DISORDERS OF THE GALLBLADDER AND BILIARY TRACT



The liver produces 500 to 1500 ml of bile per day. The major physiological role of the biliary tract and gallbladder is to concentrate this mate­rial and to conduct it silently and efficiently, in well-timed aliquots, to the intestine. In the intes­tine, biliary bile acids participate in normal fat digestion while cholesterol and a wide variety of other endogenous and exogenous compounds car­ried in bile are excreted in the feces. Normally unobtrusive, the gallbladder and biliary tree are the source of considerable pain and disability when they become infected or obstructed. This chapter will briefly outline the normal physiology of the biliary system and then focus on the path­ophysiology and clinical consequences of gall­stones, the most important biliary tract disorder, closing with a brief discussion of neoplasms and other causes of bile duct obstruction. The reader is referred to Chapter 36E for a detailed discussion of the diagnostic approach to jaundice and biliary obstruction, and to Chapter 37 for a review of the various imaging techniques used to study the bil­iary tract.





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