen on the expression of BCRP in trophoblast cells impairs the placental barrier to bile acids during maternal cholestasis.

Blazquez AG1, Briz O2, Gonzalez-Sanchez E3, Perez MJ4, Ghanem CI5, Marin JJ6.Author information 1Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: albamgb@usal.es.2Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: obriz@usal.es.3Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain. Electronic address: u60343@usal.es.4Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain; University Hospital of Salamanca, IECSCYL-IBSAL, Salamanca, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: mjperez@usal.es.5Instituto de Investigaciones Farmacologicas, Facultad de Farmacia y Bioquimica, CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina. Electronic address: cghanem@ffyb.uba.ar.6Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: jjgmarin@usal.es.AbstractAcetaminophen is used as first-choice drug for pain relief during pregnancy. Here we have investigated the effect of acetaminophen at subtoxic doses on the expression of ABC export pumps in trophoblast cells and its functional repercussion on the placental barrier during maternal cholestasis. The incubation of human choriocarcinoma cells (JAr, JEG-3 and BeWo) with acetaminophen for 48h resulted in no significant changes in the expression and/or activity of MDR1 and MRPs. In contrast, in JEG-3 cells, BCRP mRNA, protein, and transport activity were reduced. In rat placenta, collected at term, acetaminophen administration for the last three days of pregnancy resulted in enhanced mRNA, but not protein, levels of Mrp1 and Bcrp. In fact, a decrease in Bcrp protein was found. Using in situ perfused rat placenta, a reduction in the Bcrp-dependent fetal-to-maternal bile acid transport after treating the dams with acetaminophen was found. Complete biliary obstruction in pregnant rats induced a significant bile acid accumulation in fetal serum and tissues, which was further enhanced when the mothers were treated with acetaminophen. This drug induced increased ROS production in JEG-3 cells and decreased the total glutathione content in rat placenta. Moreover, the NRF2 pathway was activated in JEG-3 cells as shown by an increase in nuclear NRF2 levels and an up-regulation of NRF2 target genes, NQO1 and HMOX-1, which was not observed in rat placenta. In conclusion, acetaminophen induces in placenta oxidative stress and a down-regulation of BCRP/Bcrp, which may impair the placental barrier to bile acids during maternal cholestasis.
Toxicology and applied pharmacology.Toxicol Appl Pharmacol.2014 May 15;277(1):77-85. doi: 10.1016/j.taap.2014.02.019. Epub 2014 Mar 11.
Acetaminophen is used as first-choice drug for pain relief during pregnancy. Here we have investigated the effect of acetaminophen at subtoxic doses on the expression of ABC export pumps in trophoblast cells and its functional repercussion on the placental barrier during maternal cholestasis. The in
PMID 24631341

Japanese Journal

Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction : a feasibility study

Kawakubo Kazumichi,Kawakami Hiroshi,Kuwatani Masaki [他]
Journal of hepato-biliary
NAID 40020363680

Arterial blood gas anomaly in canine hepatobiliary disease

KANEKO Yasuyuki,TORISU Shidow,KOBAYASHI Takumi,MIZUTANI Shinya,TSUZUKI Nao,SONODA Hiroko,IKEDA Masahiro,NAGANOBU Kiyokazu
Journal of Veterinary Medical Science advpub(0), 2015
… Although pulmonary complications of liver disease have not been reported in dogs, we have frequently encountered hypoxemia in dogs with liver disorders, especially extrahepatic biliary obstruction. … By classifying type of hepatobiliary disease, dogs with extrahepatic biliary obstruction and chronic hepatitis showed significantly lower PaO2 and higher AaDO2 than in a control group. …
NAID 130005091936

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★リンクテーブル★

リンク元	「胆管閉塞症」「胆道閉塞」「胆道閉塞症」「bile duct obstruction」
拡張検索	「extrahepatic biliary obstruction」
関連記事	「obstruction」「biliary」