A bile duct is any of a number of long tube-like structures that carry bile.

Bile, required for the digestion of food, is secreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct (carrying bile to and from the gallbladder) to form the common bile duct, which opens into the intestine. The biliary tree (see below) is the whole network of various sized ducts branching through the liver. The path is as follows: Bile canaliculi Canals of Hering interlobular bile ducts intrahepatic 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 choledocholithotomy - incision into common bile duct for stone removal.A t-tube cholangiogram is a medical imaging study to evaluate the bile ducts for signs of stones and blockages after surgery on the region. This procedure allows a surgeon to check on a patient's recovery, and to determine if any additional actions are necessary. It usually takes approximately 30 minutes and comes with low risks for the patient. Some patients prefer to do the test in the morning, as it requires fasting, and it may be easier to skip breakfast and attend the appointment than to control food intake later in the day. In surgery on the gallbladder and the surrounding area, the surgeon may decide to place a drain known as a t-tube to limit the formation of blockages in the future, especially if the gallbladder is removed. During a t-tube cholangiogram, a technician can inject dye into the drain and monitor it as it moves through the body. This can allow a doctor to identify areas of blockage, stones, or other issues that might pose a risk to the patient's health. T-tubecholangiography typically takes place in an imaging center where technicians have access to all the supplies they need. Intraoperative Cholangiogram - clinical history of jaundice, pancreatitis, elevated bilirubin level, abnormal liver function test results, increased amylase levels, a high lipase level, or dilated common bile duct Choledochocystostomy creation of a drainage conduit for the common bile duct. Cholelithiasis is the medical name for hard deposits (gallstones) that may form in the gallbladder. Cholelithiasis is very common in the United States, especially in women over age 40. The cause of cholelithiasis is not completely understood, but it is thought to have multiple factors. The gallbladder stores bile and releases it into the small intestine when it is needed for digestion. Gallstones can develop if the bile contains too much cholesterol or too much bilirubin (one of the components of bile), or if the gallbladder is dysfunctional and cannot release the bile. Different types of gallstones form in cholelithiasis. The most common type, called a cholesterol stone, results from the presence of too much cholesterol in the bile. Another type of stone, called a pigment stone, is formed from excess bilirubin, a waste product created by the breakdown of the red blood cells in the liver. The size and number of gallstones varies in cholelithiasis; the gallbladder can form many small stones or one large stone. The prostate is a part of the male reproductive system that helps make and store seminal fluid. In adult men, a typical prostate is about three [60] centimeters long and weighs about twenty grams. It is located in the pelvis, under the urinary bladder and in front of the rectum. The [61] prostate surrounds part of the urethra, the tube that carries urine from the bladder during urination and semen during ejaculation. Because of its location, prostate diseases often affect urination, ejaculation, and rarely defecation. The prostate contains many small glands which make [62] about twenty percent of the fluid constituting semen. In prostate cancer, the cells of these prostate glands mutate into cancer cells. The prostate glands require male hormones, known as androgens, to work properly. Androgens include testosterone, which is made in the testes; dehydroepiandrosterone, made in the adrenal glands; and dihydrotestosterone, which is converted from testosterone within the prostate itself. Androgens are also responsible for secondary sex characteristics such as facial hair and increased muscle mass. bBegins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN).. Over time, these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells that can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to thebones, lymph nodes, and may invade rectum, bladder and lower ureters after local progression. The route of metastasis to bone is thought to be venous as the prostatic venous plexus draining the prostate connects [63] with the vertebral veins. The prostate is a zinc accumulating, citrate producing organ. The protein ZIP1 is responsible for the active transport of zinc into prostate cells. One of zinc's important roles is to change the metabolism of the cell in order to produce citrate, an important component of semen. The process of zinc accumulation, alteration of metabolism, and citrate production is energy inefficient, and prostate cells sacrifice enormous amounts of energy (ATP) in order to accomplish this task. Prostate cancer cells are generally devoid of zinc. This allows prostate cancer cells to save energy not making citrate, and utilize the new abundance of energy to grow and spread. The brain is made up of many specialized areas that work together: The cortex is the outermost layer of brain cells. Thinking and voluntary movements begin in the cortex. The brain stem is between the spinal cord and the rest of the brain. Basic functions like breathing and sleep are c ontrolled here. The basal ganglia are a cluster of structures in the center of the brain. The basal ganglia coordinate messages between mul tiple other brain areas. The cerebellum is at the base and the back of the brain. The cerebellum is responsible f or coordination and balance. Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma (as occurs inhead injury) or nontraumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well asdisorders with blood clotting can heighten the risk that an intracranial hemorrhage will occur.[1] Intracranial hemorrhage is a serious medical emergency because the buildup of blood within the skull can lead to increases inintracranial pressure, which can crush delicate brain tissue or limit its blood supply. Severe increases in intracranial pressure can cause potentially deadly brain herniation, in which parts of the brain are squeezed past structures in the skull.

CT scan (computed tomography) is the definitive tool for accurate diagnosis of an intracranial hemorrhage. Classification Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area. Intra-axial hemorrhage Intra-axial hemorrhage is bleeding within the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, andintraventricular hemorrhage, bleeding within the brain's ventricles (particularly of premature infants). Intra[2] axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds. Extra-axial hemorrhage Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:

Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma. It may result from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases inintracranial pressure can result rapidly. However, it is the least common type of meningeal bleeding and is seen in 1% to 3% cases of head injury .

Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC) Head CT shows lenticular (convex) deformity.

Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. Head CT shows crescent-shaped deformity

Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures ofaneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache (a thunderclap headache). This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention.

Epidural Hematoma The brain is enclosed in the skull, which is a rigid, solid bone. Surrounding the brain is a tough, leathery outer covering called the dura (door-uh). The dura attaches to the brain, just beneath the skull bone. The dura normally protects the brain and keeps it nourished with blood and spinal fluid. When a person receives a severe blow to the head, the brain bounces within the cavity. This movement of the brain structures may cause shearing or tearing of the blood vessels surrounding the brain and dura. When the blood vessels tear, blood accumulates within the space between the dura and the skull. This is known as an epidural hematoma (epidoor-ul hem-a-to-ma), or blood clot at the covering of the brain. When the blood accumulates between the dura and skull, swelling of the brain occurs. There is no extra room within the skull to allow for the brain to swell and for the blood to accumulate. The only way the brain can compensate is to shift the delicate structures out of the way. This can cause pressure on vital functions, such as eye opening, speech, level of awakeness (or consciousness) or even breathing. Generally, an epidural can cause serious problems and must be removed to prevent increased swelling of the brain. The procedure of choice for removal of an epidural hematoma is surgery to remove the blood clot. balfor blade extra: bulb syringe a couple of cord clamps cord blood collection kit needle counter towels rayotec and laps ioban drape

Hemostats (used for bleeders, blunt dissection) Kelley's Kocher's (used for faschia, and sometimes to clamp the umbilical cord. Long Kelley's (also used for umbilical cords) Allis Allis Adairs (some MD's use these to clamp uterine "bleeders") Babcocks (used for tubal ligations) Sponge sticks (also used on the uterus) Penningtons (uterus) Needle drivers Bandage scissors (to cut cord) Straight mayos (suture scissors) Curved Mayos (anatomy scissors) Metzenbaum scissors (used for the bladder flap and fine tissues) Pickups: Russians (uterus) Bonnies Adsons (skin) Smooth pick ups (bladder flap) Pick ups with teeth Retractors: Bladder blade Small and large richardson

vacuum