Hepatic parenchymal cells (hepatocytes and cholangiocytes) and nonparenchymal cells (hepatic sinusoidal endothelial cells, stellate cells, Kupffer cells, and pit cells) have distinct functions that are integrated through extensive cross-talk. These cells are highly polarized. The distinctive polarization pattern of hepatocytes…
Embryology The liver develops at 3 to 4 weeks’ gestation as an outgrowing diverticulum of proliferating endodermal cells from the ventral wall of the foregut in response to signals from the adjacent developing heart ( Fig. 71.1 ). In the…
Endoscopic therapy and radiologic treatment of biliary disease have evolved in separate but parallel manners. Endoscopic therapy is performed using ERCP and EUS-guided techniques. ERCP is performed primarily by endoscopists trained in a gastroenterology fellowship program, but in some centers…
Acknowledgment This work was supported by grants from the NIH DK59427 (G.J.G.) and K08CA236874 (S.H.R.). Support was also provided to Dr. Rizvi by a Pilot & Feasibility Award by the Center for Cell Signaling in Gastroenterology (P30DK084567), and an AGA…
Acknowledgments The authors acknowledge the contributions of Drs. Andrew S. Ross and Kris V. Kowdley to this chapter in previous editions of the book. Sclerosing cholangitis encompasses a spectrum of cholestatic conditions that are characterized by patchy inflammation, fibrosis, and…
Although gallstones and their complications account for most cholecystectomies, a consistent 15% of these operations are performed in patients without gallstones. In these patients, the majority of cholecystectomies are performed as treatment for 1 of 2 distinct clinical syndromes: acalculous…
Many options are available for the treatment of patients with symptomatic gallstone disease. Improvements in endoscopic, radiologic, and chemical therapies for gallstones have enhanced the overall management of these patients. Nevertheless, surgery remains the most important therapeutic option. Laparoscopic cholecystectomy…
Acknowledgment The authors acknowledge the contributions of Drs. Jeffrey D. Browning and Jayaprakash Sreenarasimhaiah to this chapter in previous editions of the book as well as the contributions of colleagues in the gallstone field. This work was supported in part…
Bile formation is essential for intestinal lipid digestion and absorption, cholesterol homeostasis, and hepatic excretion of lipid-soluble xenobiotics, drug metabolites, and heavy metals. The process of bile formation depends on hepatic synthesis and canalicular secretion of bile acids, the predominant…
Anatomy and Physiology The gallbladder is a distensible pear-shaped reservoir, the function of which is to store bile and deliver it to the duodenum for digestion (see Chapter 62 ). It is located along the undersurface of the liver and…