The biliary tract, (biliary tree or biliary system) refers to the

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, althoug ...

and

bile ducts A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. It ...

, and how they work together to make, store and secrete

bile Bile (from Latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine. In humans, bile is produced continuously by the liver (liver b ...

. Bile consists of water, electrolytes,

bile acid Bile acids are steroid acids found predominantly in the bile of mammals and other vertebrates. Diverse bile acids are synthesized in the liver. Bile acids are conjugated with taurine or glycine residues to give anions called bile salts. Primary ...

cholesterol Cholesterol is any of a class of certain organic molecules called lipids. It is a sterol (or modified steroid), a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell membr ...

phospholipid Phospholipids, are a class of lipids whose molecule has a hydrophilic "head" containing a phosphate group and two hydrophobic "tails" derived from fatty acids, joined by an alcohol residue (usually a glycerol molecule). Marine phospholipids ty ...

s and

conjugated bilirubin Bilirubin (BR) (Latin for "red bile") is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from th ...

. Some components are synthesized by

hepatocyte A hepatocyte is a cell of the main parenchymal tissue of the liver. Hepatocytes make up 80% of the liver's mass. These cells are involved in: * Protein synthesis * Protein storage * Transformation of carbohydrates * Synthesis of cholesterol, ...

s (liver cells), the rest are extracted from the

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in th ...

by the liver. Bile is secreted by the liver into small ducts that join to form the

common hepatic duct The common hepatic duct is the first part of the biliary tract. It joins the cystic duct coming from the gallbladder to form the common bile duct. Structure The common hepatic duct is the first part of the biliary tract. It is formed by th ...

. Between meals, secreted bile is stored in the gallbladder. During a meal, the bile is secreted into the

duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine ...

(part of the small intestine) to rid the body of waste stored in the bile as well as aid in the absorption of dietary fats and oils.

Structure

The biliary tract refers to the path by which

is secreted by the

then transported to the

, the first part of the

small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through t ...

. A structure common to most members of the mammal family, the biliary tract is often referred to as a tree because it begins with many small branches that end in the

common bile duct The common bile duct, sometimes abbreviated as CBD, is a duct in the gastrointestinal tract of organisms that have a gallbladder. It is formed by the confluence of the common hepatic duct and cystic duct and terminates by uniting with pancr ...

, sometimes referred to as the trunk of the biliary tree. The duct, the branches of the

hepatic artery The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder. It arises from the celiac artery and has the following branches: Additional images ...

, and the

portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. App ...

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, and can include the use of the term "hepatobiliary" when used to refer just to the liver and bile ducts. 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. The tract is as follows: *

Bile canaliculi Bile canaliculus (plural:bile canaliculi; also called bile capillaries) is a thin tube that collects bile Bile (from Latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the liver of most vertebrates that aids the ...

Canals of Hering The canals of Hering, or intrahepatic bile ductules, are part of the outflow system of exocrine bile product from the liver. Liver stem cells are located in the canals of Hering. Structure They are found between the bile canaliculi and interlob ...

>> intrahepatic bile ductule (in portal tracts / triads) >> interlobular bile ducts >> left and right hepatic ducts * These merge to form the

* The

exits the liver and joins with the

cystic duct The cystic duct is the short duct that joins the gallbladder to the common hepatic duct. It usually lies next to the cystic artery. It is of variable length. It contains ' spiral valves of Heister', which do not provide much resistance to th ...

from

gall bladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, althoug ...

* Together these form the

which joins the

pancreatic duct The pancreatic duct, or duct of Wirsung (also, the major pancreatic duct due to the existence of an accessory pancreatic duct), is a duct joining the pancreas to the common bile duct. This supplies it with pancreatic juice from the exocrine panc ...

* These pass through the

ampulla of Vater The ampulla of Vater, also known as the or the hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla. The ampulla of Vater is an impor ...

and enter the duodenum

Function

Bile is secreted by the liver into small ducts that join to form the

. 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, causing bile to be secreted into the

to rid the body of waste stored in the bile as well as aid in the absorption of dietary fats and oils by solubilizing them using

bile acids Bile acids are steroid acids found predominantly in the bile of mammals and other vertebrates. Diverse bile acids are synthesized in the liver. Bile acids are conjugated with taurine or glycine residues to give anions called bile salts. Primary ...

Clinical significance

Diagram showing the bile ducts in the pancreas CRUK 293

Gallstone A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of ...

s can form within the gallbladder and get stuck within the biliary tract, leading to various diseases depending on the location of the stone. Gallstone disease, or

cholelithiasis A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of mi ...

, is very common in the United States, impacting over 20 million people. Gallstones frequently occur without causing symptoms– this is known as asymptomatic cholelithiasis. Sometimes gallstones may get stuck in the

, which serves as a bridge between the gallbladder and the

, and can lead to inflammation in the wall of the gallbladder. This inflammation of the gallbladder is known as

cholecystitis Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain l ...

and is a common indication for surgical removal of the gallbladder, or

cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...

. Occasionally gallstones may become lodged in the common bile duct and obstruct the flow of bile from the gallbladder to the small intestine– this condition is known as

choledocholithiasis Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD) (thus '' choledocho-'' + '' lithiasis''). This condition can cause jaundice and liver cell damage. Treatments include choledoc ...

and is another indication for

. The common bile duct, commonly abbreviated CBD, is formed by the union of the cystic duct and common hepatic duct, and it later joins the

to terminate in the

Ampulla of Vater The ampulla of Vater, also known as the or the hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla. The ampulla of Vater is an impor ...

at the small intestine. The function of the common bile duct is to allow bile to travel from the gallbladder to the small intestine, mixing with pancreatic digestive enzymes along the way. One possible complication of choledocholithiasis is an infection of the bile ducts between the liver and the gallstone lodged in the common bile duct. This condition is known as acute cholangitis and is commonly associated with a triad of clinical symptoms known as Charcot's Triad, which includes fever, right upper quadrant abdominal pain, and jaundice. This constellation of symptoms has a 96% specificity for cholangitis, and can be expanded upon with the addition of hypotension and altered mental status to form Reynold's Pentad. 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 Biliary colic, also known as symptomatic cholelithiasis, a gallbladder attack or gallstone attack, is when a colic (sudden pain) occurs due to a gallstone temporarily blocking the cystic duct. Typically, the pain is in the right upper part of t ...

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 obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs ...

s. Chronic inflammatory conditions of the biliary tract, including Primary Sclerosing Cholangitis (PSC) and Primary Biliary Cirrhosis (PBC), can lead to hardening of the ducts in the biliary tree. An obstruction of the biliary tract can result in

jaundice Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme met ...

, a yellowing of the skin and whites of the eyes.

References

{{DEFAULTSORT:Hepatobiliary System Hepatology