Coucke Ethan M., Akbar Hina, Kahloon Arslan, Lopez Peter P.
McLaren Health Care
University of Tennessee Health Sciences Center
Biliary obstruction commonly refers to blockage of the bile duct system, leading to impaired bile flow from the liver into the intestinal tract. Bile is a substance that contains bile salts, bilirubin, and cholesterol and is continuously synthesized in the liver hepatocytes. Bile is then transported via the bile ducts into the second portion of the duodenum to assist with the metabolism of fats. Bile formed in the liver flows through the right and left hepatic ducts into the common hepatic duct. The common hepatic duct then joins the cystic duct arising from the gallbladder to form the common bile duct. The common bile duct then joins the pancreatic duct through its course within the head of the pancreas before opening into the duodenum through the major papilla or ampulla. The majority of the bile flows into the gall bladder through the cystic duct, where it is concentrated and temporarily stored, while the rest of the bile flows through the common bile duct into the duodenum through the sphincter of Oddi. The flow of bile into the duodenum is regulated by the release of the hormone Cholecystokinin (CCK) from the duodenum, which controls the release of stored bile from the gallbladder and the relaxation of the sphincter of Oddi. Biliary obstruction is generally referred to as blockage of the extrahepatic biliary system. Biliary obstruction can occur anywhere along this path and can lead to serious complications such as hepatic dysfunction, renal failure, nutritional deficiencies, bleeding problems, and infections. Disruption in the bile flow due to impairment of the intrahepatic biliary system is generally referred to as cholestasis. Cholestasis can present as abnormalities in serum hepatic enzymes, such as elevated bilirubin and alkaline phosphatase levels, and can lead to jaundice and pruritis. Biliary obstruction is common and affects a large portion of the world population, causing significant morbidity and mortality. The most common etiology of biliary obstruction is choledocholithiasis or gallstones, causing extrahepatic bile duct blockage. The most serious manifestation of this is the development of infection in the bile ducts called cholangitis, which can be fatal if not treated promptly.
胆管梗阻通常指胆管系统阻塞，导致胆汁从肝脏流入肠道的过程受阻。胆汁是一种含有胆盐、胆红素和胆固醇的物质，由肝脏肝细胞持续合成。然后，胆汁通过胆管输送到十二指肠的第二部分，以协助脂肪代谢。在肝脏中形成的胆汁流经左右肝管进入肝总管。肝总管再与胆囊发出的胆囊管汇合形成胆总管。胆总管在胰腺头部的行程中与胰管汇合，然后通过十二指肠大乳头或壶腹开口于十二指肠。大部分胆汁通过胆囊管流入胆囊，在胆囊中被浓缩并暂时储存，其余的胆汁则通过胆总管经奥迪括约肌流入十二指肠。胆汁流入十二指肠受十二指肠释放的胆囊收缩素（CCK）调节，CCK控制胆囊中储存胆汁的释放以及奥迪括约肌的松弛。胆管梗阻一般指肝外胆管系统阻塞。胆管梗阻可发生在这条路径的任何部位，并可导致严重并发症，如肝功能障碍、肾衰竭、营养缺乏、出血问题和感染。肝内胆管系统受损导致胆汁流动中断通常称为胆汁淤积。胆汁淤积可表现为血清肝酶异常，如胆红素和碱性磷酸酶水平升高，并可导致黄疸和瘙痒。胆管梗阻很常见，影响着世界上很大一部分人口，造成严重的发病率和死亡率。胆管梗阻最常见的病因是胆总管结石或胆结石，导致肝外胆管阻塞。其最严重的表现是胆管感染，即胆管炎，如果不及时治疗可能会致命。
